Tongue disorders

Diseases of the tongue either affect the tongue alone, or they may be diseases within the oral cavity that affect other mucous membranes or the oral cavity itself. Some are inflammatory, others are related to dysfunction or changes in the lingual papillae, and still others may involve, for example, tumours on or near the tongue. In general, several diseases of the oral cavity may also be transmitted to the tongue or may be closely related because of the proximity of the mucous membranes.

The human tongue is a muscular organ that has multiple functions. Firstly, it is very important for the intake of food and liquids into the digestive tract, but it also has tasting functions that can alert a person to the composition of a food or liquid and thus protect him or her, for example, from unsuitable substances. Also, the speech function is a very significant and important function, where the tongue is involved in the articulation of speech through the so-called articulatory modifying and modifying organs.

Diseases can affect the mucous membrane of the tongue, as well as small bumps on the tongue called papillae, but they can also affect the shape of the tongue itself, either by enlarging it or by other atrophic changes. In addition, several diseases are also related to other parts of the oral cavity and are either directly caused by them or affect the entire oral cavity, including the tongue. However, there are also diseases that involve only the tongue and are manifested by impairment of either articulation of speech or impairment of taste and other receptor functions of the tongue.

The structure of the tongue

The tongue is a muscular organ located in the oral cavity, being located on the underside and covered with mucous membrane. It is a very sensitive organ that is densely innervated, which makes it quite sensitive to the sense of touch, but also to the other senses. The function of the tongue is to receive food and liquids, thermal and tactile stimuli, and thanks to its taste receptors it can detect different tastes and is also an auxiliary organ in the production of sounds and speech. It is a multifunctional organ thanks to its sensitivity to a variety of receptors.

The tongue consists anatomically of four parts. The first is the root of the tongue, then there is the back of the tongue, the margin of the tongue, and at the end is the tip of the tongue, also sometimes called the tip. The underside is connected to the lower part of the mouth by a bridle, and when the mouth is closed, the dorsum usually touches the upper palate in its natural state. The root of the tongue points into the pharynx, while the tip, on the contrary, points out of the oral cavity. At the same time, the back of the tongue is partially separated from the root by a furrow.

The tongue is entirely covered with mucous membrane, which is formed by a multi-layered squamous epithelium. Within the mucosa are the lingual papillae, which are responsible for the perception of both gustatory and tactile stimuli. These papillae are of various shapes namely conical, gated, leaf-like, nictitated and spongy. These are basically tiny bumps that make the tongue textured. Thanks to the taste buds on the papillae, the tongue can detect sweet taste, sour taste, bitter taste and salty taste.

In addition to the mucous membrane, the muscles of the tongue are a very important part of the tongue. These muscles are innervated by the 12th cranial nerve, and most of them attach to the tendinous tissue of the tongue, which forms an entire layer under the mucous membrane of the back. A ligamentous septum separates the muscles into two symmetrical halves. Those muscles that attach to the tongue but begin outside it are called extraglossal, those that begin but also end in the tongue are called intraglossal. Thanks to the muscles, flexible movement of the tongue is possible.

Inflammations of the tongue

A very common form of tongue diseases are various inflammations. These can be various superficial and deeper inflammations, some even with the formation of suppurating deposits. Such inflammations include glossitis, but also abscess inflammations of the tongue or traumatic ulcerations of the tongue. Some arise from an infectious background, others from a non-infectious background, but they always primarily affect only the mucous membrane of the tongue and usually do not extend to other parts of the oral cavity, so they are localised inflammations.

In terms of causes, these inflammations can be traumatic, for example, with chronic irritation or injury of the tongue, or thermal caused by burning of the mucous membrane, as well as chemical based on burns or hypersensitivity to certain substances, and allergic inflammations are not exceptional. Infectious inflammations are of a different microbial nature and can be caused by viruses, bacteria and fungi. The mucous membrane of the whole tongue or only part of it may be affected.

There are several types of inflammation of the tongue, professionally called glossitis. Sometimes there is only superficial glossitis, other times it is a deep inflammation. In some cases, it can be stomatitis, which affects not only the tongue, but also other mucous membranes of the oral cavity. Most often, however, a classic inflammation of the superficial or deep type is present. If there is also mucosal damage and necrosis, an abscess or even ulcerated inflammation may develop.

Diseases of the lingual papillae

Diseases of the tongue include transient lingual papillitis. These include hypertrophies of the lingual papillae such as black tongue and hypertrophy of tongue papillae. It also includes atrophy of the lingual papillae, such as atrophic glossitis. These diseases, because they affect the papillae on the tongue, affect sensory perception and receptors and thus manifest themselves mainly in tongue sensation and receptor disorders.

