The prevalence of tongue lesions in 5150 Turkish dental outpatients

A cross-sectional study of tongue disorders among dental outpatients

PURPOSE

The tongue is a complex organ that can provide insight into oral and systemic conditions. A variety of disorders, such as geographic tongue, hairy tongue, fissured tongue, macroglossia, microglossia, and others, can be observed. The objective of this cross-sectional study, conducted on a cohort of dental patients, was to examine the prevalence of tongue disorders and their relationship with factors such as demographic data, oral hygiene practices, history of systemic diseases, and bad habits.

METHOD

The tongues of 772 dental outpatients, comprising 355 males and 417 females, were examined in detail, and the factors associated with tongue disorders were noted.

RESULTS

The prevalence of tongue disorders was 32.6 %. The remaining tongue disorders were as follows: fissured tongue (12.1 %), macroglossia (7.1 %), geographic tongue (3.4 %), hairy tongue (3.6 %), coated tongue (3.4 %), median rhomboid glossitis (0.5 %), ankyloglossia (0.4 %), glossitis (0.4 %), and microglossia (0.1 %). The most prevalent tongue disorder observed in the study cohort was fissured tongue, while both bifid tongue and idiopathic burning tongue syndrome were absent. The prevalence of macroglossia, fissured tongue, and hairy tongue was significantly higher in males than in females (p < 0.05, p < 0.05, p < 0.05, p < 0.005, respectively). A statistically significant difference was observed in the frequency of macroglossia, furred tongue, hairy tongue, and glossitis between age groups.

CONCLUSION

The findings of this study identified the most common tongue disorders and their relationship with factors such as systemic history, demographic factors, oral hygiene care, bad habits, and systemic diseases. The significance of tongue appearance in providing insight into the systemic and oral condition of the patient has once again been demonstrated.

Developing tongue coating status assessment using image recognition with deep learning

PURPOSE

To build an image recognition network to evaluate tongue coating status.

METHODS

Two image recognition networks were built: one for tongue detection and another for tongue coating classification. Digital tongue photographs were used to develop both networks; images from 251 (178 women, 74.7±6.6 years) and 144 older adults (83 women, 73.8±7.3 years) who volunteered to participate were used for the tongue detection network and coating classification network, respectively. The learning objective of the tongue detection network is to extract a rectangular region that includes the tongue. You-Only-Look-Once (YOLO) v2 was used as the detection network, and transfer learning was performed using ResNet-50. The accuracy was evaluated by calculating the intersection over the union. For tongue coating classification, the rectangular area including the tongue was divided into a grid of 7×7. Five experienced panelists scored the tongue coating in each area using one of five grades, and the tongue coating index (TCI) was calculated. Transfer learning for tongue coating grades was performed using ResNet-18, and the TCI was calculated. Agreement between the panelists and network for the tongue coating grades in each area and TCI was evaluated using the kappa coefficient and intraclass correlation, respectively.

RESULTS

The tongue detection network recognized the tongue with a high intersection over union (0.885±0.081). The tongue coating classification network showed high agreement with tongue coating grades and TCI, with a kappa coefficient of 0.826 and an intraclass correlation coefficient of 0.807, respectively.

CONCLUSIONS

Image recognition enables simple and detailed assessment of tongue coating status.

Median Rhomboid Glossitis: A Case Study

A smooth, red, oval, or rhomboid patch on the dorsal midline is the classic presentation of median rhomboid glossitis (MRG), a rare and benign lesion of the tongue. MRG is still not fully understood, which presents diagnostic hurdles and calls for additional clinical investigation. It is frequently associated with candidal infections. We describe a case of a 42-year-old man who initially appeared to have either mechanical irritation or thermal injury related to a painless patch on the dorsum surface of the tongue. We document a case of MRG that was consulted for a standard dental examination in this case report. This article also highlights a dentist's need to identify the lesion and provide appropriate education for the patient.

Two Cases of Superficial Fungal Infection Caused by Non-Albicans Candida Species Manifest Greenish-black Discoloration

The clinical manifestation of superficial candidiasis varies depending on the infectious sites and causative Candida species that brings a great challenge to diagnose or treat without mycological or pathological evidence in clinical settings. Oral mucosal candidiasis and onychomycosis are most common types of superficial candidiasis. Typically, oral mucosal candidiasis manifests as white or erythematous thrush coated on the tongue and other interior oral cavity; and onychomycosis caused by Candida spp. presents with thick, fragile, or cracked fingernails or toenails in yellow or white discoloration. Here, we report one case of patient with a black hairy tongue caused by Candida tropicalis and one case of greenish discolored onychomycosis caused by Candida parapsilosis. The cases of superficial candidiasis with the same discolored lesions were searched in literature and compared with our cases in clinical manifestation, causative pathogen and treatment. These cases highlight the importance of mycological diagnosis for identifying non-Candida albicans Candida species (NCAC) in superficial infections to guide an effective therapy.

Structural and functional abnormalities of the tongue: An epidemiological study from a tertiary care center in India

Background

The tongue is a prominent muscular organ of the oral cavity and the integrity of the tongue mucosa frequently can reflect the overall health of an individual. Many notable structural and functional alterations can affect the tongue. These changes may be symptomatic or asymptomatic. Hence, the aim of the study was to determine the prevalence of structural and functional abnormalities of the tongue in a population reporting to a tertiary care center. We also assessed the prevalence of the normal variants and evaluated the normal tongue protrusion measurement in the study population.

