YT YouTube2Text

YouTube2Text → Transcripts → Tongue Disorders

Tongue Disorders — Transcript

by DentalScholar · 10,044 words · 1,632 segments · language en · Watch on YouTube

Open in transcriber Summarize with AI Download SRT/VTT

Full transcript

0:01Chapter 17 is one of those small, nice,
0:03and very simple chapters. You will see
0:05that today I will finish the entire
0:06chapter. Okay. From now on, you will
0:08find that in one lecture or a lecture
0:09and a half. We will have finished the
0:11chapter. These are very small chapters.
0:13Not like the first two chapters. Okay,
0:16well. The tongue, as you know, is an
0:18organ located in the oral cavity. It
0:20has functions, one of its functions is.
0:26Speech articulation. And there is also.
0:30So it is also responsible for "taste
0:33disorders". In the tongue, it reflects
0:35on these functions. So I have "
0:37disorders" that might affect "motility"
0:39. It could. Affect it, causing me. It
0:46might affect, might. Cause us. It might
0:54also cause me any disease. It often
0:57causes me loss of taste. The flu that
1:01we all went through.
1:03>> Corona, Corona, do you remember the
1:05first symptom of Corona, what was it?
1:07>> No, is it smell? No, it doesn't affect
1:10smell. Corona is not like the flu. You
1:14don't get congestion like with the flu
1:16and the cold. It is a very distinct
1:19mark of Corona. Corona, if you remember
1:21, we get a fever. And our bones ache
1:23and we feel broken. A headache unlike
1:25anything we have ever felt. And then,
1:26the sense of taste goes away, okay.
1:28Then we get, what, a pulmonary
1:29infection. We get a dry cough. We don't
1:33have nasal congestion with Corona, okay
1:36. Even though I don't have nasal
1:38congestion, what happens is a loss of
1:39taste. We don't know why the Corona
1:42virus actually affects the taste buds.
1:45Does it affect the taste buds? Or does
1:46it affect the nerve supply to the taste
1:49buds? Or does it secrete particles, for
1:51example, that resemble
1:52neurotransmitters? Blockers for
1:53neurotransmitters or for the synapses
1:55in the tongue? We don't know, honestly,
1:59no one knows. But fortunately, most
2:02patients who were infected with Corona,
2:04after they recovered, their taste
2:06sensation returned. And this is one of
2:09the signs that we are recovering from
2:11Corona, okay. After seven to ten days,
2:15the taste returns and the condition
2:17improves in most patients. There is a
2:20population of patients for whom the
2:22loss of taste remained permanent. And
2:26there is a group of patients who had a
2:27different sensation of taste after
2:29Corona, okay. They stopped feeling the
2:32taste of food. They stopped accepting
2:34sweets. There are patients who stopped
2:36accepting meat after Corona. And this
2:38is something I saw, I mean, in my
2:40family there is a patient.
2:42>> I don't know, it's as if their
2:44perception of taste changed; their
2:47feeling of taste changed, for example,
2:49a piece of meat became something they
2:51don't savor. I have a dysgeusia, it
2:56goes and comes back, not related to the
2:58smell, it's related to the taste buds.
3:04We don't know the damage that Corona
3:06did to the neurons, we don't know. Okay
3:10, I have a patient who came to the
3:12clinic. She came to the clinic telling
3:14me, "Doctor.""Since I had Corona, my
3:16sense of taste went away and didn't
3:18come back.""I don't taste anything."
3:23And she took a very high dose of
3:25cortisone to reduce. They told her it
3:27was inflammation after Corona. Very
3:28high cortisone for a long period. But
3:30there is no improvement. Okay, from our
3:33readings, we told her you can go and
3:36try acupuncture. Acupuncture stimulates
3:39specific areas of the nerves. It might
3:42return, according to the study.
3:43Patients who underwent acupuncture
3:45after a loss of taste saw their taste
3:48sensation improve slightly after COVID.
3:50Okay, I don't know, I haven't followed
3:52that. I don't know if it went away. I
3:54don't know if they found anyone who
3:56performs acupuncture on the nerves that
3:59supply the tongue or taste. Okay.
4:04>> No, the taste buds are inside the
4:06papillae. However, taste buds are
4:08histological structures separate from
4:09the papillae. They contain sensory
4:12cells. They contain supporting cells.
4:15They contain the pore through which
4:17food particles enter. And they have the
4:19synapses. That connect the taste buds
4:22with the neurons. Which allows one to
4:26feel, or where taste is transmitted. To
4:30the neuron to feel. Immune stimulation
4:40of the mucosa.
4:42>> Correct, correct; also, a function of
4:44the tongue is protection, right, okay.
