Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Hairy tongue occurs in about 0.5% of adults. However, the prevalence is variable depending on the population studied.
The cause is uncertain, but it is thought to be caused by accumulation of epithelial squames and proliferation of chromogenic (i.e., color-producing) microorganisms. There may be an increase in keratin production or a decrease in normal desquamation (shedding of surface epithelial cells). Many people with BHT are heavy smokers. Other possible associated factors are poor oral hygiene, general debilitation, hyposalivation (i.e., decreased salivary flow rate), radiotherapy, overgrowth of fungal or bacterial organisms, and a soft diet. Occasionally, BHT may be caused by the use of antimicrobial medications (e.g., tetracyclines), or oxidizing mouthwashes or antacids. A soft diet may be involved as normally food has an abrasive action on the tongue, which keeps the filiform papillae short. Pellagra, a condition caused by a vitamin deficiency, may cause a thick greyish fur to develop on the dorsal tongue, along with other oral signs.
Transient surface discoloration of the tongue and other soft tissues in the mouth can occur in the absence of hairy tongue. Causes include smoking (or betel chewing), some foods and beverages (e.g., coffee, tea or liquorice), and certain medications (e.g., chlorhexidine, iron salts, or bismuth subsalicylate (Pepto-Bismol)).
This phenomenon is fairly common, with one in every 800 adults showing evidence of active lesions at any one time. It is more common in people who are experiencing stress or psychological conditions. The prevalence in females is double the prevalence in males, and it is two or three times more prevalent in people over the age of thirty-five.
One review reported overall prevalence ranges of 0.1–14.3% for geographic tongue, 1.3–9.0% for "atrophy tongue" (atrophic glossitis), and 0.0–3.35% for median rhomboid glossitis.
Malnutrition, whether by malabsorption, or poor diet, especially hematinic deficiencies (iron, vitamin B12, folic acid) can predispose to oral candidiasis, by causing diminished host defense and epithelial integrity. For example, iron deficiency anemia is thought to cause depressed cell-mediated immunity. Some sources state that deficiencies of vitamin A or pyridoxine are also linked.
There is limited evidence that a diet high in carbohydrates predisposes to oral candidiasis. "In vitro" and studies show that Candidal growth, adhesion and biofilm formation is enhanced by the presence of carbohydrates such as glucose, galactose and sucrose.
The cause is unknown. Geographic tongue does not usually cause any symptoms, and in those cases where there are symptoms, an oral parafunctional habit may be a contributory factor. Persons with parafunctional habits related to the tongue may show scalloping on the sides of the tongue (crenated tongue). Some suggest that hormonal factors may be involved, because one reported case in a female appeared to vary in severity in correlation with oral contraceptive use. People with geographic tongue frequently claim that their condition worsens during periods of psychologic stress. Geographic tongue is inversely associated with smoking and tobacco use. Sometimes geographic tongue is said to run in families, and it is reported to be associated with several different genes, though studies show family association may also be caused by similar diets. Some have reported links with various human leukocyte antigens, such as increased incidence of HLA-DR5, HLA-DRW6 and HLA-Cw6 and decreased incidence in HLA-B51. Vitamin B2 deficiency (ariboflavinosis) can cause several signs in the mouth, possibly including geographic tongue, although other sources state that geographic tongue is not related to nutritional deficiency. Fissured tongue often occurs simultaneously with geographic tongue, and some consider fissured tongue to be an end stage of geographic tongue.
In the past, some research suggested that geographic tongue was associated with diabetes, seborrheic dermatitis and atopy, however newer research does not corroborate these findings. Others suggest allergy as a major factor, e.g. to nickel sulphate. Some studies have reported a link between geographic tongue and psoriasis, although 90% of children who are diagnosed with geographic tongue do not develop psoriasis. Again however, modern research studies do not support any link between psoriasis and geographic tongue. Lesions that are histologically indistinguishable from geographic tongue may also be diagnosed in reactive arthritis (arthritis, uveitis/conjunctivitis and urethritis).
Tongue lesions are very common. For example, in the United States one estimated point prevalence was 15.5% in adults. Tongue lesions are more common in persons who wear dentures and tobacco users. The most common tongue conditions are geographic tongue, followed by fissured tongue and hairy tongue.
Many conditions can cause glossitis via malnutrition or malabsorption, which creates the nutritional deficiencies described above, although other mechanisms may be involved in some of those conditions listed.