Methods

The cross-sectional study included 1,143 dental outpatients above 18 years of age who visited the Department of Oral Medicine and Radiology between October 2021 to February 2022. Demographic details of the patients were noted. Participants were asked questions regarding any symptoms or abnormalities noticed on the tongue. The tongue was examined thoroughly for any structural/ functional abnormalities. The maximal tongue protrusion for each participant was measured by asking them to extend their tongue out. Medical history, drug history, and social history were recorded.

Results

The study included 564 male and 579 female participants; tongue lesions were positive in 66.5% of the study population. Coated tongue (26.2%) was the most frequent structural abnormality that was noted in the present study. Taste dysfunction (4.6%) was the most frequent functional abnormality. The lesions were mostly in the anterior two-thirds (4.2%) of the tongue. Functional abnormalities of the tongue were noted in 8.7% of the study participants.

Conclusions

The results of the present study showed that structural and functional abnormalities of the tongue were present in 66.5% of the population. Careful and detailed evaluation of the tongue examination is mandated in routine dental checkups. This shall help in the prompt identification of various etiological factors causing structural and functional abnormalities of the tongue.

Prevalence and Distribution of Oral Mucosal Lesions and Normal Variants among Nepalese Population

Background

Oral mucosa is encountered by various lesions and normal variants. Some are not to be worried about, whereas others may be of significance. Knowing the prevalence of oral mucosal lesions in a particular region helps better evaluate, diagnose, and, thus, manage these lesions.

Objectives

To assess the prevalence and distribution of oral mucosal lesions and normal variants among various age groups, genders, and sites of the orofacial region.

Methods

This cross-sectional study was conducted in the Department of Oral Medicine and Radiology, KIST Medical College and Teaching Hospital from January 2021 to March 2021. Three different proformas were designed according to age, gender, and location of lesions for entry as per the WHO's guide. The obtained data were entered into a Microsoft Excel sheet for frequency analysis by SPSS, and the results were tabulated.

Results

Among the records of 16572 (9703 (58.55%) males and 6869 (41.44%) females) OPD patients, 3495 (21.08%) (1934 (55.33%) males and 1561 (44.66%) females) had OMLs and 2314 (13.96%) (1626 (70.26%) males and 688 (29.73%) females) had normal mucosal variants. The most commonly seen OML categories were tobacco-associated lesions, i.e., 2056 (34.07%), tongue lesions, i.e., 1598 (26.48%), oral potentially malignant disorders, i.e., 815 (13.50%), ulcers i.e., 728 (12.06%), and infectious lesions, i.e., 256 (4.24%).

Conclusion

The Nepalese population has a wide range of oral mucosal lesions and normal variants, and this study has attempted to have baseline data for the same. The most common OML was smoker's melanosis.

Long-term use of triple antibiotic-induced black hairy tongue: A case report

Black hairy tongue is a rare condition, characterized by a black discoloration and hair-like structure appearing on the dorsal surface of the tongue. The mechanism of black hairy tongue remains unclear but could be predisposed by multiple factors. We described a case of a 53-year-old Chinese female with a diagnosis of bronchiectasis complicated with Mycobacterium abscessus infection, and a triple antibiotic regimen was prescribed for the infection. One month later, a black hairy tongue appeared. The clinical pharmacist was consulted to investigate the association of medication-related factors by the attending clinician, and the clinical pharmacist identified the potential cause and suggested an appropriate treatment for the black hairy tongue. The black hairy tongue disappeared and did not recur during subsequent treatment.

Frequency tongue coating in patients referred to Kerman Dental School and its relationship with relative factors

OBJECTIVE

There has been shown a relationship between "tongue coating" and "Simplified Oral Health Index, periodontal status, modified mallampati classification (MMC) of the oropharynx and oral malodor". The purpose of this study is to assess the frequency of tongue coating and relative factors (sex, age, smoking, systemic disease and oral health indices) among patients referred to Dental School of Kerman University.

METHODS

In this cross sectional study 250 patients referred to dental school of Kerman university of medical sciences were examined. The data collection form was included demographic data (gender, age, history of systemic disease and smoking) and Oral health indices such as TCI (Tongue coating index), OHI-S (Simplified Oral Hygiene Index), MGI (Modified Gingival Index), MMC and lost teeth. The analysis have been done using SPSS21, T-test, Pearson correlation coefficient and linear regression analysis (significance level was set at less than 0.05).

RESULTS

Tongue coating has been shown in 96% of patients with the mean percent of 45.83 ± 19.16%. Men had higher percent of TCI though it was not statistically significant. Smoking was the strongest determinant factor in people with higher TCI scores (P = 0.013). There was a positive significant correlation between OHI-S and TCI [(Pearson's coefficient(r) = 0.134, P = 0.034)].

CONCLUSION

TCI appears to be related to smoking and Simplified Oral Health Index. The evaluation of tongue coating is necessary to assess its impact on oral health status and also to motivate patients to clean their tongue as a part of their oral health care routine.

Prevalence of clinical signs, symptoms and comorbidities at diagnosis of acromegaly: a systematic review in accordance with PRISMA guidelines

OBJECTIVE

Diagnostic delay is high in acromegaly and leads to increased morbidity and mortality. The aim of this study is to systematically assess the most prevalent clinical signs, symptoms and comorbidities of acromegaly at time of diagnosis.

DESIGN

A literature search (in PubMed, Embase and Web of Science) was performed on November 18, 2021, in collaboration with a medical information specialist.

METHODS

Prevalence data on (presenting) clinical signs, symptoms and comorbidities at time of diagnosis were extracted and synthesized as weighted mean prevalence. The risk of bias was assessed for each included study using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data.

