|Year : 2021 | Volume
| Issue : 5 | Page : 868-870
Vini Rajeev1, Sulphi Abdul Basheer2, Mutassim Elnager3, A Kaneesh Karthik4, A Senthilnathan Radhakrishnan5
1 Department of Prosthodontics, Faculty of Dentistry, AIMST University, Bedong, Kedah, Malaysia
2 Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Saudi Arabia
3 College of Dentistry, King Khalid University, Abha, Saudi Arabia
4 Department of Oral and Maxillofacial Surgery, JKK Nattraja Dental College, Namakkal, Tamil Nadu, India
5 Krishna Dental Clinic, Erode, Tamil Nadu, India
|Date of Submission||30-Sep-2020|
|Date of Decision||02-Oct-2020|
|Date of Acceptance||05-Oct-2020|
|Date of Web Publication||05-Jun-2021|
Department of Prosthodontics, Faculty of Dentistry, AIMST University, Bedong, Kedah
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Cerebriform tongue (CT) is diagnosed to be a benign clinical condition that is characterized by grooves on the dorsal surface of the tongue and referred with other terminologies such as the scrotal tongue, grooved tongue, lingua fissurata, and lingua plicata which can be chronic trauma, vitamin deficiencies, and probably not a developmental malformation. The incidence of this condition was predominant among males and found to be higher with increasing age. It is very rarely observed in children. It is usually painless and sometimes food debris accumulation can irritate. CT has been reported with the association of various systemic factors and syndromes. A case of a 62-year-old male with CT is presented along with the review of the literature.
Keywords: Fissured tongue, geographic tongue, psoriasis, scrotal tongue, tongue disorders
|How to cite this article:|
Rajeev V, Basheer SA, Elnager M, Karthik A K, Radhakrishnan A S. Cerebriform Tongue. J Pharm Bioall Sci 2021;13, Suppl S1:868-70
| Introduction|| |
The tongue is a complex muscular organ which represents the clinicopathological and also physiological condition of the human body. The tongue plays an important role in taste perception, speech, swallowing, and mastication. The color, appearance, shape, gesture, texture, and coating on the tongue are majority of the factors to be well chosen for diagnosis. The monitoring of changes in the tongue, such as the thickness, size, fissures, and tooth marks are the foremost factors in diagnosing or determining the diseases and systemic health of an individual. An absence of adequate desquamation of keratin over filiform papillae, reactive or inflammatory process, and discoloration caused by the chromogenic bacteria or yeast on the superior surface of the tongue is responsible for a large number of progressive diseases.
CT is a common condition in 20%–30% of the population and is predominantly asymptomatic. The concomitant incidence of CT and geographic tongue (GT) has been reported in several studies. The idea that CT follows GT and that CT incrementally increases with age and systemic conditions has also been thought of by researchers.
Clinically, cerebriform tongue (CT) is distinguished by grooves or furrows that vary in depth and are more commonly noted along with the dorsal and/or dorsolateral aspects of the tongue. It is most certainly a benign condition that never turns into malignancy even though careful examination and investigation has to be done to rule out probable etiological factors. Multiple studies have revealed associations between CT and other systemic diseases, such as psoriasis, diabetes, and orofacial granulomatosis.,
| Case Report|| |
A 62-year-old male reported to a private dental hospital in Erode, India, with a complaint of stains and hard deposit in the teeth and an occasional mild burning sensation on the upper surface of the tongue while taking spicy or acid foods. Medical history revealed diabetes mellitus and hypertension. The patient was taking the following medications: metformin (1000 mg) and metoprolol (100 mg). The patient had a smoking history for the past 25 years and does not have a previous medical history of sleep apnea, seizures, trauma, or tongue biting. Extraoral examination revealed normal facial symmetry, no cutaneous lesions were to be found, and nails were apparently normal. The erythematous area was prominent in the base of the fissures, and no spontaneous bleeding was present. The other oral soft tissues and structures were well within normal limits.
