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1-Tongue papillae. 2-Food debris. 3-Bacteria. 4-Desquamated epitheliu m.

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The tongue coating is continuously formed and is removed by: 1-Mechanical factors: speaking and chewing food. 2-Salivary flow. The tongue coating varies in different individuals and it varies in the same individual during the day, it is marked in the morning since cleaning factors are at rest.

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Tongue coating is in a continuous process of removed and formation. If removal exceeds formation atrophy If formation exceeds removal increased tongue coating.

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A- Atrophy of tongue coating The cells forming the filiform papillae and fungiform papillae are of high metabolic activity so any disturbance in enzyme, circulation or nutrients leads to atrophy. During the process of atrophy: the filiform are affected first, followed by fungiform papillae. During regeneration: the fungiform regenerate first followed by regeneration of filiform. Circumvallate and foliate are permanent structures of the tongue coating, don t participate in atrophy.

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Atrophy of tongue coating

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1- Deficient or impaired utilization of nutrients 1-Iron deficiency anemia. 2-Pulmonary Vinson syndrome. 3-Pernicious anemia. 4-Anemia associated with parasitic infection as ascaris and bilhariziasis. 5-Malnutrition, malabsorption. 6-Sprue (saffty diarrhea). 7-Chronic alcoholism. 8-Vit B deficiency especially (vit B2, B6B12, folic acid and nicotinic acid

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2- Peripheral vascular disease 1-Angiopathy: diabetes mellitus. 2-Vasulitis: systemic lupus erythematosus. 3-Endarteritis obliterans: syphilitic glossitis. 4-Obliteration of small blood vessels: scleroderma, submucous fibrosis. 5-Localized vascular insufficiency in elderly patients.

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3-Therapeutic agents 1-Drugs that interfere with the growth and maturation of the epithelium e.g cyclosporine. Induce candidosis e.g. antibiotic, steroid. Induce xerostomia e.g anticholinergic drugs, radiotherapy.

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5- Miscellaneous 1- Frictional irritation: atrophy at tip & lateral borders of tongue. 2- Atrophic lichen planus. 3- Epidermolysis bullosa: ulceration healed by scar. 4- Long standing xerostomia. 5- Diabetes and chronic candidosis may produce a lesion called central papillary atrophy.

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B- Increased tongue coating The filiform papillae which constitute the keratinizing surface of the tongue are in continuous state of growth and their height is determined by the rate of desquamation process. The later is induced by friction with food, palate and upper anterior teeth, during eating and speech.

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B- Increased tongue coating Physiological increase in tongue coating is usually observed in the morning, since the local cleaning factors, (mastication, speech and salivary flow) are at rest. Interference with the physiology of the mouth may affect the rate of desquamation.

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Increased tongue coating

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Furred tongue

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Etiology: Basically the abnormal increase in tongue coating is due to local environmental changes represented by lack of function and/or changes in the oral flora and these are attributed to: 1- Drugs a- Topical and systemic use of antibiotics. b- Antiseptic mouth washes. c- Oxygen releasing mouth rinse.

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Etiology: 2- Febrile illness (general body dehydration, decreased salivary flow, liquid diet and poor oral hygiene). 3-Stomach upset, vomiting associated with intestinal or pyloric obstruction, debilitated or terminally ill patient. 4- Mouth breathing

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Clinical features: The increased tongue coating may be stained particularly on the mid dorsum by food, tobacco, drugs of possibly by microorganisms. In debilitated, dehydrated and terminally ill patients the increased tongue coating may be very thick and has been described as leathery coating.

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Treatment Consist of brushing the dorsal surface of the tongue several times a day systemic antibiotic should not be interrupted but antifungal agent should be used locally. Topical antibiotic and mouth washes should not be used. The condition usually regresses spontaneously when the normal jaw and tongue activity are restored.

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Black hairy tongue Definition It is a condition characterized by hypertrophy of filiform papillae associated with growth of black pigment micro organism.

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Hairy tongue

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Black hairy tongue

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Etiology 1-Sodium perporate and sodium peroxide mouth wash that stimulate growth of filiform papillae. 2-Topical and systemic antibiotics: ex: penicillin, tetracycline, aureomycin. 3- Systemic disturbance: anemia, hyperacidity, peptic ulcer. 4- Predisposition in some people.

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Clinical features May be asymptomatic or may cause gagging and tickling.

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Management Removal of the cause stop tpical antibiotic . Burshing of the tongue. N.B. Systemic antibiotic should not be stopped, but antifungal ointment is prescribed in additional to the antibiotic. N.B. Pseudo black hairy tongue means discolouration of tongue by food, smoking and drugs without actual hypertrophy of filiform papillae.

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Site: the dorsum of the tongue. It is an irregularly outlined area, devoid of filiform papillae, with red dots representing fungiform papillae. {occasionally devoid of fungiform}. The margin of the depillated area is raised with yellowish, whitish tinge. The margin of the lesion shifts as much as inch per day due to renewed of papillae in one area and loss in another area. It occurs chiefly in children and young adults.