RESULTS

Risk of bias and heterogeneity was high in the 124 included articles. Clinical signs and symptoms with the highest weighted mean prevalence were: acral enlargement (90%), facial features (65%), oral changes (62%), headache (59%), fatigue/tiredness (53%; including daytime sleepiness: 48%), hyperhidrosis (47%), snoring (46%), skin changes (including oily skin: 37% and thicker skin: 35%), weight gain (36%) and arthralgia (34%). Concerning comorbidities, acromegaly patients more frequently had hypertension, left ventricle hypertrophy, dia/systolic dysfunction, cardiac arrhythmias, (pre)diabetes, dyslipidemia and intestinal polyps- and malignancy than age- and sex matched controls. Noteworthy, cardiovascular comorbidity was lower in more recent studies. Features that most often led to diagnosis of acromegaly were typical physical changes (acral enlargement, facial changes and prognatism), local tumor effects (headache and visual defect), diabetes, thyroid cancer and menstrual disorders.

CONCLUSION

Acromegaly manifests itself with typical physical changes but also leads to a wide variety of common comorbidities, emphasizing that recognition of a combination of these features is key to establishing the diagnosis.

Black Tongue Discoloration

An 80-year-old man developed asymptomatic black discoloration of the dorsal surface of his tongue 1 week after hospitalization for surgical and antibiotic treatment of septic arthritis of the shoulder. He reported no prior lingual discoloration and did not smoke cigarettes, use chewing tobacco or illicit drugs, or drink alcohol. What is the diagnosis and what would you do next?

Oral Bacteria Dysbiosis in Patients with Linezolid-Induced Black Hairy Tongue: A Case Series

Linezolid-induced black hairy tongue is a self-limiting benign disease that is rare. Here, we report three patients who developed black hairy tongue after linezolid treatment. The severe dysbiosis of oral bacterial communities was observed in all these patients. Proteobacteria was the most prevalent phylum (over 90%) at the black tongue stage. Furthermore, the dramatic oral bacterial alteration took a long time to reverse after the BHT resolved.

Diode Laser Surgery as a Conservative Management of Hairy Tongue Lesion Resistance to Treatment

Hairy tongue is a furry appearance on the dorsum surface of the tongue with variable colors. This lesion is due to defective shedding of filiform papillae. Various treatments are proposed for this condition like keratolytic agents, surgical procedure with a scalpel, or laser application. In this case study, we reported successful treatment of hairy tongue with a diode laser. The diode laser with wavelength 810 nm, power of 4 watts, a pulse width of 20 milliseconds, and an interval of 20 milliseconds by a 400-micron optical fiber was selected for treatment of this lesion. There was no bleeding during this minimally invasive surgery, and the patient experienced a low level of pain. Loss of taste function was completely resolved. Based on the result of this study, a diode laser can be a good alternative for minimally invasive surgical treatment of hairy tongue.

Outbreak of oral ulcers (glossitis) among the students of three central schools under Tsirang district Bhutan, 2018

Background

Nutritional deficiencies are common worldwide and is most notable in low and middle income countries. In the early weeks of September 2018, oral sores mostly affecting the tongue were reported in three central schools under Tsirang district, Bhutan. A total of 204 students were affected in the three central schools. All the affected students have been assessed on the outbreak and nutritional survey was conducted in the three schools.

Methods

A total of 204 students who complained of different oral lesions in the affected three schools were screened by the dental surgeon for clinical assessment and administered questionnaire for nutritional assessment by the nutritionist. Twenty-one students randomly selected were sent for blood tests for micronutrient assays and complete blood count. 41 students were tested for Exfoliative cell cytology to test for fungal elements. The collected data was double entered and validated using Epi-Data version 3.1 and analysed using Stata 15 IC. The characteristics of the participants are presented as frequencies, percentages, mean and standard deviation (SD).

Results

Almost all the affected students in all the three schools had complaints of Burning Sensation (n = 158) followed by Pain (n = 153), Impaired Taste Sensation (n = 100) and Intolerance to Spicy Food (n = 95). Nutritional assessment analysis suggested schools not meeting the Recommended Dietary Allowance (RDA) for all components of Vitamin B complexes and Iron.

Conclusion

Clinical assessments and nutritional survey analysis found inadequate vitamin rich dietary intakes among all the three schools. Implementation of a strict school feeding program with a balanced diet has been suggested accordingly.

Clinical Orodental Anomalies in Taiwanese Children under Age Six: a Study Based on the 1995-1997 National Dental Survey

There are few published studies that report the prevalence of intraoral anomalies for young children. The purpose of this study was to investigate the prevalence and distribution of several congenital oral and paraoral anomalies in Taiwanese children under age six. Twenty-five cities and townships were randomly sampled in different areas of Taiwan using the stratified method. These cities and townships represent cross-sectional samples of geographic locations and socioeconomic levels. A total of 981 Taiwanese children under age six were examined with dental mirrors and explorers as part of the national dental survey. The results of this survey indicated an 11.31% prevalence of geographic tongue. This number is higher than that reported in studies previously performed in different countries. The occurrence of double teeth in primary dentition was found to be 2.14%. Ankyloglossia had a frequency of 1.22%, and primary talon cusp a frequency of 0.61%. Seven (0.71%) children exhibited fissured tongues. Thirteen (1.33%) cases of hypodontia were found. These values were different from those reported in several other countries, which may be attributed to differences in the ethnic and racial composition of the population studied.