4:49Alright, one of the most important
4:51symptoms that can affect a patient's
4:53tongue. Is the sore tongue. Or the
4:56tongue that is, what, painful or. Burns
4:59; what are the causes of a sore tongue
5:02in these patients? Okay. It could be.
5:21All of them can cause it for us. Also,
5:25if we have [inflammation], right,
5:27especially. That appears to us in the
5:35form of, or we said that. It is
5:43accompanied by a sore or sense; also,
5:45there is a syndrome accompanied by it,
5:48or one of its most important symptoms
5:51is burning mouth syndrome, where I
5:53don't have a clear cause for the
5:56patient's feeling of a burning
5:58sensation on the tongue or in the mouth
6:01; okay, most of it is psychological,
6:03but in reality, they are in pain; okay,
6:06we don't have depletion. The patient
6:09doesn't have anemia. They don't have a
6:11candida infection. But they have a
6:13burning sensation. Sometimes the
6:15burning sensation is confined to the
6:17tongue and is called. Burning tongue
6:19syndrome. And sometimes it is over the
6:22entire oral mucosa. It is called what?
6:24Burning mouth syndrome. Now, we have
6:27erythema migrans, or geographic tongue
6:30conditions. In which there is depletion
6:34of the tongue. But its cause is unknown
6:37. It is neither anemia nor a candida
6:40infection. It is common among families.
6:43Meaning the mother, father, and child
6:44might have it. It is also sometimes
6:46accompanied by a sore tongue or a
6:48burning sensation.
6:49>> Well, what about psychological? How is
6:51it psychological, the one before it?
6:54>> Severe stress, high anxiety.
6:57>> Okay, those things can trigger burning
6:59mouth syndrome; the people most
7:01affected by burning mouth syndrome are
7:04females, middle-aged females.
7:06>> Mouth. Not. Let's go back a bit. It is
7:13considered one of the. Because of. It's
7:28called fungiform. Every [papilla] is
7:33called. It looks like a mushroom in
7:39shape. It is found in the anterior part
7:41of the tongue. Okay. Distributed among
7:44the filiform papillae. We also have the
7:47foliate papillae. Which are on the
7:49lateral borders of the tongue. They
7:51look as if they are fissured. And
7:54finally, we have the circumvallate
7:55papillae. They are circular papillae.
7:58In the shape of a V. Between the
8:01anterior two-thirds and the posterior
8:03third. Okay. These are the four
8:06papillae. That make up the dorsum of
8:09the tongue. We also said that the
8:11papillae, inside the epithelium of the
8:13papillae, we have taste buds. Except
8:15for one papilla. Who remembers it? It
8:21doesn't have them. Okay. Part of the
8:27papilla. Part of it is, if you also
8:31remember. Of course, these taste buds
8:36are responsible for the sense of taste.
8:39Whether it's sweet, salty, hot. Okay.
8:43The front ones, the bitter ones.
8:46responsible for these types of taste.
8:50The first condition we have related to
8:52the tongue, is the furred tongue. What
8:55does "furred" mean?
8:57>> Furry. Actually, the dorsum of the
9:00tongue looks as if it has fur, or is
9:03covered in fuzz. That is why it is
9:05called a furred tongue. What is the
9:07cause of a furred tongue? It is caused
9:09by the elongation of the filiform
9:11papillae. They lengthen. We get
9:13hyperplasia of the filiform papillae.
9:15They grow a little bit, okay. They
9:18lengthen 1 to 2 mm beyond their normal
9:20state. When they lengthen, they give
9:22the impression of what? That it's like
9:25fur, or like fuzz on the surface of the
9:29tongue. And because the filiform
9:32papillae are keratinized, I find the
9:34fur is white, as you can see here, due
9:37to the keratinization of the tip. of
9:42What is the cause? Actually, the cause
9:44is unknown. It is believed that smoking
9:48can trigger it. It is also believed
9:50that infection can trigger it. Young
9:56children who have high fever, it was
9:58found that after having a high fever,
10:00they develop a furred tongue. But is
10:02there a clear, specific cause? There is
10:05no clear, specific cause for a furred
10:07tongue. What do patients feel when they
10:10have a furred tongue? Actually, the
10:12patient does not experience any type of
10:16pain. There is no sore tongue, no
10:18burning sensation, and no pain. What do
10:21patients complain about? They complain
10:24about a bad taste, and what? Halitosis,
10:26and bad breath. Where did the bad taste
10:30and halitosis come from for these
10:32patients? It came from the colonization
10:35of the bacteria there. Or, didn't we
10:40say the filiform papillae elongated,
10:42increasing the surface area, creating
10:44crevices? They became like places where
10:47these anaerobic bacteria can hide. More
10:51so than when I have a normal tongue
10:53surface. So these bacteria colonize the
10:57crevices of the filiform papillae. They
11:00produce substances that emit a bad,
11:03pungent smell. And substances that
11:05cause the bad taste. Most of them are
11:08fusiform bacteria. Okay, they produce
11:11sulfur. Sulfur gives us that bad breath
11:15. And the metallic taste. When the
11:18patient swallows, they feel a bad taste
11:20. It’s a metallic taste, like iron.
