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Forum Category: General Dentistry

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What a Tongue Tells You about a Patient's Oral Health

An examination of your patient’s tongue provides indications of many different health conditions and infections. A healthy tongue is pink in color and covered with papillae—but white, red or black tongues can be signs of possible serious medical conditions.

White tongue 

If your patient has white patches or white spots on the tongue, this condition can be an indication of oral thrush. (Keep in mind that a white coating may cover the tongue’s surface because of temporary non-serious conditions such as dehydration or dry mouth.) Oral thrush is a Candida yeast infection that develops in the mouth, and it can be an indicator of a weakened immune system, HIV or diabetes.

White, fuzzy patches on your patient’s tongue may be a sign of leukoplakia. Modern Dentistry states that leukoplakia involves an excessive growth of cells in the mouth, and it can be a precursor to cancer. Leukoplakia can also manifest as a reaction to chronic smoking and irritation from rough teeth or dentures that do not fit properly.

Red tongue  

A red and bumpy tongue can indicate Scarlet Fever in your patient. If he has a high fever as well, he may have this condition, and fortunately it can be treated with antibiotics. Scarlet Fever usually affects children, yet it can develop in an adult patient who has strep throat.

A red tongue can also tell you that your patient may suffer from a vitamin deficiency. If the tongue appears red, it could mean that they are not getting enough vitamin B-12 and folic acid. This deficiency may be remedied by taking supplements or adjusting diet.

Kawasaki disease is a condition that can cause a young patient’s tongue to appear red and have a strawberry-like appearance. Affecting children five years old and younger, Kawasaki disease is a serious condition that involves inflammation of the walls of arteries throughout the body, and should be treated immediately by a doctor.

Black tongue 

A black hairy tongue usually does not indicate any serious health problem. If your patient’s tongue appears to be hairy and black, it is due to a bacteria growth and overgrown papillae. It generally indicates poor dental hygiene, or that the patient may be taking antibiotics.

Canker sores 

Canker sores are painful mouth ulcers that can occur anywhere inside the mouth, most notably on or under the tongue and in the cheeks. Contrary to popular belief, canker sores are not contagious nor are they associated with the herpes virus. They are generally caused by stress or injury (such as from biting or wearing braces), and the tendency to develop canker sores is usually inherited. 

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What a Tongue Tells You about a Patient's Oral Health

11:27 AM | May 08,2017
It is amazing how much a person's tongue can say about their health. Often patients do not understand the importance of brushing their tongue or how we as practitioners can tell something is wrong based on its appearance. The different colors and manifestations of the tongue can guide us to a correct diagnosis that can improve a patient's life. Checking the tongue during a head and neck examination is imperative to the overall assessment of the patient and their oral health; not only to identify all of those diseases that manifest in the mouth but to detect oral cancer as well.

What a Tongue Tells You about a Patient's Oral Health

09:50 PM | May 03,2017
From immunologic status to basic oral hygiene a patient's tongue can tell us so much about their daily life, health status habits etc. While white areas (leukoplakia) might indicate frictional keratosis or pre-malignancy, black spots may indicate poor oral hygiene or even a systemic pigmenting condition known as Peutz-Jeugers. It is vital that practitioners examine the dorsum, lateral, and ventral tongue areas as it give us much information and are even high risk cancer sites for the most common intramural cancer, squamous cell carcinoma.

What a Tongue Tells You about a Patient's Oral Health

08:09 PM | Feb 21,2017
This post makes some great points. At our dental program, we do in fact check the tongue during a head and neck oral cancer screening at every visit. When looking for lesions, one tip that's often overlooked is to dry the field. Wiping the floor of the mouth, and ventral and lateral tongue with a gauze or cloth can help you spot surface irregularities and color changes more easily. If a painless white non-wipeable plaque with erythema is present on the lateral or ventral tongue in a middle aged smoker, there's a good chance that it could be epithelial dysplasia. If its ulcerated and rapidly growing, and may be causing tooth mobility or pain and paresthesia, squamous cell carcinoma better be on the differential.

What a Tongue Tells You about a Patient's Oral Health

06:54 PM | Jan 25,2017
I like the post. It is very informative. The issue is that when you get to clinic though, it is not always as obvious as they make it on the lecture slides in class. So you should always be careful in clinic.

What a Tongue Tells You about a Patient's Oral Health

09:10 PM | Jan 03,2017
Very informative! We just discussed this in my Oral Pathology class. White lesions, although of some concern, are usually non-invasive. Most presentations of squamous cell carcinoma (in fact 93% of cases) will display some redness. If your patient has a white lesion, watch it for no more than 6 weeks. If it does not go away, perform a biopsy! All red lesions should immediately be biopsied.

What a Tongue Tells You about a Patient's Oral Health

02:15 AM | Dec 15,2016
This is a great and informative debrief! At UCSF, we have touched upon some of these topics (e.g. candidiasis, canker sores, Scarlet Fever) but have yet to piece everything together for application in a clinical setting. This is something I would love to add to share with my classmates and implement in our trainings for oral screening.

What a Tongue Tells You about a Patient's Oral Health

08:36 PM | Jul 23,2016
Very informative! Certain medications can cause also cause tongue discoloration color as well. For example, Pepto-Bismol contains bismuth, which may cause tongue temporary discoloration due to its sulfur content. Patients may present with this black or dark tongue discoloration, but it is harmless, and should not be of any long-lasting concern.