A Multicenter Study of Tongue Lesions from Thailand

OBJECTIVE

Tongue lesions constitute a considerable proportion of the oral lesions. Previous studies on tongue lesions were based on clinical studies. There has been a scarcity of the studies which are based on histopathological examination. This study aimed to determine the prevalence, demographic, and pathologic features of tongue lesions from Thailand.

MATERIALS AND METHODS

 Biopsy records of the participating institutions were reviewed for lesions on the tongue diagnosed during 1998 to 2017. Demographic data were collected from the biopsy records. Locations were arbitrarily classified as dorsal, lateral, and ventral surfaces, tip of the tongue, and the combination of sites. Lesions of the tongue were classified as reactive/inflammatory, developmental, immune-mediated, cystic, benign, premalignant, malignant, infectious, and miscellaneous categories.

STATISTICAL ANALYSIS

 Data were analyzed by descriptive statistics using SPSS version 20.0.

RESULTS

 Of the 44,188 accessioned cases, 2,153 cases (4.87%) were diagnosed from the tongue. The age of the patients ranged from 3 to 93 years with the mean ± standard deviation = 45.26 ± 20.48 years. The female-to-male ratio was 1.49:1. The majority of the tongue lesions were encountered at the lateral border of the tongue (47.66%). Most of the tongue lesions in the present study (53.74%) fell into the reactive/inflammatory category. Irritation fibroma was the most prevalent lesion (18.99%) followed by squamous cell carcinoma (16.91%), and mucus extravasation phenomenon (14.26%), respectively.

CONCLUSIONS

 This study offers new perspective into the study of tongue lesions apart from the clinically based studies. It also demonstrates the difference between the pediatric and the elderly patients. This study provides invaluable database for clinicians when formulating the clinical diagnosis of tongue lesions.

Dermatologic manifestations associated with electronic cigarette use

BACKGROUND

Electronic cigarette use continues to rise, yet there are no reviews summarizing dermatologic manifestations associated with electronic cigarettes in the literature.

OBJECTIVE

To review the literature regarding cutaneous manifestations associated with electronic cigarette use and increase awareness of side effects associated with this rapidly developing public health epidemic.

METHODS

The PubMed database was searched for related literature. All studies involving the effects of electronic cigarette use on the skin or mucosa were obtained and reviewed for evidence.

RESULTS

Contact dermatitis, thermal injuries, and oral mucosal lesions have been reported with the use of electronic cigarettes.

LIMITATIONS

The conclusions presented in individual case reports or series are not based on randomized controlled trials.

CONCLUSION

Electronic cigarettes can present with harmful dermatologic manifestations.

Oral mucosal lesions and risk factors in elderly dental patients

Background. The aim of this study was to determine the prevalence of oral lesions in terms of sex, age, educational status, medication use, systemic diseases, the duration of denture use and tobacco or alcohol use.

Methods. A total of 709 voluntary patients (375 males and 334 females), aged ≥60 years, were interviewed by one investigator for demographic data, systemic diseases, tobacco or alcohol use, denture use and the duration of denture use.

Results. The majority of the participants (87.6%) had one or more oral mucosal lesions. The prevalence of oral mucosal lesions was 46.3% in males and 41.3% in females (P=0.76). The most common oral mucosal lesion was a sublingual varicosity in both males and females. A statistically significant difference was observed between the three age groups (60–64, 65–69, and ≥70 years) with regard to the prevalence of oral mucosal lesions (P=0.02). There was a significant relationship between the presence of systemic diseases and oral mucosal lesions (P=0.01). There was also a significant relationship between denture use and oral mucosal lesions (P=0.001). Smoking and a history of smoking were also significant predictive factors for oral mucosal lesions (OR: 3.385, P=0.045).

Conclusion. Although the majority of oral mucosal lesions detected in the present study were benign, there were some patients with premalignant and malignant lesions. Therefore, periodic oral examinations for detection of precancerous and cancerous lesions are important, especially in the elderly, smokers and denture users.

Black and Brown: Non-neoplastic Pigmentation of the Oral Mucosa

Black and brown pigmentation of the oral mucosa can occur due to a multitude of non-neoplastic causes. Endogenous or exogenous pigments may be responsible for oral discoloration which can range from innocuous to life-threatening in nature. Physiologic, reactive, and idiopathic melanin production seen in smoker's melanosis, drug-related discolorations, melanotic macule, melanoacanthoma and systemic diseases are presented. Exogenous sources of pigmentation such as amalgam tattoo and black hairy tongue are also discussed. Determining the significance of mucosal pigmented lesions may represent a diagnostic challenge for clinicians. Biopsy is indicated whenever the source of pigmentation cannot be definitively identified based on the clinical presentation.

Black Hairy Tongue: Predisposing Factors, Diagnosis, and Treatment

Black hairy tongue (BHT) is a benign condition commonly found among people who smoke, have poor oral hygiene, are immunocompromised, or have a medical condition limiting their ability to practice good oral hygiene. Though this condition is harmless, patients need to be educated on etiology as many common medications are associated with this condition. Patients being placed on certain antibiotics or antipsychotics should be educated on the importance of good oral hygiene or cessation of habits that promote BHT. Similarly, those with medical conditions increasing the risk for the development of BHT should schedule routine visits with their dentist or dental hygienist. Prognosis is good, and treatment consists of gentle brushing of the tongue, but many anecdotal reports exist demonstrating the use of medications or other products to treat this condition. This review addresses the epidemiology, clinical presentation, pathophysiology, etiology, histology, differential diagnosis, and treatment of BHT and lists all of the medications reported to cause this condition.