- Alcoholism
- Sprue (celiac disease, or tropical sprue), secondary to nutritional deficiencies
- Crohn’s disease
- Whipple disease
- Glucagonoma syndrome
- Cowden disease
- Acquired immunodeficiency syndrome (AIDS)
- Carcinoid syndrome
- Kwashiorkor amyloidosis
- Veganism and other specialized diets,
- Poor hydration and low saliva in the mouth, which allows bacteria to grow more readily
- Mechanical irritation or injury from burns, rough edges of teeth or dental appliances, or other trauma
- Tongue piercing Glossitis can be caused by the constant irritation by the ornament and by colonization of Candida albicans in site and on the ornament
- Exposure to irritants such as tobacco, alcohol, hot foods, or spices
- Allergic reaction to toothpaste, mouthwash, breath fresheners, dyes in confectionery, plastic in dentures or retainers, or certain blood-pressure medications (ACE inhibitors)
- Administration of ganglion blockers (e.g., Tubocurarine, Mecamylamine).
- Oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris
- Heredity
- Albuterol (bronchodilator medicine)
- Schizophrenia
A painful tongue may be an indication of an underlying serious medical condition and nearly always merits assessment by a physician or dental surgeon.
Smoking, especially heavy smoking, is an important predisposing factor but the reasons for this relationship are unknown. One hypothesis is that cigarette smoke contains nutritional factors for "C. albicans", or that local epithelial alterations occur that facilitate colonization of candida species.
In traditional Chinese medicine, scalloping of the tongue is said to indicate qi vacuity. In some homeopathic sources, scalloping of the tongue is said to be indicative of high blood pressure.
Genetic resistance is the preferred disease management strategy because it allows farmers to minimize chemical intervention. Less pesticide and fungicide can encourage biological control agents, reduce production costs, and minimize the chemical residues in fruit. Some genetic varieties of raspberry are better than others for the control of leaf spot. Nova and Jewel Black are both resistant varieties, while Prelude and Honey Queen Golden Raspberry have some resistance, but can be susceptible depending on environmental conditions. Reiville, Canby, Encore and Anne are the most susceptible varieties.
Cultural practices are also important for the management of Raspberry Leaf Spot. Sanitation, which includes the removal of all plant debris and infected canes in the fall, reduces places for the pathogen to overwinter. Pruning the raspberry plants and planting in rows will allow for airflow to dry leaves, creating an uninviting environment for fungi. Furthermore, air flow circulation is important for reducing sporulation and successful infection. Lastly, avoid wounding the plants, as this may provide the fungus with an opportunity to infect.
Geographic tongue is a common condition, affecting 2-3% of the adult general population, although other sources report a prevalence of up to 14%. It is one of the most common tongue disorders that occurs in children. The condition often starts in childhood, sometimes at an early age, but others report that the highest incidence occurs in the over 40 age group. Females are sometimes reported to be more commonly affected than males, in a 2:1 ratio, although others report that the gender distribution is equal.
Behavior therapy is important especially when the kids are in their primary dentition in the pre-adolescent age. Improving habits at this time may lead to self-correction of open bite in many cases. Sometimes presence of infantile swallowing into early childhood may lead to an anterior open bite in patients. Habit control through appliances such as Tongue crib or Tongue spurs may be used in adolescent ages if the behavior modification fails to stop the habit.
Raspberry Leaf Spot is a plant disease caused by Sphaerulina rubi, an ascomycete fungus. Early symptoms of infection are dark green spots on young leaves. As the disease progresses, these spots turn tan or gray in color. Disease management strategies for Raspberry Leaf Spot include the use of genetically resistant raspberry plant varieties and chemical fungicide sprays.
Raspberries are an important fruit, mainly grown in Washington, Oregon and California. Although they are also grown in the Midwest and northeastern states, the output is not nearly as great due to the colder weathers and shorter growing seasons. "S. rubi" prefers warmer and wetter conditions, which can make raspberry production very difficult in California.
Melanoglossia is a medical condition in which the tongue becomes blackened.
This is usually caused by a bacterial infection or allergic reaction.