11:23>> Metal.
11:25>> A mineral.
11:26>> More like iron.
11:27>> More like iron.
11:28>> More like iron.
11:29>> Okay. What is the treatment? First, the
11:32disease. Okay. So we manage patients
11:35who have a furred tongue. But only when
11:38I have what symptoms? When the patient
11:45has halitosis, I tell him the only
11:47treatment is for me to scrape his
11:49tongue. To scrape the tongue using a
11:52scraper. Okay. A tool that scrapes the
11:56tongue. This scraping of the tongue
11:59only removes what? The elongated
12:02filiform papillae. That's why I don't
12:04advise any patient with a normal tongue
12:06to scrape their tongue with a scraper.
12:09They can brush the tongue with a brush.
12:12They can flip the toothbrush to the
12:14other rough surface. To remove the
12:17plaque, the plaque layer on the tongue.
12:19No problem, but to reach the scraper
12:21stage, there must be elongation of the
12:24filiform papillae. Because if they use
12:27a scraper and the tongue is normal,
12:28they might get erosions. They might get
12:31what? Like ulcerations. So the patient
12:34will be in pain. Meaning he would be
12:35harming or wounding himself.
12:37>> Doctor, are you talking about tongue
12:40brushes? Yes, that’s the one. We
12:42shouldn't use them. They are only for
12:44patients who really need them, because
12:45they are actually sharp. They scrape
12:47the tongue. I used to recommend them,
12:50let's say, for patients. For those who
12:53have hairy tongue or furred tongue.
12:55Okay. I don’t rely on patients to
12:57prescribe them. Regular patients,
12:59because they might like to, you know,
13:00scrub too much. And while they are
13:02scraping, they end up hurting
13:03themselves.
13:04>> Okay, I prescribe them for patients who
13:06have furred tongue that is like iron.
13:10Ah, okay. Well, another condition that
13:15can affect the tongue is what's called
13:17foliate papillitis, or inflammation of
13:19the foliate papillae. The cause of this
13:22inflammation is unknown, why I get
13:23inflammation in the foliate papillae.
13:25But it could be trauma, it could be
13:27spicy food, or it could be a specific
13:30burn from hot food that triggered
13:32inflammation in the foliate papillae.
13:34Because the foliate papillae are
13:36located on the borders of the tongue,
13:38they appear as nodules. Like an
13:41inflamed pimple, a tender nodule on the
13:44lateral borders of the tongue. As you
13:47can see in the picture above, as you
13:49can see in the picture below. Okay, the
13:52patient is not aware of it. While
13:54eating, they start feeling pain in that
13:56area. They look and find as if there is
13:59a pimple, or as if their tongue is a
14:00bit swollen. Okay, is any treatment
14:02required? No treatment is required.
14:04Just as it came, it goes away on its
14:06own. Okay, as soon as the patient
14:07avoids contact with irritants it goes
14:14away on its own.
14:15>> It is Then when it happens, my mother
14:20would say eat tahini, eat tomatoes and
14:22salt, what do they have to do with it?
14:25>> Okay, I don’t know about the tomatoes
14:26and salt.
14:27>> But it is known that the sesame oil
14:30found in tahini. Or tahini made from
14:32sesame oil. Sesame has very high
14:35antioxidants. Okay. These antioxidants
14:38might reduce the inflammatory process.
14:40So it helps with healing. There is also
14:42a study done on herpes labialis. On
14:46actually using tahini. When tahini is
14:49applied to the area with herpes
14:51labialis. They saw that it heals faster
14:54than untreated herpes labialis. Okay.
14:58Well, tahini, as we said, has
15:00anti-inflammatory properties. It has
15:03high Vitamin E. It helps with healing
15:05and so on.
15:07>> It protects, it acts like a shield.
15:10>> It softens and creates a shield, so it
15:12accelerates healing.
15:14>> Okay, so I wouldn’t be surprised if
15:17it actually works for patients to put
15:19tahini or olive oil, or rinse with sage
15:22, it might help.
15:25>> What did we say were its causes? Just
15:28as it came, it goes away. It could be
15:30trauma. It could be hot food, but. The
15:32exact cause is not well defined. Okay,
15:35so the other condition we might see on
15:37the tongue is lingual varicosities,
15:39which are like varicose veins, okay.