Black hairy tongue after chemotherapy for malignant brain tumors

Black hairy tongue (BHT) developed in five patients (2.6%) among 192 patients undergoing chemotherapy for malignant brain tumors. Three patients with a history of diabetes mellitus developed BHT within 10 days after the initiation of chemotherapy. The other two patients suffered more than 100 days after induction and lymphopenia of grade 3 or worse developed for more than 20 days, which was not observed in the three patients with diabetes. We found that BHT could develop after chemotherapy for malignant brain tumors. Patients with diabetes mellitus presented early after chemotherapy, while patients with longstanding severe lymphopenia presented in late phase.

Malignant Tumors of Tongue in Iranian Population

BACKGROUND

The incidence of oral cancers varies from one country to another, which can be clarified by the difference in the distribution of the risk factors and the possible etiologies. Tongue is a main segment of oral cavity and malignant lesions of this region accounts for nearly 30% of all oral cancers.

OBJECTIVES

In the present study, we evaluated the pattern of tongue cancer in Iranian population and compared these findings with those previously reported in the other countries.

METHODS

In this multicenter, retrospective cross-sectional study recorded cases of the malignant tongue tumors in the cancer research center (CRC) of Shahid Beheshti University of Medical Sciences were extracted. The patient records and their microscopic reports were retrieved from the archives and age, sex and microscopic types were evaluated. It is to be noted that the CRC has been serving as a cancer registry center for major hospitals all over the country since the year of 2003. Thus, the obtained statistics are highly reliable.

RESULTS

During the years 2003 to 2008, a total number of 952 new cases of the tongue cancer were recorded in the CRC. Most cases are diagnosed in the sixth and seventh decades of life. 450 cases (47.2%) occurred in men and 489 cases (51.36%) in women. Four different types of malignant lesions (epithelial, salivary gland, hematopoietic and mesenchymal) were diagnosed. Epithelial tumors were the most prevalent malignancies (93%) of which squamous cell carcinoma (SCC) made up 87.39% of all lesions. Salivary gland tumors had the second place with 3.15% of the total lesions.

CONCLUSIONS

In Iranian population, squamous cell carcinoma is the most prevalent malignancy of tongue and it is notable that the ratio of female to male population was equal. These lesions were prevalent in the sixth and seventh decades of life. Thus screening examination of tongue by dentist especially in elderly patients is necessary for early detection of cancerous lesions.

Paediatric Geographic Tongue: A Case Report, Review and Recent Updates

Geographic tongue is a benign recurrent condition of uncertain aetiology affecting the tongue characterized by loss of epithelium especially filiform papillae giving a characteristic appearance. The clinical presentation may vary from asymptomatic to painful and burning ulceration. The condition is commonly seen in adults but few cases are reported in children. A case of asymptomatic geographic tongue in three-year-old male child and literature review with new insight in aetiology is presented here. Management depends on the clinical condition and underlying aetiology.

Immediate results of photodynamic therapy for the treatment of halitosis in adolescents: a randomized, controlled, clinical trial

Light with or without chemical agents has been used to induce therapeutic and antimicrobial effects. With photodynamic therapy, the antimicrobial effect is confined to areas covered by a photosensitive dye and irradiated with light. The aim of the present study was to evaluate the effect of photodynamic therapy for the treatment of halitosis in adolescents through the analysis of volatile sulfur compounds, especially sulfide. A controlled, clinical trial was conducted with 45 adolescents randomly allocated to three groups: group 1, photodynamic therapy administered to the dorsum of the tongue; group 2, treatment with a tongue scraper; and group 3, treatment with a tongue scraper combined with photodynamic therapy. The diagnosis of halitosis was performed using gas chromatography before and after treatment. Comparisons were made using the Kruskal-Wallis test followed by the Student-Newman-Keuls test, with the level of significance set at 5 % (p < 0.05). After treatment, a statistically significant reduction in halitosis was found in all groups (p < 0.001). The greatest reduction in total sulfides (median = 0) occurred with the combination of tongue scraper and photodynamic therapy. The present study describes a novel option for the treatment of halitosis in adolescents with an immediate effect that does not involve the mechanical aggression of the lingual papillae that occurs with conventional treatment.

TRIAL REGISTRATION

Photodynamic Therapy in Adolescents Halitosis ( https://clinicaltrials.gov/ct2/show/NCT02007993?term=NCT02007993&rank=1 )Number: NCT02007993FUNDING:FAPESPNumber: 2013/13032-8.

Factors associated with geographic tongue and fissured tongue

OBJECTIVES

The primary objective of this study was to investigate the association of systemic diseases, use of medications, allergies and tobacco habits with geographic tongue (GT) and fissured tongue (FT) lesions. The secondary objectives were to evaluate the clinical characteristics of tongue lesions and to compare the overall results for referred and non-referred patients.

METHODOLOGY

Non-referred patients with GT (GTgp; n = 130) and FT (FTgp; n = 62) were examined by general practitioners (gp) and compared to a control group without oral mucosal lesions (C; n = 1029). Referred patients with GT (GTs; n = 166) and FT (FTs; n = 15) were examined by oral medicine specialists (s) and compared to GTgp and FTgp. Statistical analyses were performed using unpaired t-test or Fisher's exact test. A multiple logistic regression model was developed to control for age and gender as confounders.