An anterior open bite occurs in humans when the front teeth fail to touch and there is no overlap between upper incisors and lower incisors. Anterior open can be caused by functional habits such as digit sucking, tongue thrust or long-term pacifier use. When digit sucking habit is present in the late primary to early mixed dentition stages, it can lead to different side-effects such as upper teeth flaring out, lower teeth flaring in, increase in the open bite and the overjet. A posterior crossbite in these children along with decrease in intercanine and intermolar width is also found. The more intense (longer) the habit, the worse the malocclusion may be.
Pacifier use has also shown to cause anterior open bites in children. Pacifier use which lasts longer than 18 months, may cause this malocclusion. It is shown that as long as the sucking habit stops before the eruption of permanent teeth, the open bite self-corrects. In some cases, behavior modification may be necessary to eliminate the dental habits. If all else fails, then a tongue crib can be used.
Bacterial
- (Plaque-induced) gingivitis—A common periodontal (gum) disease is Gingivitis. Periodontal refers to the area the infection affects, which include the teeth, gums, and tissues surrounding the teeth. Bacteria cause inflammation of the gums which become red, swollen and can bleed easily. The bacteria along with mucus form a sticky colorless substance called plaque which harbours the bacteria. Plaque that is not removed by brushing and flossing hardens to form tartar that brushing doesn't clean. Smoking is a major risk factor. Treatment of gingivitis is dependent on how severe and how far the disease has progressed. If the disease is not too severe it is possible to treat it with chlorhexidine rinse and brushing with fluoride toothpaste to kill the bacteria and remove the plaque, but once the infection has progressed antibiotics may be needed to kill the bacteria.
- Periodontitis—When gingivitis is not treated it can advance to periodontitis, when the gums pull away from the teeth and form pockets that harbor the bacteria. Bacterial toxins and the body's natural defenses start to break down the bone and connective tissues. The tooth may eventually become loose and have to be removed.
- Scarlet fever is caused by streptococci species, and starts as tonsilitis and pharyngitis before involving the soft palate and the tongue. It usually occurs in children where a fever occurs and a rash develops on the skin. It is treated with penicillin and the prognosis is generally excellent.
Viral
- Herpes simplex (infection with herpes simplex virus, or HSV) is very common in the mouth and lips. This virus can cause blisters and sores around the mouth (herpetic gingivostomatitis) and lips (herpes labialis). HSV infections tend to recur periodically. Although many people get infected with the virus, only 10% actually develop the sores. The sores may last anywhere from 3–10 days and are very infectious. Some people have recurrences either in the same location or at a nearby site. Unless the individual has an impaired immune system, e.g., owing to HIV or cancer-related immune suppression, recurrent infections tend to be mild in nature and may be brought on by stress, sun, menstrual periods, trauma or physical stress.
- Mumps of the salivary glands is a viral infection of the parotid glands. This results in painful swelling at the sides of the mouth in both adults and children. The infection is quite contagious. Today mumps is prevented by getting vaccinated in infancy. There is no specific treatment for mumps except for hydration and painkillers. Sometimes mumps can cause inflammation of the brain, testicular swelling or hearing loss.
Fungal
- Oral candidiasis is by far the most common fungal infection that occurs in the mouth. It usually occurs in immunocompromised individuals. Individuals who have undergone a transplant, HIV, cancer or use corticosteroids commonly develop candida of the mouth and oral cavity. Other risk factors are dentures and tongue piercing. The typical signs are a white patch that may be associated with burning, soreness, irritation or a white cheesy like appearance. Once the diagnosis is made, candida can be treated with a variety of anti fungal drugs.
Blight refers to a specific symptom affecting plants in response to infection by a pathogenic organism. It is a rapid and complete chlorosis, browning, then death of plant tissues such as leaves, branches, twigs, or floral organs. Accordingly, many diseases that primarily exhibit this symptom are called blights. Several notable examples are:
- Late blight of potato, caused by the water mold "Phytophthora infestans" (Mont.) de Bary, the disease which led to the Great Irish Famine
- Southern corn leaf blight, caused by the fungus "Cochliobolus heterostrophus" (Drechs.) Drechs, anamorph "Bipolaris maydis" (Nisikado & Miyake) Shoemaker, incited a severe loss of corn in the United States in 1970.
- Chestnut blight, caused by the fungus "Cryphonectria parasitica" (Murrill) Barr, has nearly completely eradicated mature American chestnuts in North America.
- Fire blight of pome fruits, caused by the bacterium "Erwinia amylovora" (Burrill) Winslow "et al.", is the most severe disease of pear and also is found in apple and raspberry, among others.
