Archive for February, 2006
The tongue, like the rest of the inner surface of the mouth, may have several diseases common to the inner mouth cavity. However, its refinements in touching and tasting bring it in contact with all substances entering the mouth and expose it to more irritation than the rest of the oral cavity.
Tongue Discoloration. A gray tongue discoloration, coated on the tongue with a map-like appearance, is often called “geographic tongue” and is of little significance. This condition is known to persist at times for years without any disease being
Fig. 26. Geographic tongue-a clearly demarcated discoloration of the tongue surface, arriving and departing without an exactly known cause. It is sometimes thought due to body metabolism and sometimes to external pigmentation as from excessive smoking.
present. It ordinarily disappears in a short time without any treatment and may well represent a temporary gastric upset.
Brownish-yellow Tongue Discoloration has two usual meanings. The first is the over-use of tobacco in which the tongue is stained with nicotine and tar to produce brownish stain on its surface. The stain will disappear shortly after the use of tobacco is stopped.
The second possible meaning of a brownish-yellow tongue may mean pernicious anemia. When the possibility of tobacco staining is not present, and the patient is fifty years of age or over, the lemon-yellow tongue may have serious meaning, and should be seen by the physician.
Bluish Discoloration on the tongue is usually a type of birthmark. It is usually painless, does not bleed and is not sore, is
Fig. 27. Blood vessel tumors (angiomas) usually exist since birth as birthmarks. Soft bluish masses, they are usually painless and rarely cancerous.
slightly elevated and occasionally covered with small amounts of hair. They have great nuisance value but little actual danger. They, of course, exist from childhood.
Fiery Red Coloration of the tongue, usually means glossitis, or an irritated tongue. Glossitis can be quite painful and appears to have no apparent cause. It is however, frequently due to a deficiency of vitamins, particularly vitamin B12, and frequently improves when this vitamin is given. The condition is thought by some physicians to be a pre-cancerous condition and worthy of careful observation.
Examination of the Tongue
The tongue is examined mainly in natural light, and at least partially with forced extension. Grasp the tip of the extended tongue between the thumb and forefinger, (wrapped in a hand-derchief) and pull the tongue forcibly forward and downward for complete exposure.
1. Examine the tongue for any unusual discoloration. Note any irregular “map-like” gray coating, yellowish-brown
discoloration, bluish discoloration area, or extreme fiery redness to the entire tongue. Discolorations of the tongue
may have definite meanings, some of great significance.
2. Examine the tongue for any white, leathery, and possibly stiffened areas. Such whitened regions are often leuko-
3. Observe closely in the forcibly extended tongue, any sore, ulcer, bleeding or unusual growths visible or touchable. Particularly examine the side, under-surface and back of the tongue as far as possible. Finding of any sore or lesion of the tongue of this nature may mean cancer.
4. Observe the tongue’s ability to move to all regions in all directions. Paralysis in any direction is important.
Cracked Teeth. A tooth broken from trauma or any other cause may not be painful or diseased itself, but jagged, sharp edges of the teeth are often points of chronic irritation for the gums, cheeks and tongue. Continued irritation becomes serious eventually, as a possible cause of cancer and other disease within the mouth. Broken, cracked teeth, therefore, are always a matter of concern for the dentist, in the prevention of further disease.
Pyorrhea. Pyorrhea is responsible for the greatest proportion of teeth lost during the adult years. The tooth itself is not involved but the surrounding gum is infected and discharges pus as it recedes farther and farther. It is difficult to check and seeks to destroy the tooth socket in the bone. Pyorrhea is most often due to a slackening in routine dental care in later years, accompanied by a foregone conclusion that the teeth will become lost eventually, no matter what care is given them. After the teeth are lost, the gums overcome the infection and the Pyorrhea is ended.
False Teeth. After the loss of permanent teeth, the wearing of dentures and plates is dictated more by custom of society rather than by absolute necessity. Adjustment to the wearing of artificial teeth may be quite difficult at times, but such problems are usually solved with patience, especially when under the care and guidance of a good dentist.
