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Indicators of systemic disease in the oral cavity and tongue

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General information

The fact that the tongue and the oral mucosa may reflect internal processes of the whole organism is ancient knowledge. This knowledge has been applied by doctors since the classical period. The art of tongue diagnosis stems from this tradition and is part of traditional Chinese medicine (TCM) and Ayurvedic (Indian) medicine.

Whilst diagnosis through assessment of the features of the tongue is not taught as a separate part of dental medicine in a more specific sense, dentists are often confronted with various appearances of the tongue and oral mucosa in their daily work which may help them when assessing their patients' health.

Therefore, it is extremely important to know that the oral mucosa plays a role in numerous systemic diseases, in some cases oral symptoms being the first manifestation of a disease. Furthermore, any change of the tongue (colour, form, mobility, coating) may be indicative of a disease.
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Oral manifestations of systemic diseases

Systemic infections
Measles see Koplik's spots
Scarlet fever Strawberry tongue
Rubella Petechial lesions on the palate and uvula
Whooping cough Traumatic ulceration of the lingual fraenum
Varicella (chickenpox) Macular rash with central vesicles; round erosions
Infectious mononucleosis Aphthous stomatitis,
haemorrhage,
ulcerative tonsillitis
Diphtheria Pseudomembranous stomatitis
Syphilis see Interstitial glossitis (luetic glossitis)Precancerous lesion in the tertiary stage!)
Immune deficiency syndrome (e.g. AIDS)
Herpes simplex see Herpetic stomatitis
EBV see Hairy leukoplakia
HHV-8 (human herpesvirus 8) see Kaposi's sarcoma
Mucosal, skin, and connective tissue disorders
Keratosis and dyskeratosis see Lichen ruber planus, etc.
see Vesicular dermatoses Pemphigus vulgaris,
Benign mucosal pemphigoid,
Exudative erythema multiforme
Drug-induced bullous lesions
Lichenoid dermatoses E.g. drug-induced lichenoid lesions
see Collagenosis Sjögren's syndrome,
Scleroderma (progressive, systemic; PSS)
Haematological diseases
Polycythaemia vera Teleangiectasia
see Iron-deficiency anaemia and Plummer Vinson syndrome (PVS) Atrophic glossitis, atrophy of oral and oesophageal mucosa,
Symptoms of PVS: dysphagia, angular stomatitis,
Oesophageal stricture (Precancerous lesion!)
Congenital erythropoietic porphyria Brown teeth (UV: red)
Pancytopenia, agranulocytosis, acute leukaemia, etc. Severe stomatitis, necrotic gingivitis, ulcers, haemorrhage
Thrombocytopathy/thrombocytopenia Haemorrhage
Plasmocytoma (solitary or systemic) Tumour manifestation in tongue, palate, tonsils, lips, gingiva
Hodgkin's disease Tumour manifestation mainly in the tonsils
see Poisoning, adverse effects of medicinal drugs
Methaemoglobinaemia Blue tongue
Chronic lead poisoning with toxic anaemia Greyish purple lead line around the necks of the teeth
Chronic arsenic poisoning Deposit of melanin (arsenic melanosis)
Hydantoin Gingival hyperplasia
Nicotine see Black hairy tongue,
see Leukoplakia (Precancerous lesion!),
see Leukokeratosis
see Deficiency disorders, avitaminosis
Vitamin-A deficiency Xerostomia,
Squamous epithelial metaplasia of the vermilion of the lips
Vitamin-B12 deficiency Epithelial atrophy,
Increased vascularisation (Hunter's glossitis)
Vitamin-C deficiency Scurvy, haemorrhage, ulcers,
Gingival hyperplasia
Iron deficiency Xerostomia,
Smooth tongue, burning tongue,
Dysphagia,
Squamous epithelial metaplasia of oral and/or oesophageal mucosa
(Plummer-Vinson syndrome, Precancerous lesion!)
Cachexia Melanin deposits in skin and mucosa
Metabolic disorders, endocrinopathies
Diabetes mellitus see Candidiasis,
Atrophy of the lingual papillae (atrophic glossitis),
frequent (ulcerative) stomatitis,
light red mucosal discolouration
Primary and secondary hypercholesterolaemia, hyperlipidaemia see Rarely xanthelasma
Amyloidosis (primary or secondary) Amyloid deposits in the tongue (macroglossia),
as well as in other organs (spleen, liver, kidney),
and especially in vessel walls
Other storage disorders (e.g. glycogenosis, mucopolysaccharidosis, etc.) Macroglossia, etc.
Acromegaly Macroglossia
Myxoedema Macroglossia
see Addison's disease Bronze discolouration of tongue (melanin deposit)
Haemochromatosis Dark-brown tongue (iron pigment deposit)
Cardiovascular diseases
Right-sided heart failure Congested tongue
(purple cyanotic mucosal discolouration,
increase in tongue volume)
Left-sided heart failure Carmine red discolouration of the tongue without increase in volume
Other chronic diseases
Liver disease Atrophic glossitis,
hyperkeratosis,
gingival bleeding
Renal failure Pseudomembranous stomatitis
Diseases of the gastro-intestinal tract see Chronic recurrent aphthae