RESULTS

Compared to the C group, GTgp patients used more anti-hypertensive medications and Swedish snus (p < 0.01). The GTgp group consisted of older males (p < 0.001) compared to C. Compared to the GTgp group, the GTs group was younger, more likely to have symptomatic lesions (p < 0.0001) and comprised of more females. Among the groups examined, FT patients had the highest mean age.

CONCLUSION

This study identified an association between GT and anti-hypertensive medications, as well as the use of Swedish snus. It also found differences in the activities and symptoms of the lesions between referred patients and their counterparts who were seen in general dental practice; these parameters influenced the results when these conditions were taken into account.

Clinical features and histological description of tongue lesions in a large Northern Italian population

Background

Only few studies on tongue lesions considered sizable populations, and contemporary literature does not provide a valid report regarding the epidemiology of tongue lesions within the Italian population. In this report, the histopathological and clinical appearance of 1.106 tongue lesions from northern Italians are described and discussed.

Material and Methods

The case records of patients referred for the diagnosis and management of tongue lesions, from October 1993 to October 2013, were reviewed. Histological data were also obtained and blindly reexamined.

Results

For instance, a biopsy performed on a lingual ulcer has a strong predicting association with a carcinoma, whereas a biopsy on a white lesion predicts for a leukoplakia or oral lichen planus. Moreover, a biopsy of erosion is representative of bullous diseases, whereas a biopsy on a verrucous-papillary lesion is significant for fibroma. Furthermore, carcinomas occur in the majority of cases on the lingual edge or pelvis, oral lichen planus is mainly seen on the edge, and fibromas mostly on the lingual tip.

Conclusions

The high frequency of tongue involvement of such different diseases emphasizes the importance of histological characterization and that some diseases occur more frequently than others, with a peculiar clinical aspect and a more common area. In fact our survey can help the clinician in advancing diagnostic hypothesis, on the basis of the elementary lesion and its site of involvement.

Key words:Tongue lesions, clinical appearance, histological description.

Black hairy tongue syndrome

Black hairy tongue (BHT) is a benign medical condition characterized by elongated filiform lingual papillae with typical carpet-like appearance of the dorsum of the tongue. Its prevalence varies geographically, typically ranging from 0.6% to 11.3%. Known predisposing factors include smoking, excessive coffee/black tea consumption, poor oral hygiene, trigeminal neuralgia, general debilitation, xerostomia, and medication use. Clinical presentation varies but is typically asymptomatic, although aesthetic concerns are common. Differential diagnosis includes pseudo-BHT, acanthosis nigricans, oral hairy leukoplakia, pigmented fungiform papillae of the tongue, and congenital melanocytic/melanotic nevi/macules. Clinical diagnosis relies on visual observation, detailed history taking, and occasionally microscopic evaluation. Treatment involves identification and discontinuation of the offending agent, modifications of chronic predisposing factors, patient's re-assurance to the benign nature of the condition, and maintenance of adequate oral hygiene with gentle debridement to promote desquamation. Complications of BHT (burning mouth syndrome, halitosis, nausea, gagging, dysgeusia) typically respond to therapy. Prognosis is excellent with treatment of underlying medical conditions. BHT remains an important medical condition which may result in additional burden on the patient and health care system and requires appropriate prevention, recognition and treatment.

Tongue lesions

BACKGROUND

Some authors have shown that tongue lesions represent an important segment of oral mucosal lesions group, with prevalence varying among epidemiologic studies from different countries.

OBJECTIVES

The aim of this study was to describe the prevalence of tongue lesions in a Brazilian population.

METHODS

A collaborative study was conducted using data from 5 anatomic pathology services in Brazil. After data collection, these tongue lesions were separated in 4 groups: G1/malignant tumors, G2/benign tumors, G3/reactive lesions, and G4/other lesions.

RESULTS

Analysis of 6231 specimens for which oral biopsy was performed showed 760 cases (12.2%) diagnosed in the tongue. From this total, 306 cases (40.3%) occurred in females, and 454 (59.7%) occurred in males. Ages ranged from 3 to 93 years, with a global average of 45.3 years. The largest numbers of cases were represented by reactive lesions (44.6%), followed by benign tumors (27.9%), malignant tumors (18.6%), and other lesions (8.9%).

CONCLUSIONS

Tongue diseases were more common in male patients, and most of them were reactive lesions or benign neoplasms, but 18.6% were malignant neoplasms. The occurrence of malignant neoplasm increased notably with age.

An analysis of biopsy-proven tongue lesions among 8,105 dental outpatients

AIM

The aim of the present study was to analyze data on the characteristics of tongue lesions in dental patients seeking care at the Oral Pathology Service of Tehran University of Medical Sciences, from 1985-2010.

MATERIALS AND METHODS

Demographic data and histopathologic diagnoses were recorded for all lesions that were documented as occurring on the tongue according to the patient records in our department. Statistical analysis included chi-square, t-, and Fisher's exact tests. A 95% confidence interval (CI) was calculated, and p < 0.05 was considered significant.

RESULTS

Tongue lesions constituted 6.3% of all received specimens which included 46 different defects. The most common lesions were lichen planus (LP), irritation fibroma (IF), squamous cell carcinoma (SCC) and pemphigus vulgaris (PV). Tongue lesions were significantly more common in women compared to men (CI = 0.65-0.94, p = 0.02). Mean age (47 years) did not differ between male and female subjects (CI = -2.49 - 3.93, p = 0.06). The dorsal surface followed by the lateral aspect was the most common site for tongue lesions.