- Bacterial leaf blight of rice, caused by the bacterium "Xanthomonas oryzae" (Uyeda & Ishiyama) Dowson.
- Early blight of potato and tomato, caused by species of the ubiquitous fungal genus "Alternaria"
- Leaf blight of the grasses
On leaf tissue, symptoms of blight are the initial appearance of lesions which rapidly engulf surrounding tissue. However, leaf spot may, in advanced stages, expand to kill entire areas of leaf tissue and thus exhibit blight symptoms.
Blights are often named after their causative agent, for example Colletotrichum blight is named after the fungi "Colletotrichum capsici", and Phytophthora blight is named after the water mold "Phytophthora parasitica".
It is an uncommon condition, occurring with equal prevalence in males and females and at any age.
Crenated tongue (also called scalloped tongue, pie crust tongue, lingua indentata, or crenulated tongue) is a descriptive term for the appearance of the tongue when there are indentations along the lateral borders (the sides), as the result of compression of the tongue against the adjacent teeth.
The oral mucosa in the area of crenation is usually of normal color, but there may be erythema (redness) if exposed to a high degree of friction or pressure. Crenated tongue is usually asymptomatic and harmless.
It is not a disease as such, but usually results from habits where the tongue is pressed against the lingual surfaces (the side facing the tongue) of the dental arches, or from any cause of macroglossia (enlarged tongue), which in itself has many causes such as Down syndrome.
Where crenation is caused by parafunctional habits, there may also be associated bruxism, linea alba, or morsicatio buccarum.
Tongue diseases can be congenital or acquired, and are multiple in number. Considered according to a surgical sieve, some example conditions which can involve the tongue are discussed below. Glossitis is a general term for tongue inflammation, which can have various etiologies, e.g. infection.
There are many oral and maxillofacial pathologies which are not fully understood.
- Burning mouth syndrome (BMS) is a disorder where there is a burning sensation in the mouth that has no identifiable medical or dental cause. The disorder can affect anyone but tends to occur most often in middle aged women. BMS has been hypothesized to be linked to a variety of factors such as the menopause, dry mouth (xerostomia) and allergies. BMS usually lasts for several years before disappearing for unknown reasons. Other features of this disorder include anxiety, depression and social isolation. There is no cure for this disorder and treatment includes use of hydrating agents, pain medications, vitamin supplements or the usage of antidepressants.
- Aphthous stomatitis is a condition where ulcers (canker sores) appear on the inside of the mouth, lips and on tongue. Most small canker sores disappear within 10–14 days. Canker sores are most common in young and middle aged individuals. Sometimes individuals with allergies are more prone to these sores. Besides an awkward sensation, these sores can also cause pain or tingling or a burning sensation. Unlike herpes sores, canker sores are always found inside the mouth and are usually less painful. Good oral hygiene does help but sometime one may have to use a topical corticosteroid.
- Migratory stomatitis is a condition that involves the tongue and other oral mucosa. The common migratory glossitis (geographic tongue) affects the anterior two thirds of the dorsal and lateral tongue mucosa of 1% to 2.5% of the population, with one report of up to 12.7% of the population. The tongue is often fissured, especially. in elderly individuals. In the American population, a lower prevalence was reported among Mexican Americans (compared with Caucasians and African Americans) and cigarette smokers. When other oral mucosa, beside the dorsal and lateral tongue, are involved, the term migratory stomatitis (or ectopic geographic tongue) is preferred. In this condition, lesions infrequently involve also the ventral tongue and buccal or labial mucosa. They are rarely reported on the soft palate and floor of the mouth.
This is a common condition present in denture wearers. It appears as reddened but painless mucosa beneath the denture. 90% of cases are associated with Candidia species, and it is the most common form of oral candidiasis. Treatment is by antifungal medication and improved dental hygiene, such as not wearing the denture during sleep.
Morsicatio buccarum really is a type of frictional keratosis. The term is derived from the Latin words, "morusus" meaning "bite" and "bucca" meaning "cheek". This term has been described as "a classic example of medical terminology gone astray".
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) states that cheek biting may be a manifestation of body-focused repetitive behavior disorder.
Oral florid papillomatosis is a condition characterized by a white mass resembling a cauliflower covering the tongue and extending onto other portions of the mucous membranes. This is a type of verrucous carcinoma.