Transcript of 1-Tongue papillae. 2-Food debris. 3-Bacteria. 4-Desquamated epitheliu m.
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- 1-Tongue papillae. 2-Food debris. 3-Bacteria. 4-Desquamated
epitheliu m.
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- The tongue coating is continuously formed and is removed by:
1-Mechanical factors: speaking and chewing food. 2-Salivary flow.
The tongue coating varies in different individuals and it varies in
the same individual during the day, it is marked in the morning
since cleaning factors are at rest.
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- Tongue coating is in a continuous process of removed and
formation. If removal exceeds formation atrophy If formation
exceeds removal increased tongue coating.
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- A- Atrophy of tongue coating The cells forming the filiform
papillae and fungiform papillae are of high metabolic activity so
any disturbance in enzyme, circulation or nutrients leads to
atrophy. During the process of atrophy: the filiform are affected
first, followed by fungiform papillae. During regeneration: the
fungiform regenerate first followed by regeneration of filiform.
Circumvallate and foliate are permanent structures of the tongue
coating, don t participate in atrophy.
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- Atrophy of tongue coating
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- 1- Deficient or impaired utilization of nutrients 1-Iron
deficiency anemia. 2-Pulmonary Vinson syndrome. 3-Pernicious
anemia. 4-Anemia associated with parasitic infection as ascaris and
bilhariziasis. 5-Malnutrition, malabsorption. 6-Sprue (saffty
diarrhea). 7-Chronic alcoholism. 8-Vit B deficiency especially (vit
B2, B6B12, folic acid and nicotinic acid
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- 2- Peripheral vascular disease 1-Angiopathy: diabetes mellitus.
2-Vasulitis: systemic lupus erythematosus. 3-Endarteritis
obliterans: syphilitic glossitis. 4-Obliteration of small blood
vessels: scleroderma, submucous fibrosis. 5-Localized vascular
insufficiency in elderly patients.
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- 3-Therapeutic agents 1-Drugs that interfere with the growth and
maturation of the epithelium e.g cyclosporine. Induce candidosis
e.g. antibiotic, steroid. Induce xerostomia e.g anticholinergic
drugs, radiotherapy.
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- 5- Miscellaneous 1- Frictional irritation: atrophy at tip &
lateral borders of tongue. 2- Atrophic lichen planus. 3-
Epidermolysis bullosa: ulceration healed by scar. 4- Long standing
xerostomia. 5- Diabetes and chronic candidosis may produce a lesion
called central papillary atrophy.
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- B- Increased tongue coating The filiform papillae which
constitute the keratinizing surface of the tongue are in continuous
state of growth and their height is determined by the rate of
desquamation process. The later is induced by friction with food,
palate and upper anterior teeth, during eating and speech.
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- B- Increased tongue coating Physiological increase in tongue
coating is usually observed in the morning, since the local
cleaning factors, (mastication, speech and salivary flow) are at
rest. Interference with the physiology of the mouth may affect the
rate of desquamation.
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- Increased tongue coating
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- Furred tongue
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- Etiology: Basically the abnormal increase in tongue coating is
due to local environmental changes represented by lack of function
and/or changes in the oral flora and these are attributed to: 1-
Drugs a- Topical and systemic use of antibiotics. b- Antiseptic
mouth washes. c- Oxygen releasing mouth rinse.
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- Etiology: 2- Febrile illness (general body dehydration,
decreased salivary flow, liquid diet and poor oral hygiene).
3-Stomach upset, vomiting associated with intestinal or pyloric
obstruction, debilitated or terminally ill patient. 4- Mouth
breathing
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- Clinical features: The increased tongue coating may be stained
particularly on the mid dorsum by food, tobacco, drugs of possibly
by microorganisms. In debilitated, dehydrated and terminally ill
patients the increased tongue coating may be very thick and has
been described as leathery coating.
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- Treatment Consist of brushing the dorsal surface of the tongue
several times a day systemic antibiotic should not be interrupted
but antifungal agent should be used locally. Topical antibiotic and
mouth washes should not be used. The condition usually regresses
spontaneously when the normal jaw and tongue activity are
restored.
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- Black hairy tongue Definition It is a condition characterized
by hypertrophy of filiform papillae associated with growth of black
pigment micro organism.
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- Hairy tongue
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- Black hairy tongue
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- Etiology 1-Sodium perporate and sodium peroxide mouth wash that
stimulate growth of filiform papillae. 2-Topical and systemic
antibiotics: ex: penicillin, tetracycline, aureomycin. 3- Systemic
disturbance: anemia, hyperacidity, peptic ulcer. 4- Predisposition
in some people.
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- Clinical features May be asymptomatic or may cause gagging and
tickling.
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- Management Removal of the cause stop tpical antibiotic .
Burshing of the tongue. N.B. Systemic antibiotic should not be
stopped, but antifungal ointment is prescribed in additional to the
antibiotic. N.B. Pseudo black hairy tongue means discolouration of
tongue by food, smoking and drugs without actual hypertrophy of
filiform papillae.
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- Site: the dorsum of the tongue. It is an irregularly outlined
area, devoid of filiform papillae, with red dots representing
fungiform papillae. {occasionally devoid of fungiform}. The margin
of the depillated area is raised with yellowish, whitish tinge. The
margin of the lesion shifts as much as inch per day due to renewed
of papillae in one area and loss in another area. It occurs chiefly
in children and young adults.