CONCLUSION

It seems that dental practitioners should be perceptive of LP, IF, SCC and PV, when examining the tongue. Histopathologic analysis is essential for achieving final diagnosis in a considerable number of lesions that commonly occur on this organ. Clinical significance: Access to demographic/prevalence data in different populations may be useful in clinical settings and could be complimented by histopathologic diagnosis in most instances. The present findings can be compared with those obtained from other epidemiologic studies in this field resulting in valuable data which may be used in several types of investigations. .

Prevalence of oral mucosal lesions in an adult Iranian population

Background

Nowadays the importance of oral health to life quality is not obvious to anyone in our world. Oral lesions can interfere with daily social activities in involved patients through impacts on mastication, swallowing and speech and symptoms like xerostomia, halitosis or dysesthesia.

Objectives

To assess the prevalence and types of oral lesions in a general population in Rasht, Northern Province of Iran.

Patients and Methods

1581 people aged > 30 years old who were inhabitant of Rasht, Iran, enrolled in a cross-sectional study. For each individual a detailed questionnaire based on the world health organization (WHO) guidelines in order to diagnosis of the lesions was filled and it contained all the required data. Participants were divided into two groups with and without oral mucosal lesions and oral mucosal lesions were divided into two groups with and without. Demographic characteristics and clinical information including age, sex, smoking (cigarette and tobacco), opium consumption, medication and oral and dental hygiene were collected and compared between these two groups.

Results

The prevalence of mucosal lesions in our study was 19.4%. Our data demonstrated higher prevalence of oral mucosal lesions in males and young adults (30-40 years). The most common mucosal lesion among our participants was Fissured tongue(4%), followed by Fordyce granules(2.8%), geographic tongue(2.6%) , Pigmentation(2.5%), Candida(1.8%), Smoker Plate(1.6%), lingual Varices(1.5%), Petechiae(1.4%) and lingual labial(1.4%) . Leukoplakia was observed only in two people (0.1%).No case of malignant lesions was detected. No statistically significant difference was confirmed between the two groups regarding smoking, opium consumption, medication and oral and dental hygiene.

Conclusions

Our data has provided baseline information about epidemiologic aspects of oral mucosal lesions which can be valuable in organized national program targeting on oral health and hygiene in the society.

Prevalence of tongue lesions in the Indian population

Objective: Tongue lesions are a health concern for the dental practitioners and the patients as they constitute a significant proportion of oral mucosal lesions. The aim of the present study was to determine the prevalence of various tongue lesions in the Indian population. Material and methods: 4926 patients attending the Department of Oral Medicine and Radiology were examined for the presence of various tongue lesions during the period from October, 2010 to September, 2012. The age of the patients ranged from 12-80 years with a mean age of 36.51 years. Results: The prevalence of tongue lesions was 12.07%. The most common lesion diagnosed was coated tongue affecting 28.0% of the subjects, followed by geographic tongue (16.4%), fissured tongue (14.9%) and depapillated tongue (11.5%). Males were more frequently affected than females. The most common systemic condition observed in the patients with tongue lesions was anaemia (189), followed by hypertension (47) and diabetes mellitus (38). Conclusion: The high prevalence necessitates adequate awareness of the various tongue lesions in the general population. The dental clinicians should also be knowledgeable about the etiopathogenesis, clinical presentation, diagnosis, and treatment of these lesions.

Key words:Tongue lesions, prevalence, Indian population, coated tongue.

Prevalence study of oral mucosal lesions, mucosal variants, and treatment required for patients reporting to a dental school in North India: In accordance with WHO guidelines

The aim of the study was to evaluate the prevalence of oral mucosal lesions (OML) in adult patients reporting to the dental outpatient department at the Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India. The purpose was to determine the priorities in oral health education, preventive measures, and identify the group in urgent need of treatment.

Increased prevalence of geographic tongue in burning mouth complaints: a retrospective study

OBJECTIVES

The objective of this study was to assess the frequency of geographic tongue and fissured tongue (GFT) in patients with burning mouth syndrome (BMS). Our hypothesis was that benign soft tissue changes to the tongue, such as GFT, are associated with BMS.

STUDY DESIGN

Retrospective review of 161 patients with BMS and 87 TMJ dysfunction cases as control. Frequency of GFT and demographics for both groups was assessed.

RESULTS

In the BMS group, 26.7% of the subjects were diagnosed with GFT, whereas in the control group, 11.5% had GFT (P < .05). In the subgroup of BMS with GFT, the male-to-female ratio was approximately 1:2, whereas the male-to-female ratio of those with BMS and no GFT was approximately 1:5 (P < .05).

CONCLUSIONS

Our results demonstrate a higher than expected prevalence of GFT among patients with BMS compared with a control group of patients with TMJ. In males, GFT may be a significant predictor for BMS.

Prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, Northeast Iran

OBJECTIVE

The aim of this study was to determine the prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, northeast of Iran.

BACKGROUND

This study was conducted to assess the prevalence of oral lesions in the institutionalized elderly.

METHODS

In this survey, we studied all of the nursing homes in Mashhad; a total of five encompassing 237 residents. The subjects were examined and lesions recorded in a designed checklist. T-test, chi-square and Fisher's exact tests were used for the analysis.

RESULTS

The mean age of the patients was 79.59 ± 8.88. Ninety-eight per cent of cases had at least one oral mucosal lesion. The most common lesions were fissured tongue (66.5%), atrophic glossitis (48.8%), sublingual varicosity (42%) and xerostomia (38%). There was no significant difference in the prevalence of denture-related lesions (DRLs) between men and women (p > 0.05). Xerostomia was more prevalent in 70-79-year-old than in 60-69-year-old subjects. No case of oral malignant lesion was detected.