What a Tongue Tells You about a Patient's Oral Health

04:40 PM | Mar 29,2016
I thought this was pretty interesting. My mom called me the other day about how she "lost some of the bumps" on her tongue. After a couple weeks, I went home for the holidays and decided to take a look and sure enough it was an erythematous form of candidiasis. She wear's a bridge and her medical history also contributes to it as well. It was pretty bizarre because we had just talked about it in oral pathology so it was pretty cool to apply that knowledge from the classroom!

What a Tongue Tells You about a Patient's Oral Health

10:39 PM | Mar 22,2016
Thanks so much for this very informative forum post! It's so fascinating and important to understand how various systemic diseases are manifested in the oral cavity. Your post does a great job at simplifying several key signs and symptoms in the oral cavity of moderate to severe systemic diseases. Part of being a dental health care provider is seeing more than just teeth when a patient opens their mouth. It's absolutely necessary for dentists to be aware of systemic diseases that are manifested in the mouth. Beyond that, dental health professionals need to strive to understand the oral health of each patient becoming more than just tooth technicians. Dentists need to see the person behind the teeth, the family behind the person and the community behind the family.

What a Tongue Tells You about a Patient's Oral Health

07:48 AM | Mar 01,2016
This is a great article. So many times we look in the mouth and take the tongue for granted. Its so easy to just focus on the teeth and gums that we often times forget to look at what is right in front of us. Sometimes it can make the difference in the diagnosis if we are not careful. We must remember as a dentist that we are responsible for treating the entire head, neck, and mouth. But overall I think this article has some great insight and pointers on how to differentiate and what to suspects give the different possible presentations of the tongue.

What a Tongue Tells You about a Patient's Oral Health

10:10 PM | Feb 21,2016
Great review of oral path! As oral healthcare professionals, it is important that we realize how the tongue is a crucial part of the mouth. Being through with our head and neck exams, could lead to an important systemic diagnosis. Looking for early sign on the tongue and making proper recommendations to our patients is the step in the direction of providing overall healthcare. I will definitely keep this in mind in clinic while doing soft tissue exam.

What a Tongue Tells You about a Patient's Oral Health

09:36 PM | Feb 21,2016
Great read! Dentists have the first glance into the overall health of the patient when performing oral examination. Learning the signs and complications of the oral health is important in helping the patient in detecting possible disease. It is a way into holistic dentistry by giving full recognition to the connection between the mouth and the body by addressing the signs and symptoms found in oral examination.

What a Tongue Tells You about a Patient's Oral Health

06:38 PM | Feb 21,2016
I agree with the comment below that it's important to remember that the mouth is a window to the patient's overall health. Our role as healthcare providers cannot just be limited to the teeth. Many physicians never perform oral exams because they trust that we, as dentists, have it covered. That means thorough oral exams are an imperative part of our job, and we must be able and informed enough to catch and identify abnormal findings. I think the point above about vitamin deficiency provides a great example of a condition that may be unbeknown to your patient but that has a large affect on their overall health. A simple dietary fix would help them to alleviate symptoms that they hadn't even noticed or those which they did not have an explanation for. In this way, we can help our patients with more than just their teeth.

What a Tongue Tells You about a Patient's Oral Health

12:29 AM | Jan 05,2016
This post provides great information to keep handy in clinic! As part of the patient's oral exams in my school, we do oral cancer screenings on every patient, and I like to focus on the soft tissue before even looking at the teeth. The posterior lateral borders of the tongue are the areas where most oral cancer appears, so it is very important to check for any abnormal signs. Another condition worth mentioning is Geographic tongue, a benign lesion on the dorsal area of the tongue. It appears as red patches with white perimeters. It can last months to years, but does not require any treatment.

What a Tongue Tells You about a Patient's Oral Health

07:49 AM | Dec 17,2015
Really cool post! This is something we should be incorporating into our oral cancer screenings. This is also something important for our pt to know. It's easy to explain them what healthy and non healthy look like.

What a Tongue Tells You about a Patient's Oral Health

11:21 PM | Dec 13,2015
Great post!! I think a lot of students focus in on teeth and forget to really pay attention to the soft tissues of the mouth. Knowing what is normal and what isn't is a huge part of what we do as oral healthcare providers! Looking at what is going on with a patient's tongue specifically can help clue us in to a lot of things, including oral hygiene as well as other potential systemic conditions.

What a Tongue Tells You about a Patient's Oral Health

02:20 PM | Dec 07,2015
I really enjoyed reading this post and I think it draws attention to an aspect of dentistry that doesn't get as much attention as it should. The mouth is like a window into the human body, as it including the tongue can tell us so much about a patient. As future dentists, we are at the forefront of a patient's health. We are the healthcare providers that see patients on a regular basis and not just if they are sick. As dental professionals, it is important that we realize how important even just looking at a tongue can be.

What a Tongue Tells You about a Patient's Oral Health

10:30 AM | Nov 18,2015
This is an excellent point that the average person may miss because as we all know some of our patients tend to neglect their tongue, even when it comes to brushing! Recently, I learned that many times dental practitioners are the first to notice bleeding disorders such as Hemophilia in pediatric patients due to their inability to control bleeding issues in the oral cavity, this includes the tongue! Our level of observation needs to be thorough to truly evaluate the oral heath and thus the overall health of the patients that we treat.