A fairly common problem of tongue papillae is a black and hairy tongue. This is a benign disease caused by darkening of the tongue and is most often due to poor hygiene. Bacteria also form a plaque on the tongue which darkens and can sometimes enter the digestive system. Conversely, a white tongue, where the tongue papillae are coated with a whitish coating, is a symptom of a fungal or yeast infection and is sometimes also a symptom of diabetes or bowel disease.

Atrophic changes on the tongue include, for example, Hunter's atrophic glossitis, which is a relatively common disease of this type affecting only the mucous membrane of the tongue. In this disease there is a smoothing of the lingual papillae and it may also be caused by a kind of anaemia. Thus, a dry and smooth tongue is often a symptom of the disease, but it can also be a signal that a person has coeliac disease. Also, tongue smoothness can also be related to chronic inflammation or vitamin B12 deficiency.

Changes on the tongue

Changes to the tongue include either direct developmental defects or acquired deformities or other changes to the lining of the tongue or anywhere on its surface or shape. These include diseases such as atrophy of the tongue, grooved tongue, enlarged tongue, hypertrophy of the tongue or forms of a crooked tongue. In this case, the most common are the hatched tongue, the scalloped tongue and the scrotal tongue. These diseases are also frequently related to other organs in the body and may reflect their diseases as well.

A very common condition is macroglossia, which is a change in the size of the tongue and its enlargement. This disease has several causes, whether it is a congenital disease, an inflammatory disease, a metabolic disorder and sometimes a traumatic cause. Thus, it is often a symptom rather than the pathological condition itself. The opposite of macroglossia is atrophy of the tongue, where there is a general flaccidity of the tongue muscles and damage to the mucous membrane, with advanced atrophy usually related to neurological causes.

A furrowed tongue can be a symptom of a general deficiency of important minerals and vitamins in the body, for example, a deficiency of B vitamins.Sometimes the tongue is also cracked, which can be a congenital condition or a condition caused either by an inflammatory process or by a deficiency of vitamins in the body. Tongue anomalies also include hypertrophy, for example hypertrophy of the roots of the tongue or the underside of the tongue, which can also be painful and cause problems with speech.

Tumours and ulcers

The tongue is also affected by various ulcerative diseases, such as aphthae, known professionally as aphthous ulcers. However, viral cold sores on the tongue can also be a problem, but in this case it may not be a specific disease affecting only the lining of the tongue, but also the lining of the oral cavity as a whole or even the lips. However, the most problematic are definitely tongue tumours, which may be isolated to the tongue or affect the entire oral cavity.

Aphthous ulcers are a form of small ulcers that appear throughout the oral cavity, most commonly on the palate and on the tongue, either on its upper or lower side. They can arise from a variety of causes, most commonly a reaction to a substance, medication, food or toothpaste or toothbrush when the mucous membranes are over-irritated. Some are minor, others major and recurrent. But very unpleasant are herpes viruses that cause herpetic stomatitis, when unpleasant sores occur on the tongue and other mucous membranes.

Roughly half of the tumours in the oral cavity are tongue tumours, which originate directly from the tongue lining. They are most common in people over 50 years of age and can be caused by long-term smoking, drinking alcohol, viral infections or even long-term mechanical irritation. Some are malignant, others benign and, depending on the size, are treated by either removing the tumour or shrinking it. Unfortunately, most tumours are malignant and can often resemble larger ulcers.

Other diseases of the tongue

Other diseases of the tongue, which affect its mucous membrane but also other parts of the tongue, include burning tongue syndrome, also called glossodonia or glossopyrosis. A person feels a burning sensation on the tongue for no apparent cause or reason, and may also experience different tastes in the oral cavity out of nowhere. The exact causes are unknown, but it is thought to be a neurological disease. Various allergies on the tongue are also quite common and are caused, for example, by medicines, toothpaste, dentures or other external factors.

Oral leukoplakia is a dangerous type of disease that affects the oral cavity as well as the tongue and its mucous membranes. This is a disease in which white patches can be observed on the tongue and oral mucosa, which have no apparent cause and cannot be removed by palpation or touch. In most cases, however, there is a risk of these spots turning into benign tumours, in which case surgical removal is necessary as they could turn into oral cancer.

Also, in various traumatic conditions, either directly in the oral cavity or at the beginning of the pharynx, the functions of the tongue may be disturbed, especially in the context of food intake or speech articulation. In mucosal diseases, there is also a condition called geographic tongue, which may take the form of benign migratory glossitis or total glossitis. In most cases, these are well-treated conditions, and are most commonly manifested by striations and migrating coloured patches on the tongue, which also change in appearance.