DISCUSSION

These findings revealed a higher prevalence of oral mucosal lesions in Mashhad city compared with other studies conducted in other major cities in Iran and abroad. The results emphasise the necessity of national programmes towards oral health promotion.

Oral mucosal lesions in skin diseased patients attending a dermatologic clinic: a cross-sectional study in Sudan

Background

So far there have been no studies focusing on the prevalence of a wide spectrum of oral mucosal lesions (OML) in patients with dermatologic diseases. This is noteworthy as skin lesions are strongly associated with oral lesions and could easily be neglected by dentists. This study aimed to estimate the frequency and socio-behavioural correlates of OML in skin diseased patients attending outpatient's facility of Khartoum Teaching Hospital - Dermatology Clinic, Sudan.

Methods

A cross-sectional hospital-based study was conducted in Khartoum from October 2008 to January 2009. A total of 588 patients (mean age 37.2 ± 16 years, 50.3% females) completed an oral examination and a personal interview of which 544 patients (mean age 37.1 ± 15.9 years, 50% females) with confirmed skin disease diagnosis were included for further analyses. OML were recorded using the World Health Organization criteria (WHO). Biopsy and smear were used as adjuvant techniques for confirmation. Data were analysed using the Statistical Package for Social Science (Version 15.0.1). Cross tabulation and Chi-square with Fisher's exact test were used.

Results

A total of 438 OML were registered in 315 (57.9%, males: 54.6% versus females: 45.6%, p < 0.05) skin diseased patients. Thus, a certain number of patients had more than one type of OML. Tongue lesions were the most frequently diagnosed OML (23.3%), followed in descending order by white lesions (19.1%), red and blue lesions (11%) and vesiculobullous diseases (6%). OML in various skin diseases were; vesiculobullous reaction pattern (72.2%), lichenoid reaction pattern (60.5%), infectious lesions (56.5%), psoriasiform reaction pattern (56.7%), and spongiotic reaction pattern (46.8%). Presence of OML in skin diseased patients was most frequent in older age groups (62.4% older versus 52.7% younger, p < 0.05), in males (63.2% males versus 52.6% females, p < 0.05), patients with a systemic disease (65.2% with systemic versus 51.9% without systemic disease, p < 0.05) and among current users of smokeless tobacco (toombak) (77% current use versus 54.8% no use, p < 0.00).

Conclusions

OML were frequently diagnosed in skin diseased patients and varied systematically with age, gender, systemic condition and use of toombak. The high prevalence of OML emphasizes the importance of routine examination of oral mucosa in a dermatology clinic.

Drug-induced black hairy tongue

Black hairy tongue (BHT) is a benign, self-limiting disorder characterized by abnormally hypertrophied and elongated filiform papillae on the surface of the tongue. The prevalence of BHT is quite variable, ranging from 0-53.8% depending on the population. Many predisposing factors to BHT exist, and several drugs and drug classes have been implicated in causing this disorder. A modified Naranjo adverse drug reaction probability nomogram specific for BHT was used to rate causality for the available published case reports of drug-induced BHT. From the available data, antibiotics and drugs capable of inducing xerostomia are the drug classes that have modest evidence of causality and a rational mechanism. The presence of underlying predisposing factors in these cases along with the variable prevalence of BHT make drawing firm conclusions difficult. Treatment for BHT involves eliminating any predisposing issues and practicing scrupulous oral hygiene. Drug therapy and physical removal of the elongated filiform papillae are available for resistant cases. Clinicians should be aware of the prevalence, the predisposing factors and drug classes that may play a role in the development, and the treatment of BHT.

Lip and oral mucosal lesions in 100 renal transplant recipients

BACKGROUND

Renal transplant recipients (RTRs) appear to be more susceptible to the development of oral mucosal disease and lip cancer as a result of graft-preserving immunosuppressive therapy. However, reports regarding these pathologies other than lip cancer are scarce and not studied in a detailed manner in this patient population.

OBJECTIVE

The aim of this study was to determine the prevalence rates and clinical features of lip lesions and oral mucosal lesions (OMLs) in RTRs.

METHODS

In all, 100 consecutive RTRs (21 female and 79 male) and 79 healthy age- and sex-matched control subjects (23 female and 56 male) were screened for all pathologic and pseudopathologic lip lesions and OMLs, with special interest on precancerous and cancerous lesions. Information about possible associated risk factors such as smoking and alcohol consumption was also obtained. Dermatologic investigation included clinical observation and direct microscopic examination, culture, and histopathological evaluation when indicated.

RESULTS

One or more lip lesions, OMLs, or both were noted in every participant of both groups. Fordyce spots on the lips was the most common lesion in the patient group (73%), followed by diffuse gingival enlargement (39%), fissured tongue (35%), and oral candidiasis (26%). The last 3 disorders were significantly more common in RTRs, whereas the frequency of Fordyce spots in patients and control subjects was similar. No actinic cheilitis, lip cancer, or oral malignancy was observed.

LIMITATIONS

This was a relatively small sample size for evaluating precancerous and cancerous lip lesions and OMLs, as they are less frequently observed than benign lesions.

CONCLUSIONS

Some of the benign OMLs (oral candidiasis and diffuse gingival enlargement) are increased in RTRs mainly as a result of the immunosuppressive therapy or drug side effects. Precancerous or cancerous lesions were not observed on the lips or the oral mucosa of our RTRs. This finding is in direct contrast with those of previous studies, yet this can be related to the limited sample size of this study regarding these lesions.