15:42Don’t we have varicose veins that can
15:44affect the legs? Which are veins that
15:47are enlarged, dilated. They have
15:50weakness, and they are tortuous, the
15:52veins, right. Just as we have varicose
15:55veins in the legs, we might. Have
15:56varicosities in the lingual vein. How
16:00does lingual varicosities appear? They
16:02appear to us as bluish/purple. On these
16:09areas. They might also occur in some
16:12places. Appear as a nodule or a bump.
16:18What does that mean? It means it has no
16:21stalk. We have nodules that are
16:24pedunculated, or have a neck. Like the
16:26warts that appear. Or tags, epithelial
16:29tags, skin tags. They are prominent and
16:32have a neck. A lesion or nodule. Its
16:36base narrows and connects to what? By a
16:39neck to the skin. Or to the mucosa, the
16:43sessile nodule, which is flat. Or a
16:48growth in the epithelium. Or any. Place
16:51where the entire base is attached to
16:54the tissue. It does not have a neck.
16:56Okay. So, I have two terms: sessile and
17:00pedunculated nodule. It has a neck, it
17:03has a neck. Whereas the sessile is what
17:06? Attached. The entire diameter of the
17:10nodule is directly connected to the
17:13tissue. Okay, in varicosities, we see
17:18nodules. However, As you can see.
17:27Tortuous, twisted with a sessile nodule
17:31.
17:34>> Does it cause danger, is it painful? It
17:36is neither dangerous nor painful. We
17:44know that varicose veins in the legs
17:46and feet have a high risk of deep vein
17:49thrombosis, right? That it might block.
17:53And I might get thrombosis. And this
17:55thrombosis becomes an embolism. It
17:57could reach the lung directly. And
17:58cause a pulmonary embolism for me. Most
18:01of the time, okay. But with
18:04varicosities, I have no risk of
18:06embolism. Nor thrombosis, okay.
18:11>> It is impossible to confuse it with
18:13something raised.
18:15>> There is no ulcer here, there is no
18:17break in continuity here; only the
18:19lingual vein is enlarged, tortuous in
18:22shape, and because it is so enlarged,
18:24it creates bumps or protrusions for me.
18:28>> And its color is...
18:31>> Okay.
18:33>> Its color is lilac because it is a vein
18:35.
18:36>> Well, we also have another condition
18:38that can affect the tongue, which is
18:41erythema migrans. Erythema migrans has
18:44another name, which is geographic
18:46tongue. Why did we call it geographic
18:49tongue?
18:49>> Like a map.
18:51>> It resembles a world map, not just in
18:53its shape, but also in that it changes.
18:57You know how the globe keeps moving,
18:59the earth moves. Every time I look at
19:02the globe, I find it in different
19:03continents. The same goes for erythema.
19:07The shape of the lesions resembles
19:11continents or a world map. And every
19:15time we look at it, every month we look
19:17at it, every month and a half, we find
19:18it has changed. That is why. Erythema
19:21migrans is called geographic tongue. So
19:25, what do we see in erythema migrans?
19:28Actually, it is very common. It is very
19:31common. We see it a lot in the
19:33population. Okay. We might see it in
19:372-4%of the population. Every 100 people
19:41have it. So, its cause...how do we see
19:47it? We have. These. Or they are. Their
20:05shape...Okay, their presentation.
20:12Coming from what? Coming from an
20:14erythematous halo on the borders. And
20:17coming from hyperkeratinization. Okay.
20:20Once again, it acts. On the tongue. It
20:28is considered. So I find a red line and
20:36a white line around the edges of this
20:38lesion. Its shape is distinctive. It
20:40does not have ragged margins. Its edges
20:42are not jagged or irregular. They are
20:45circular or curved margins. Okay.
20:48Another feature that really
20:50characterizes erythema migrans. It is
20:52characterized by the fact that it
20:54changes in its shape between visits.
20:57The areas that have depapillation,
20:59after a while, have repapillation and
21:02return to normal. And the areas that
21:05were papillated become depapillated. So
21:08the first time I see a lesion of
21:10depapillation here. The second time I
21:12see the lesion here. The third time I
21:14see the lesion here, and so on.
21:17>> The white spot here is normal
21:19papillation.
21:21>> It is.
21:21>> Ah.
21:22>> Yes, this is normal, this is unaffected
21:25. Here I have depletion; this area,
21:28this area—look up here, this whole
21:30area is depletion. Look at the borders,
21:34on the edges I have erythema, and after
21:37the erythema, I have
21:38hyperkeratinization. See this white
21:41part? That's hyperkeratinization, okay.
21:45>> Hyperkeratinization is not a response.
21:58I said atrophy; atrophy, which is
22:00depletion. Yes, there is atrophy in the
22:03epithelium, which results in depletion,
22:06okay.
22:06>> Ah.
22:07>> Exactly, we have hyperkeratinization
22:09and erythema. Now let's talk about them
22:12histologically more. Well, the
22:14depletion affects which papillae? It
22:16affects the filiform papillae, okay.
