Why do physicians and dentists always ask you to “Stick out your tongue and say ‘Aaahhh’”? Examination of the tongue can offer diagnostic clues to your health including diet and immunity. Here are some of the most common tongue conditions and health issues they are connected with. GEOGRAPHIC TONGUE Geographic tongue affects up to 14 % of the population and the etiology is unknown. It is a benign condition where the tongue appears to have bands of red and white areas. The red areas are caused by papillary atrophy and these areas move and change spontaneously. No treatment is necessary except when sensitive to trigger foods such as spices , then a topical oral steroid would be used. FISSURED TONGUE Fissured tongue is deepening of the normal physiologic grooves of the tongue. It usually occurs with aging and requires no treatment. Fissured tongue has been associated with Down syndrome, acromegaly, psoriasis, Sjogren Syndrome, and Melkersson-Rosenthal syndrome (facial nerve palsy). Gentle tongue brushing can help prevent inflammation from debris getting trapped in the grooves. HAIRY TONGUE This is a benign condition where keratin accumulates on the papilla forming projections that resemble hair. The color can vary from white, tan, to black. It is associated with tobacco use and poor oral hygiene. Treatment with a tongue scraper usually improves appearance and helps with halitosis. MEDIAN RHOMBOID GLOSSITIS This condition appears as a red shiny spot on the center of the tongue. Its border is well circumscribed and it may occasionally burn or itch. This is usually associated with candida infection and can be treated with antifungals. Underlying causes of immunosuppression should be considered. ATROPHIC GLOSSITIS Atrophic glossitis presents as a smooth glossy appearance. This is caused by atrophy of the filiform papillae which usually accompanies an underlying condition. Nutritional deficiencies in folic acid, vitamin B, and iron can be a common cause. Other conditions associated with atrophic glossitis include amyloidosis, celiac disease, chemical irritants, drug reactions, candidiasis, sarcoidosis, Sjogrens, and pemphigus. Sources: medicalpicturesinfo.com, emedicalhub.com, kandyganesan.com, regionalderm.com, hxbenefit.com
By Christine Ambrose Almost 4 in 10 women who are pregnant will experience increased inflammation of the gums. This condition, known as pregnancy gingivitis, is caused by the increase of the hormone progesterone. This results in gums that appear red and bleed easily after brushing or flossing. Current treatment is mostly prevention: daily brushing, flossing and rinsing with an anti-gingivitis mouthwash. The Journal of Clinical Periodontology recently published a study that showed promising treatment with BioGaia probiotic lozenges. Severe gingivitis that is left untreated is a risk factor for developing periodontitis or gum disease. There have been studies that link mothers with severe gum disease with premature birth (32 weeks). Don’t skip routine, preventive dental care. Professional cleanings can help alleviate the inflammation. For more information on pregnancy and dental care, see our blogs: http://www.newtonwellesleydentalpartners.org/pregnancy-dental-care/ http://www.newtonwellesleydentalpartners.org/women-and-family/dental-issues-pregnancy/
By Christine Ambrose This summer I had the unfortunate experience of catching Hand-foot-and-mouth disease (HFMD). Parents with young children, beware! HFMD is the most well-known enterovirus infection and most common among infants and young children. Enteroviruses include poliovirus, coxsackievirus A and B, and echovirus. The incubation period is usually 4 to 7 days and more common in the summer season. Onset of the virus begins with flu-like symptoms, e.g. fever, fatigue, sore throat. First oral lesions will develop and precede the development of skin lesions on the hands and feet. The mouth sores appear vesicular in nature and range 2-7mm in diameter. The photo here demonstrates the sores which I developed! They appear as flat white spots with red borders affecting the hard and soft palate, tongue, and inner lips. The sores are extremely painful and make eating solids very difficult. Development of similar rashes on the hands and feet causes a tingling sensation, making it painful to hold things and walk. No treatment is recommended except palliative (OTC pain medication) because the disease is self-limiting and ulcerations resolve in 1 week. Be careful of areas where children play (daycare, playgrounds) and wash hands thoroughly!
By Christine Ambrose SCHOOL AGED CHILDREN (6-12 years old) At this point, instead of actively performing the oral hygiene routine, the parent can provide active supervision. You may only need to help in brushing or flossing in certain difficult to reach areas. Actively inspect your child’s teeth for cleanliness with a disclosing agent. Fluoride toothpaste can be used as the risk for ingesting is low and mouth rinses can be introduced to prevent gum disease and decay. Orthodontic treatment increases the risk for decay so special attention is needed in brushing and flossing. The used of a fluoride rinse is highly recommended for those in orthodontic treatment. ADOLESCENTS Now your teenager is actually capable of performing very good oral hygiene but compliance is another issue. Motivating a teen to assume responsibility for personal hygiene maybe complicated.* There are studies that have shown self- esteem generally declines between ages 11 and 14 before improving into adulthood and that there is a correlation between self-esteem and tooth-brushing behavior. It will be important for the parent to help and guide teenagers through this stage. Appearing authoritarian can backfire so be ready to adapt to these challenges. Have your teenager understand that as young adults they need to increase their responsibilities. Make sure your child is educated on how plaque can damage their teeth and cause tooth loss, appealing to their appearance which may motivate them. For more information, contact Newton Wellesley Dental Partners. Source: Dentistry for the Child and Adolescent. Ralph McDonald, David Avery, Jeffrey Dean. 2004 Mosby, Inc
By Christine Ambrose Many parents ask me, “What am I supposed to do for their teeth?” Home care changes throughout childhood and has different levels of involvement. Here is a look at ages 0-6 years. Next week we’ll cover school aged and adolescents. INFANTS (0-1 years old) It is generally a good idea to begin cleaning your child’s teeth as soon the first tooth erupts. It can be done by wrapping a moistened washcloth around the finger and gently massaging the teeth and gums. Cradle your child with one arm for reassurance while massaging the teeth with the other hand. This should be done once daily. There is no need for toothpaste at this age. The American Academy of Pediatric Dentistry recommends that children see a dentist for the first time no later than 12 months. Usually at the first visit, the dentist will review oral hygiene care, fluoride intake, and dietary issues with nursing and bottle caries. TODDLERS (1-3 years old) Now you can start using a toothbrush, but only with non fluoridated toothpaste because of the inability of children to expectorate. Model good brushing for your child. Unfortunately it is unrealistic that your child will adequately remove all plaque so the parent is still the primary caregiver in accomplishing this. If your child resists letting you help, you can sit on the floor with legs stretched out and position your child’s head between your thighs. Although a little awkward, you can control your child’s arms and legs with your legs and hopefully get the job done! Make it a special time for the child and praise as much as possible. PRESCHOOLERS (3-6 years old) Although your child has improved dexterity, they still need help in order to adequately clean their teeth. Toothpaste can be introduced but use no more than a pea sized amount. Introduce your child to flossing. Stand behind your child facing the same direction. Use your non dominant arm to support the head while using the hand to retract cheeks, use the other hand to brush. Using a frontal approach is generally discouraged because of the lack of head support. For more information, contact Newton Wellesley Dental Partners.