Cancer and Similar Growths of the Gums. Cancer involving the gums usually extends from cancer growing in the floor of the mouth or side of the tongue. It appears as an ulcerating, irregular sore similar to a large canker sore, and it bleeds easily. There are several other growths of the gums which are difficult to identify or distinguish from cancer. Accurate diagnosis then requires an exact medical investigation, including x-ray study and microscopic identification.
The treatment of cancer of the gum as well as other similar growths, is usually a matter of surgery or x-ray treatment. Because such treatments are markedly successful in early stages but sadly unsuccessful in later stages, continual soreness anywhere on the gums as well as other regions of the mouth should be brought with haste to proper medical authorities.
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Advancing years exact a heavy toll of the teeth in infection, decay and actual loss. In early years of life, heredity and nutrition are most important to the teeth. In later years, especially after fifty, tooth life is in direct proportion to care received.
Decay. Tooth decay slows down considerably in adult years as compared with the formative years of childhood. It can, however, start at any age and often continues until the tooth is lost. Prevention of tooth decay means proper and regular cleaning of the teeth, along with routine dental inspection and hygiene.
Abscess (Infected) Teeth. An abscessed tooth, with an accumulation of pus in and about a root, often develops from cracked or decayed teeth. Sometimes the abscess is very small, but frequently reaches the size of a walnut with terrific pain, high fever and a greatly swollen jaw and neck.
Because of its many consequences, besides the pain involved, abscessed teeth must be treated as early as possible. The very val-
Fig. 25. Abscessed teeth are frequently the cause of other ailments in the body such as arthritis, skin difficulties, etc. They are almost impossible to cure and should be removed.
uable x-ray can easily locate the abscess and even picks out small abscesses before they cause discomfort. Dental treatment may require removal of the abscessed tooth, although at times treatment which allows the tooth to remain is successful in curing the abscess.
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Examination of the Teeth and Gums
Stand before a well lighted mirror and examine the teeth as well as possible with the aid of a small pocket mirror, inserted into the mouth.
1. Examine the teeth for discoloration. Gross discoloration of the teeth often is due to external causes such as tobacco. Darkly, indented lines in teeth crevices often represent decay. Yellowish discoloration in worn-down edges of the teeth, is the appearance of the inner dentine of the tooth.
2. Feel the teeth with tongue and finger for sharp, broken edges or possibly decayed portions of the tooth structure.
3. Determine the firmness of the tooth in its setting. Grasp each tooth and attempt to move the tooth gently in its
socket. Very loose teeth, possibly in reddened or retracted gums, may mean pyorrhea.
4. Examine the gums for swelling or soreness about the remaining teeth. Gently press a finger against the gum, both
inside and outside and look for any blood or pus discharge, to indicate possible pyorrhea. An accompanying tenderness
and swelling, may represent abscess formation.
5. Run the tip of the finger along the gum surfaces for any soreness, ulceration or external sore, possibly indicating cancer or other growth.
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Cancer of the lips. Any sore, crack, ulcer or other type of lip lesion that persists for over two weeks, could be a lip cancer. This disease sometimes results from chronic irritations of objects such as nails, hooks or pipes in the mouth, and to excessive exposure to sunlight. Cancer of the lip has one characteristic feature about it-it does not heal completely. It is well to remember that lip cancer, like cancer everywhere, is usually small in its beginning, but unfortunately, is often allowed to reach large proportions before medical aid is sought. Good judgement is
Fig. 24. Cancer of the lip begins as a wart-like thickening, followed by an open sore. It is most often seen in men and usually in the lower lip. Thought to be partly caused by biting, irritation, sunlight and pipe-smoking, it is one of the most common sites for cancer in the body.
over-ridden by the hopeful thought that somehow the lip sore will go away by itself. Happily, malignancies of the lip can be adequately treated. X-ray therapy and surgical procedures combined, enjoy a marvelously high rate of cure. Only the long-standing and neglected malignancy in the lip grows beyond the point of probable cure.
Lip Paralysis. Inability to move the lip through certain normal functions such as puckering, compressing the lips, smiling or loss of sensation about the lips, usually means some or all of the muscles controlling the lips are paralyzed. Such situations occur in facial paralysis, strokes of short or long-standing, and in several other complex nerve diseases. These difficulties should quickly be brought to the attention of the physician for early diagnosis and proper treatment.