The tongue, a muscular organ, is connected with speech, deglutition, and taste functions. It serves as an organ that can be accessed easily for checking an individual’s health and it also reveals the body’s state of hydration. It is believed that the tongue mirrors the gastro-intestinal system and therefore any unusual performance of the stomach as well as intestines tends to be shown on the tongue.

The tongue undergoes certain typical changes in certain specific diseases. This is the reason that a tongue examination is extremely important and will provide certain hints for diagnosis. All physicians check the tongue and take into account the changes in shape, size, color, coating, moisture, nature of papillae & movements, etc.

The tongue’s appearance in certain atypical conditions:

a. When the body is paralyzed on one side (hemiplegia) the tongue shifts towards the side that’s paralyzed when stuck out.

b. In diseases such as parkinsonisum Tremulus, delirium tremens, and thyrotoxicosis, a quavering tongue movement is observed. Quivering is also observed in tense patients.

c. The tongue tends to atrophy and get paralyzed with fibrillation in advancing bulbar palsy. In due course the tongue becomes withered and lies useless at the base of the mouth. Now, this state is connected with oozing of saliva and speech loss.

d. In case of chorea (which is characterized by involuntary persistent movements) the patient might be unable to hold the stuck out tongue under check, it will constantly be involuntarily shifting.

The tongue moistness provides some hint regarding the body’s state of hydration. The reduction of water volume results in peripheral circulatory malfunction typified by faintness, dehydration, edginess, anorexia, vomiting, queasiness, parched and dry tongue.

In the below conditions, dryness of tongue is observed.

a. Advanced uraemia

b. Subsequent stages of acute sickness

c. Diarrhea

d. Hyponatraemia

e. Hypovolumic shock

f. Heat exhaustion

g. Severe intestinal blockage

h. Prolonged fasting

i. Starvation

a. Central cyanosis:

In cyanosis, the mucus membrane takes on a bluish discoloration because of reduction of the oxygen supply in the blood. Now this is observed in anoxia, cardiac arrest, and respiratory failure. The tongue, lips, etc. turn a pale blue in cyanosis.

b. Jaundice:

The body’s all mucus surfaces (including tongue) take on a yellowish discoloration due to the blood having bilirubin. Jaundice is noticed in bile duct obstruction, hepatitis, mounting obliteration of RBCs, etc.

c. Advanced uremia:

Here, in the blood, urea and other kinds of nitrogenous waste products increase because of renal failure. The tongue turns brown in color.

d. Keto acidosis:

Here, there is acidosis with buildup of ketone bodies observed chiefly in diabetes mellitus. The tongue turns brown in color and from the mouth a distinctive ketone odor emanates.

e. Riboflavin deficiency:

Vitamin B2 deficiency leads to the tongue turning magenta in color with lips becoming sore and developing fissures.

f. Niacin deficiency:

Vitamin B3 (niacin) deficiency and also deficiency of some other vitamins of the B complex group makes the tongue to become a brilliant crimson or cherry red.

g. Anemia:

This results due to the decline in the hemoglobin count of the blood. The tongue turns pale in acute anemia.

a. Bad breath:

Bad breadth is chiefly caused by the development of a whitish covering (bio layer) on the surface of the tongue, which houses countless anaerobic bacteria leading to the generation of odious gases. Those who suffer from bad breath could have a solid coating on the tongue’s extreme end.

b. Typhoid fever:

The tongue takes on a white furry coating in typhoid fever.

c. Candidiasis:

The body’s mucus surfaces are affected by this fungal infection. The tongue has sloughing white lesions on it.

d. Sloughing white lesions are also there in hypoadrenalism and diabetes.

e. Secondary syphilis:

Trepenoma pallidum infection gives rise to the sexually transmitted diseased, syphilis. In the subsequent stage of syphilis we can notice mucous spots, which are not painful, and are smooth white shiny opalescent plaques that cannot be easily rubbed off.

f. Leokoplakia:

In this case, the oral cavity and tongue sport white keratotic patches. This condition is a lead up to cancer.

g. AIDS:

In patients diagnosed with AIDS, hairy leukoplakia is observed.

h. Peritonitis:

Here the peritoneum (the abdominal cavity’s inner covering which also lines the intestines and holds them in position) gets inflamed and the tongue takes on a whitish furred appearance.

i. Severe illness:

In certain severe diseases, furring is also noticed.

Papillae are tiny outcrops on the tongue that are linked to taste. A healthy tongue has several kinds of papillae. In certain diseases there are a few peculiar changes, which are as follows.

a. Hairy tongue:

Now this condition is because of lengthening of filiform papillae witnessed in indigestion, bad oral hygiene, and general weakness.

b. Geographic tongue:

In this case erratic red and white splotches become visible on the tongue. Now these lesions seem similar to a geographic map. However, the actual cause is not identified.

c. Median rhomboid glossitis:

Here there is an even nodular red section in the tongue’s posterior mid line. This condition is a congenital one.

d. Nutritional deficiency:

Here, glossitis (swelling of tongue) occurs resulting in papillary hypertrophy with atrophy following it.

e. Benign migratory glossitis:

This is a tongue inflammation where visible on the tongue are multiple annular regions of desquamation of the papillae, and these move from one area to another in a couple of days.

f. Riboflavin and thiamine deficiency:

The B complex vitamin deficiencies produce fungiform and hypertrophied filiform papillae.

g. Iron and niacin deficiency:

Here, there is shriveling of papillae. In case of iron deficiency, a smooth tongue is observed.

h. Deficiency of Vitamin A:

This produces a rutted tongue.

i. The tongue turns smooth in case of nutritional megaloblastic anemia.

j. Folic acid deficiency:

In this case, macrocytic megaloblastic anemia together with glossitis is witnessed.

k. Cyano coblamine deficiency:

In this case, glossitis along with peripheral neuropathy and macrocytic megaloblastic anemia is noticed.

l. Scarlet fever:

This is a streptococcal infection, where brilliant red papillae stick out from a bulky white fur, and afterwards the white layer fades away leaving puffed-up papillae on the brilliant crimson surface and is known as a strawberry tongue.

a. Apthous ulcer:

Such kinds of ulcers are round and excruciating and often occur in individuals suffering from stress. May be linked with food allergy. The common locations are oral mucosa tongue, lips, etc.

b. Herpes simplex:

This is a severe vesicular eruptions caused by the herpes simplex virus. Once these vesicles burst it develops into ulcers.

c. Cancerous Ulcers:

These kind of cancerous ulcers have inverted edges with a tough foundation. Moreover bleeding is also witnessed. Tongue cancer is a regular phenomenon in people chewing tobacco.

d. Syphilitic ulcers:

These Syphilitic fissures extend lengthwise. In primary syphilis additional genital chancre is noticed on the tongue. Manifold shallow ulcers are noticed at the sides and underneath the tongue in case of secondary syphilis. In tertiary syphilis, on the centerline of the tongue’s dorsum, gumma may be observed.

e. Dental ulcers:

Such kind of ulcers is caused by the carious teeth’ sharp edges.