The tongue is a muscular organ associated with the function of deglutition, taste, and speech. It acts as an easily accessible organ for the assessment of the health of an individual and shows the state of hydration of the body. It is said that the tongue is the mirror of the gastrointestinal system and any abnormal functioning of the stomach and intestines will be reflected on the tongue. 

Some characteristic changes occur in the tongue in some particular diseases. That is why the examination of the tongue is very essential and will give some clues for diagnosis. All doctors examine the tongue and they consider the changes in size, shape, color moisture, coating, nature of papillae and movements ect. 

The appearance of tongue in some abnormal conditions:- 

1) Movements of the tongue:-

a) In one-sided paralysis of the body(hemiplegia)tongue moves towards the paralyzed side when protruded.    

b) Tremulous movement of the tongue is seen in diseases like thyrotoxicosis, delirium treatment,s, and parkinsonism. Tremor is also seen in nervous patients. 

c) In progressive bulbar palsy there will be wasting and paralysis of the tongue with fibrillation. Eventually, the tongue gets shriveled and lies functionless on the floor of the mouth. This condition is associated with dribbling of saliva and loss of speech. 

d) In chorea(involuntary rhythmic movements) the patient may not be able to keep the protruded tongue at rest, it will be moving involuntarily. 

2) Moistness of the tongue:-

The moistness of the tongue gives some indication of the state of hydration of the body. Water volume depletion leads to peripheral circulatory failure characterized by weakness, thirst, restlessness, anorexia, nausea, vomiting, dry tongue.

Dryness of the tongue is seen in the following conditions.

a) Diarrhoea

b) Later stages of severe illness

c) Advanced uremia

d) Hypovolemic shock

e) Heat exhaustion

f) Hyponatraemia

g) Acute intestinal obstruction

h) Starvation

i) Prolonged fasting.

3) Change in color of the tongue:-

a) Central cyanosis:-

Cyanosis is the bluish discoloration of the mucus membrane due to a decrease in the amount of oxygen in the blood. This is seen in heart failure, respiratory failure, and anoxia. In cyanosis tongue, Lipsettbecomese pale bluish.

b) Jaundice:-

This is the yellowish discoloration of all mucus surfaces of the body (including the tongue)due to an increase of bilirubin in the blood. Jaundice is seen in hepatitis, bile duct obstruction, increased destruction of RBCs and ect...

c) Advanced uremia:

This is the increase of urea and other nitrogenous waste products in the blood due to kidney failure. Here the tongue becomes brown. 

d) Ketoacidosis:-

This is the acidosis with an accumulation of ketone bodies seen mainly in diabetes mellitus. Here the tongue becomes brown with a typical ketone smell from the mouth. 

e) Riboflavin deficiency:-

The deficiency of this vitamin (vitamin B2) produces a magenta color of the tongue with soreness and fissures of lips.      

f) Niacin deficiency:-

The deficiency of niacin (vitamin B3)and some other B complex vitamins results in bright scarlet or beefy red tongue. 

g) Anaemia:-

It is the decrease in the hemoglobin percentage of the blood. In severe anemia tongue becomes pale. 

4) Coating on the tongue:-

a) Bad breath:-

The main cause for bad breath is the formation of a pasty coating(biofilm) on the tongue which lodges thousands of anaerobic bacteria resulting in the production of offensive gases. Those who complain about bad breath may have a thick coating on the posterior part of the tongue. 

b) Typhoid fever:-

In typhoid, fever the tongue becomes white-coated like fur. 

c) Candidiasis;-

It is a fungal infection that affects the mucus surfaces of the body. On the tongue, there will be sloughing white lesions.

d) In diabetes and hypoadrenalism there will be sloughing white lesions. 

e) Secondary syphilis:-

Syphilis is a sexually transmitted disease caused by treponema pallidum infection. In the second stage of this disease, we can see mucous patches which are paipainlessmo oth white glistening opalescent plaques that can not be scraped off easily. 

f) Leukoplakia:-

Here white keratotic patches are seen on the tongue and oral cavity. This is a precancerous condition.

g) AIDS:-

In these patients, hairy leukoplakia is seen. 

h) Peritonitis:-

It is the inflammation of the peritoneum(inner covering of abdominal cavity which also covers the intestines and keeps them in position) in this condition there is white furring of the tongue. 

i) Acute illness:-

Furring is also seen in some acute diseases. 

5) Papillae:-

These are small projections on the tongue associated with taste. There are different types of papillae on the healthy tongue. In some diseases,e some abnormal changes are following. 

a) Hairy tongue:-

This condition is due to the elongation of filiform papillae seen in poor oral hygiene, general debility, and indigestion. 

b) Geographic tongue:-

Here irregular red and white patches appear on the tongue. These lesions look like a geographic map. The exact cause is not known. 

c) Median rhomboid glossitis:-

In this condition, there is a smooth nodular red area in the posterior midline of the tongue. This is a congenital condition. 

d) Nutritional deficiency:-

In nutritional deficiency, there is glossitis(inflammation of the tongue) leading to papillary hypertrophy followed by atrophy.     

e) Benign migratory glossitis:-

It is an inflammatory condition of the tongue where multiple annular areas of desquamation of papillae appear on the tongue which shifts from area to area in a few days.

f) Thiamine and riboflavin deficiency:-

The deficiency of these vitamins causes hypertrophied filiform and fungiform papillae.

g) Niacin and iron deficiency:-

In this condition, there is atrophy of papillae. A smooth tongue is encountered in iron deficiency. 

h) Vitamin A deficiency:-

This causes furrowed tongue. 

i) In nutritional megaloblastic anemia tongue becomes smooth. 

j) Folic acid deficiency:-

Here macrocytic megaloblastic anemia with glossitis is seen. 

k) Cyano cobalamine deficiency:-

Here glossitis with macrocytic megaloblastic anemia and peripheral neuropathy is encountered.   

l) Scarlet fever;-

In this streptococcal infection, bright red papillae are standing out of a thick white fu for thee white coat disappears leaving enlarged papillae on the bright red surface and is called the strawberry tongue.  

6) Ulcers on the tongue:-- 

a) Aphthous ulcer:-

These are round painful ulcers that appear in stressed individuals frequently. May be associated with a food allergy. Usual sites are the tongue, lips, oral mucosa, and ect. 

b) Herpes simplex:-

It is an acute vesicular eruption produced by the herpes simplex virus. When these vesicles rupture it forms ulcers. 

c) Ulcer in cancer:-

Cancerous ulcers are having everted edges with a hard base. Bleeding is also seen. Cancer of the tongue is common in tobacco chewers. 

d) Syphilitic ulcers:-

Syphilitic fissures are longitudinal in direction. In primary syphilis extragenital chancre is seen on the tongue. In secondary syphilis, multiple shallow ulcers are seen on the undersurface and sides of the tongue. In tertiary syphilis, gumma may be seen on the midline of the dorsum of the tongue.

e) Dental ulcers:-

These ulcers are produced by sharp edges of carious teeth.

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