22:18That is why these patients never come
22:21complaining. That I stopped tasting.
22:24Because the filiform papillae even when
22:29I have depletion of these...they have
22:32...Okay, it's normal. They keep tasting
22:38. They don't have a problem with taste.
22:40Why are there many pictures of erythema
22:42migrans? So you know that for every
22:44patient, the clinical presentation
22:46differs from the other. Okay, keep in
22:50mind, to diagnose erythema migrans
22:52correctly, I have well-demarcated
22:54erythema and hyperkeratinization.
22:59>> Why?
22:59>> Meaning as a color. In it, there's
23:05white—a red and white color.
23:07Hyperkeratinization, two—erythema and
23:10hyperkeratinization. The erythema is
23:14inside the lesion, at the edges of the
23:16lesion, and the hyperkeratinization is
23:19at
23:20>> as if it were the outer edges, okay?
23:23It's like a double line, one white and
23:25one red, for every patient.
23:27>> For every patient.
23:28>> Well, why is this response to the
23:30depletion?
23:32>> It tries to protect itself.
23:34>> As a response to the injury. When I
23:38have depletion, it means only part of
23:40the epithelium is gone, so the
23:42epithelium tries to protect itself
23:44through hyperkeratinization. Okay, all
23:48papillae or just the filiform that do
23:50this?
23:51>> The filiform—for the filiform
23:53papillae around the depleted area,
23:55around.
23:59>> Okay, another thing that helps us
24:01diagnose geographic tongue is that
24:02after several weeks, its shape changes.
24:05I still have depletion, but it's
24:07different from the first visit the
24:09patient had.
24:10>> Its location is different.
24:11>> Its location is completely different.
24:14The area that was depleted becomes
24:16replenished. And the area that was
24:18replenished becomes depleted. It
24:20becomes different; the shape changes
24:22between every visit and the next.
24:24Histologically, how do I see it? Areas
24:26that have depletion, like here. I lose
24:29the filiform papillae hairs. Do you
24:31remember what the filiform papillae
24:33look like? Like hair, okay, pointed,
24:36okay. They are lost. We get atrophy in
24:39the epithelium and depletion. The area
24:42at the edge of the depletion, I get an
24:44inflammatory infiltrate. How did I know
24:47I have an inflammatory infiltrate? I
24:49see cells, their nuclei are dark in
24:52color, okay. Which are purple-stained
24:56nuclei. That is an indication that I
24:58have an inflammatory cell infiltrate.
25:00Look at the difference between the
25:01connective tissue here in color and the
25:03connective tissue here in color. Which
25:06one has more purple in it?
25:08>> Exactly. This means I have immune
25:10infiltration in the area. So, how do I
25:14see the transition? It means I have
25:20depletion. So I see, what is it? On the
25:24border, I have a depletion area. At the
25:28end of the depletion, I have I see it
25:34as redness. If I continue a bit more.
25:38If I continue a bit more, I see we have
25:40hyperkeratinization here. Just like I
25:42see what I have in the picture here on
25:44the right, below. A. It is considered
25:49normal. Ah, next to the one that has
25:54infiltration on the right there.
25:57>> No, that's depletion.
25:59>> Below.
26:00>> It is.
26:00>> Ah.
26:01>> Meaning it doesn't have infiltration,
26:02but it has...
26:03>> It has depletion, and we also have an
26:05immune response, but not as strong as
26:07there.
26:08>> Definitely. Well, let's look here at
26:12the histopathology of erythema migrans.
26:15It is very important to look here for a
26:17second, guys. Okay. In this area, if
26:20you notice, I have the borders of the
26:23erythema migrans. In this area, I have
26:26an inflammatory infiltrate. These cells
26:28with the purple nuclei. This means I
26:31have an inflammatory infiltrate here.
26:33Here I have the area clinically, which
26:35forms an erythematous halo at its edge.
26:38Look at the hyperkeratinization here.
26:39Do you see the stratum corneum at the
26:42border? I see it as a white line. Okay.
26:46So, always Okay? Does anyone not
27:00understand it?
27:02>> Tell me again. Okay. Always the area
27:06with depletion, where there is loss or
27:09atrophy of the epithelium, its border
27:11is limited by an area of inflammatory
27:14infiltrate. As a way to stop this creep
27:18of the depletion. It appears clinically
27:21, I see it with my eyes in the
27:22patient's mouth. Erythematous halo.
27:27After the erythematous halo response to
27:29injury, I get something else. There is
27:32inflammation going on. I get
27:34hyperkeratinization. Clinically, it
27:36appears as a white line. Okay, white
27:39line. If we go back here, I have a
27:45depleted area. Do you see all this area
27:48? No, here I have the depleted area,
27:50it’s shiny. It is limited by an area
27:53where there is inflammation on the
27:56edges. The borders are also limited by
27:59an area that had hyperkeratinization,
28:01the white line. Okay, then we go back
28:05to normal, then the depleted.
