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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 868-870  

Cerebriform Tongue


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 Submission30-Sep-2020
Date of Decision02-Oct-2020
Date of Acceptance05-Oct-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Vini Rajeev
Department of Prosthodontics, Faculty of Dentistry, AIMST University, Bedong, Kedah
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_628_20

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   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

How to cite this URL:
Rajeev V, Basheer SA, Elnager M, Karthik A K, Radhakrishnan A S. Cerebriform Tongue. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Jul 27];13, Suppl S1:868-70. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/868/317594




   Introduction Top


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.[1] 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.[2] 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.[3]

CT is a common condition in 20%–30% of the population and is predominantly asymptomatic.[4] 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.[5]

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.[6] Multiple studies have revealed associations between CT and other systemic diseases, such as psoriasis, diabetes, and orofacial granulomatosis.[7],[8]


   Case Report Top


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.
Figure 1: Fissured tongue

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Figure 2: Deep groove in the middle of the tongue

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   Discussion Top


The tongue is a significant muscular tissue in the oral cavity. It has various functions such as chewing, talking, taste, and deglutition.[9] 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.[2]

CT clinically can have many exaggerated smooth filiform papillae without hairs and histologically show subepithelial infiltration of polymorphonuclear leukocytes.[4],[10] 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.[11]

Kullaa-Mikkonen had classified the CT into two types based on reading the extent of the inflammation in biopsied tongue tissue.

  1. CT with clinically normal filiform papillae
  2. Fissured tongue syndrome, where the fissures are existed with GT.[12]


Another study portrayed a newer classification for CT, based on its pattern, regularities of pattern, associated signs, and other already present systemic diseases.[13]

  1. Based on the pattern of tongue fissures


    1. Central longitudinal pattern: Vertical fissure which extends along the midline of the superior surface of the tongue
    2. Central transverse pattern: Horizontal fissure/fissures which are crossing the midline of the tongue
    3. Lateral longitudinal pattern: Vertical fissure/fissures running laterally to the midline of the tongue
    4. Branching pattern: Transverse fissures that extend from the midline longitudinal fissure (branching tree appearance)
    5. Diffuse pattern: Fissures widely distributed across the dorsal surface of the tongue.
    6. Based on number of tongue fissures


    1. Mild: Tongue fissures which are 1–3 in number
    2. Moderate: Tongue with >3 fissures
    3. Severe: Tongue with >10 fissures.
    4. Based on the analogous symptoms such as burning sensation and feeling of food lodgment.


    1. Absence of burning sensation
    2. 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.[14] 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.[3],[15],[16]


   Conclusion Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kullaa-Mikkonen A. Studies on lingua fissurata. Proc Finn Dent Soc 1986;82 Suppl 4:1-48.  Back to cited text no. 1
    
2.
Jung CJ, Jeon YJ, Kim JY, Kim KH. Review on the current trends in tongue diagnosis systems. Integr Med Res 2012;1:13-20.  Back to cited text no. 2
    
3.
Casu C, Nosotti MG, Sinesi A. Hairy tongue, geographic tongue, scrotal tongue and systemic connections: Clinical images and an overview. Dentist Case Rep 2019;3:01-03.  Back to cited text no. 3
    
4.
Mangold AR, Torgerson RR, Rogers RS 3rd. Diseases of the tongue. Clin Dermatol 2016;34:458-69.  Back to cited text no. 4
    
5.
Dafar A, Çevik-Aras H, Robledo-Sierra J, Mattsson U, Jontell M. Factors associated with geographic tongue and fissured tongue. Acta Odontol Scand 2016;74:210-6.  Back to cited text no. 5
    
6.
Järvinen J, Mikkonen JJ, Kullaa AM. Fissured tongue: A sign of tongue edema? Med. Hypotheses 2014;82:709-712.  Back to cited text no. 6
    
7.
Marcoval J, Viñas M, Bordas X, Jucglà A, Servitje O. Orofacial granulomatosis: Clinical study of 20 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:e12-7.  Back to cited text no. 7
    
8.
Guggenheimer J, Moore PA, Rossie K, Myers D, Mongelluzzo MB, Block HM, et al. Insulin-dependent diabetes mellitus and oral soft tissue pathologies: II. Prevalence and characteristics of Candida and Candidal lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:570-6.  Back to cited text no. 8
    
9.
Marks R, Radden BG. Geographic tongue: A clinicopathology review. Aust J Dermatol 1981;22:75-79.  Back to cited text no. 9
    
10.
Feil ND, Filippi A. Frequency of fissured tongue (lingua plicata) as a function of age. Swiss Dent J 2016;126:886-97.  Back to cited text no. 10
    
11.
Reamy BV, Derby R, Bunt CW. Common tongue conditions in primary care. Am Fam Physician 2010;81:627-34.  Back to cited text no. 11
    
12.
Kullaa-Mikkonen A, Penttilä I, Kotilainen R, Puhakainen E. Haematological and immunological features of patients with fissured tongue syndrome. Br J Oral Maxillofac Surg 1987;25:481-7.  Back to cited text no. 12
    
13.
Sudarshan R, Sree Vijayabala G, Samata Y, Ravikiran A. Newer classification system for fissured tongue: An epidemiological approach. J Trop Med 2015;2015:262079.  Back to cited text no. 13
    
14.
Binmadi NO, Jham BC, Meiller TF, Scheper MA. A case of a deeply fissured tongue. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:659-63.  Back to cited text no. 14
    
15.
Chandel S, Khan MA, Singh N, Agrawal A, Khare V. The effect of sodium bicarbonate oral rinse on salivary pH and oral microflora: A prospective cohort study. Natl J Maxillofac Surg 2017;8:106-9.  Back to cited text no. 15
[PUBMED]  [Full text]  
16.
Madeswaran S, Jayachandran S. Sodium bicarbonate: A review and its uses in dentistry. Indian J Dent Res 2018;29:672-7.  Back to cited text no. 16
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