A provisional diagnosis of CT [Figure 1] and [Figure 2] was given. Routine blood investigation revealed mild anemia. The patient was strictly advised to immediately stop his smoking habits and incorporate better oral hygiene aids. The patient was also advised to start on a balanced diet as a routine, prescribed sodium bicarbonate oral rinse, and recommended gentle daily brushing of the tongue along with the teeth.
| Discussion|| |
The tongue is a significant muscular tissue in the oral cavity. It has various functions such as chewing, talking, taste, and deglutition. The coating of the tongue is believed to reflect the condition of the gastrointestinal tract as well as the nature and the site of the pathogenic factors. In particular, attributes such as color, form, moisture content, thickness, and spreading range are considered to reflect the progression of a pathological condition. The alteration of these normal features of the tongue is considered an indication of a systemic disease or condition.
CT clinically can have many exaggerated smooth filiform papillae without hairs and histologically show subepithelial infiltration of polymorphonuclear leukocytes., CT can be a heredity condition, with some studies suggesting that this condition represents a polygenic mode or an autosomal dominant trait inheritance with incomplete penetrance. In the literature, CT has been associated with few syndromes such as CoffinLowry syndrome, Fraser syndrome, Sjogren's syndrome, Down syndrome, Melkersson–Rosenthal syndrome, Maroteaux–Lamy syndrome, ectrodactyly–ectodermal dysplasia–cleft syndrome, Mohr syndrome, and Pierre Robin syndrome.
Kullaa-Mikkonen had classified the CT into two types based on reading the extent of the inflammation in biopsied tongue tissue.
- CT with clinically normal filiform papillae
- Fissured tongue syndrome, where the fissures are existed with GT.
Another study portrayed a newer classification for CT, based on its pattern, regularities of pattern, associated signs, and other already present systemic diseases.
- Based on the pattern of tongue fissures
- Central longitudinal pattern: Vertical fissure which extends along the midline of the superior surface of the tongue
- Central transverse pattern: Horizontal fissure/fissures which are crossing the midline of the tongue
- Lateral longitudinal pattern: Vertical fissure/fissures running laterally to the midline of the tongue
- Branching pattern: Transverse fissures that extend from the midline longitudinal fissure (branching tree appearance)
- Diffuse pattern: Fissures widely distributed across the dorsal surface of the tongue.
- Based on number of tongue fissures
- Mild: Tongue fissures which are 1–3 in number
- Moderate: Tongue with >3 fissures
- Severe: Tongue with >10 fissures.
- Based on the analogous symptoms such as burning sensation and feeling of food lodgment.
- Absence of burning sensation
- Burning sensation present.
In general, isolated narrow fissures itself will not lead to any further complication and no treatment is necessary, but the associated diseases need to be ruled out. Deep fissures can result in entrapment of food within the groves, causing irritation and inflammation. A soft toothbrush or tongue scrappers can be used after food to avoid food getting accumulated on the tongue. Patient was advised to use mouthwash (0.2% solution of chlorhexidine gluconate) before bedtime. He has to gargle 20ml twice daily for 30 seconds. Sodium bicarbonate oral rinse could be contemplated as an effective alternative for chlorhexidine or other alcohol-based mouthwashes, especially when long-duration usage is needed. 1% sodium bicarbonate solution is recommended as an oral rinse for 1 min, three to four times a day. Sodium bicarbonate promotes patient comfort by maintaining the moisture content of the oral epithelial cells and also helps in the reduction of secondary infection risk.,,
| Conclusion|| |
CT is one of the most common tongue diseases in routine general dental practice. Dental and medical practitioners should know the etiology, clinical appearance, and diagnosis of CT. However, it is better to promote good oral hygiene and avoid precipitation by local factors that might increase symptoms, such as acidic and spicy foods, alcohol, and irritants in kinds of toothpaste and mouth rinses.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]