28:11>> Yes, exactly, erythema at the borders
28:14of the depletion, okay. Well. Does it
28:25have a treatment? It has a treatment,
28:27okay. In this condition, the cause is
28:30unknown. Most of the time, patients do
28:32not complain of symptoms; they don't
28:34even feel they have it. They have no
28:45symptoms.
28:45>> They come to us at the clinic.
28:48>> We discover they have it.
28:51>> Not in.
28:52>> They have symptoms. Now, a group of
28:55about 10%of patients have symptoms.
28:57>> The symptoms of erythema migrans, how
29:00do they show? Soreness and sensation.
29:04With food, if they eat something sour,
29:06if they eat something burning, you feel
29:08that the pain they have is much more
29:10than a normal patient, okay.
29:12>> Yes.
29:13>> Opposite of the disease?
29:15>> I don’t understand, opposite of what?
29:16>> The disease we talked about before.
29:19>> Ah, the furry tongue and hairy tongue.
29:22Yes, hairy tongue and furry tongue do
29:23not have depletion. So, there is no
29:26burning sensation. Okay. Here I have
29:29depletion. But most patients do not
29:31have symptoms. They are symptomless.
29:34Okay. However, in a group of patients,
29:37they might have soreness. Soreness.
29:40Okay, sensitivity. State. They also
29:46have lower tolerance for food. Meaning
29:50their tolerance for burning and sour
29:52food is lower than regular patients.
29:54Okay.
29:55>> Is it normal to have an inflammatory
29:56response without symptoms?
29:57>> That is rare.
29:59>> Yes. And this erythema migrans is also
30:02familial. Meaning the father has it,
30:04the mother has it, the child has it,
30:06the brother has it. Okay. One must
30:12differentiate erythema migrans from
30:14other diseases. Like Lyme disease, and
30:17like erythema chronicum migrans. These
30:20have different treatments. Erythema
30:22migrans has no treatment. Lingual
30:25papillitis is also inflammation in one
30:28of the papillae, meaning.
30:33>> No, no, we didn't say, we said there is
30:35loss of the papilla, and the papilla
30:38has no nerves, so the patient is not
30:41affected by pain, okay. They might have
30:44increased sensitivity to food, well,
30:46not allergy, hypersensitivity. Their
30:48sensitivity is that, for example, sour
30:50things hurt them a lot. Or they get
30:52annoyed by it, okay. So, the
30:53sensitivity or tolerance to food
30:55increases in the patient, okay.
30:57>> Instead of eating something big, there
30:59is pain.
31:00>> Some patients have sore tongue without
31:02eating, and some patients only when
31:04they eat.
31:06>> Sore.
31:07>> Sore.
31:10>> Sore tongue means painful.
31:12>> Sore tongue is painful, not sore throat
31:13.
31:15>> Okay, sore tongue means their tongue
31:17might hurt without eating.
31:19>> In the case we just mentioned, the
31:21migratory one. Yes, okay. A percentage
31:24of patients feel pain without eating. A
31:26percentage of patients only when they
31:28eat, like sour, sweet, bitter, or
31:30strong foods, they might feel pain. And
31:33most patients are asymptomatic, without
31:35symptoms. Okay. Lingual papillitis is
31:40another condition, another disease that
31:44can affect the tongue. There is
31:47inflammation in the fungiform papillae
31:50here. The inflammation in lingual
31:52papillitis affects the fungiform
31:54papillae. It is not known why there is
31:56inflammation in the fungiform papillae.
31:57It is said to be trauma. It is said
32:00that some food, hot food, triggers
32:02inflammation of the papillae. Okay, how
32:05does the inflammation appear to us? The
32:08fungiform papillae swell up. They look
32:11like a small nodule, like a small bump.
32:15Most of us have had fungiform
32:17papillitis once or twice or more in our
32:19lives.
32:20>> You'd be...bravo. You're eating,
32:23drinking. You find as if there is a
32:24bump on your tongue. It keeps bothering
32:26you because it's protruding and so on.
32:28You feel that it hurts you. You go to
32:31the mirror. You look and find as if
32:33there is a bump on your tongue. It is
32:35tender, this bump is painful to the
32:37touch, okay. And the patient feels pain
32:40in that bump, because there is
32:41inflammation, doctor.
32:43>> And nothing is needed; just as it came,
32:45it goes.
32:46>> Just as it came, it goes, okay, how
32:49does it look? You see it there above.
32:53>> Okay. Because it's the fungiform
32:55papillae, so usually the papillitis is
32:57on the anterior and lateral borders of
32:59the tongue. Anterior tongue, here on
33:02the lateral borders. Okay. Rare. I mean
33:07, I rarely see it in patients, we
33:09agreed. Alright, another condition we
33:16have is hairy tongue. These conditions
33:20can affect the tongue. Hairy tongue is
33:22very similar to furred tongue.
33:27>> What happens with hairy tongue? There
33:30is also elongation of the filiform
33:31papillae. Like a furred tongue, like
33:33fur. The tongue that has fur on it, the
33:35hairy tongue. The tongue gets like hair
33:37on it, because there is elongation of
33:39the filiform papillae. But this
33:42elongation reaches several millimeters.
33:45From 3 to 9 millimeters. Not 1 to 2
33:48millimeters. Okay. It grows very long.
33:51Sometimes it feels like there is a hair
33:53stuck inside your mouth. Sometimes when
33:56someone. Swallows a hair, they feel
33:58bothered or that they want to vomit,
34:00right, or they want to take it out,
34:01they actually try to take it out. These
34:04patients who have hairy tongue. One of
34:06the symptoms they have is, what? They
34:08have gag reflex. Okay, it can reach the
34:11gag reflex. What is the reason the
34:13patient gets a hairy tongue? First, it
34:15is very common. 1%of patients might
34:17have a hairy tongue. Who are the people
34:20most likely to have it? Smokers.
34:22>> Heavy smokers.
34:24>> Yes, heavy smokers might get it,
34:26radiotherapy patients who have cancer
34:28and are being treated with radiotherapy
34:30, it's possible. Are we okay?
34:36>> What?
34:37>> With or without keratinization, there
34:40will be keratinization or smokers
34:42exposed to radiation therapy.
34:47>> Okay. The hairy tongue appears. The
34:51hairy tongue might show elongation of
34:53the filiform papillae. It might be pale
34:57, meaning it takes the tongue's natural
35:00color. It has hyperkeratinization, so
35:05it's normal. Okay. And it might have
35:10discoloration, so it appears brown or
35:12black. Okay. What is the cause of the
35:17discoloration? Also bacterial
35:20colonization, but...This time, it is
35:23black discoloration on a patient who
35:26has a hairy tongue as a result. Due to
35:30this bacterial colonization, the
35:32bacteria cause black pigmentation of
35:34the tongue. Okay, so the tongue in
35:37patients with a hairy tongue could be
35:40normal. The tongue has a pale pink
35:43color. It could be brown, especially in
35:46heavy smokers. Due to smoking, we get
35:50this staining.
35:51>> What? So it is not...no.
35:56>> How can we have very long filiform
35:58papillae that are very prominent?
36:01>> Ah.
36:01>> Okay.
36:02>> Not swollen.
36:03>> The sensation is...
36:04>> Not swollen, they are just long and
36:06prominent.
36:07>> Ah.
36:07>> Like hairs, like hair, also.
36:10>> Okay.
36:12>> Well, what were we talking about? Ah,
36:16the brown discoloration can be seen a
36:19lot in heavy smokers. Smoke and
36:22nicotine, the nicotine burn can cause
36:24precipitation on the tongue, giving us
36:26this brown discoloration. First, it
36:32might cause black discoloration. The
36:37color is because of the smoking
36:39material. Or maybe, maybe smoking with
36:44the hairy tongue causes staining that
36:47gives it this brown discoloration. And
36:52the black discoloration, the black
36:54appearance inside the tongue fibers,
36:57this blackness is for treatment.
37:07>> What do patients feel when they have a
37:09hairy tongue? They have no sores, they
37:12have no sensation. Then what do they
37:14feel? They feel...Like fur, okay. So
37:20what is the treatment for it? Also, it
37:22doesn't require anything from us other
37:26than a scraper. We must differentiate,
37:29especially when the hairy tongue is not
37:31accompanied by discoloration.
37:33Differentiate between it and...Between
37:35candidiasis, which is chronic
37:37hyperplastic candidiasis. Okay. In
37:39chronic hyperplastic candidiasis, I
37:42also have hyperkeratinization in the
37:44mucosa. It might look very similar to
37:47the elongation of the filiform papillae
37:49, which is keratinized, right? But...It
37:51gives me a white layer. This white
37:53layer cannot be wiped off. So I need...
37:58>> Candidiasis also happens with...
38:01>> Does candidiasis also come with
38:02elongation or just hyperkeratinization?
38:05When you see it, you might not think so
38:08, but the symptoms...Are the same.
38:15>> Maybe there is a difference.
38:17>> And the history and underlying cause in
38:20chronic candidiasis. Of course, of
38:25course, you have to be sure. Take a
38:28scraping and send it to the lab. If
38:31they find hyphae of Candida, it is
38:33chronic hyperplastic candidiasis. That
38:35one’s treatment is not scraping.
38:37Because the hyphae remain deep inside
38:39the epithelium. Its treatment is
38:41topical antifungal, and we might even
38:42reach systemic.
38:45>> Or doctor, the appearance is pale and
38:47...we said it must be pale, then we
38:49talked about candidiasis, we said there
38:52is a white layer on it, keratinization,
38:54it’s not a white layer, it's
38:56hyperkeratinization. Okay. When it
39:02looks pale, it means we have
39:04keratinization. Which is from the
39:08keratinized filiform papillae. So I
39:10also see some whiteness on it. Not very
39:14much. Ah, right.
39:22>> There is a breakthrough, doctor.
39:24>> Let me finish this before Glossitis,
39:26and we'll take a break. Okay, Black
39:29Tongue. Before Glossitis, there is a
39:31condition called Black Tongue. In Black
39:34Tongue, I don't have what?
39:37>> I don't have elongation of the papillae
39:39, but I do have pigmentation. What is
39:44the pigmentation? It could be due to...
39:49Like iron. Like bismuth. Bismuth, which
39:52is an antacid. Taken to relieve stomach
39:55acidity. It can cause pigmentation.
39:58Iron supplements can cause black
40:00pigmentation on the tongue. Also, what
40:03I take, antiseptic lozenges. The
40:07lozenges that sterilize. They might
40:10activate black-pigmented bacteria. And
40:14cause colonization on the tongue
40:16without filiform elongation. Causing
40:18black pigmentation. Wait, we also have
40:21external factors. Like chlorhexidine.
40:25It's a mouthwash known for its ability
40:28to stain teeth and mucosa. Especially
40:30the tongue. It causes brownish
40:32pigmentation. Coffee can also cause
40:37brown pigmentation. Tattoos, many
40:41people get tongue tattoos. It can be a
40:44cause of...Black pigmentation. See the
40:46patients.
40:50>> Patients with anemia.
40:52>> Don't they also...
40:56>> Regarding them, what is the iron
41:00medication?
41:02>> Iron.
41:04>> Iron, iron.
41:06>> Okay.
41:07>> So what is the local thing I need?
41:09>> Black-pigmented bacteria.
41:11>> Ah.
41:11>> Okay. Like how, for example...
41:18>> Like Strepsils. It's not an antiseptic.
41:22Strepsils is a soothing solution with
41:25Vitamin C to relieve the soreness.
41:28There are lozenges that are
41:30antimicrobial.
41:32>> They are like chlorhexidine, meant to
41:34sterilize or reduce harmful bacteria.
41:37Now, this reduction of bacteria might
41:39also affect the good bacteria, and the
41:41harmful bacteria might activate more.
41:43You understand? It causes...
41:45>> Regarding the mouthwash, first of all,
41:47the black stain goes away.
41:49>> It might go away, it might go away with
41:52scraping too. It's a condition where
41:55the components are reversible because
41:57it's very good; chlorhexidine treats
41:59periodontitis. Okay, it's very useful,
42:02it goes away naturally. Staining occurs
42:05, give it three weeks, once
42:06desquamation of the tongue happens, the
42:09stains disappear. Okay, break.
42:11>> Yes.
42:12>> 10 minutes. If you have a quiz, what do
42:15we do about the marks? Electronic.
42:19>> Computerized, they call it, meaning in
42:23the computer labs, okay.
42:25>> Let's continue. It doesn't look right.
42:39Speaking of the midterm, we won't bring
42:41six. There's an allergy here, it's
42:44normal. Okay. What are the signs and
42:49symptoms of an inflammatory response?
42:52We have erythema. We have pain. We have
42:55dilation. We have atrophy of the
42:58epithelium. And it's also accompanied
43:01by sensations. One of the most famous
43:06causes is iron deficiency anemia. 15%of
43:09the cause of glossitis is iron
43:11deficiency anemia. 15%of glossitis is
43:15iron deficiency anemia. Don't
43:18underestimate someone who comes to you
43:19saying my tongue burns or hurts. Okay,
43:22do not underestimate this. Treatment
43:24might start at the dentist even if they
43:27have iron deficiency anemia. Also,
43:29Vitamin B group deficiencies, mainly
43:32Vitamin B12 deficiency. It causes
43:35glossitis migrans, which is what? Which
43:38is geographic tongue. It can also cause
43:41the sores that happen. It is considered
43:46...It is all...That happens. With the
43:57action...Which is a disease we studied
44:05in the last lecture. It is one of the
44:07conditions...Lichen planus. We have a
44:14phenotype, we said lichen planus if it
44:16appears on the tongue. It appears as an
44:20inflammatory response. For glossitis,
44:28which is an infection. Okay, it can
44:31cause glossitis. Also Streptococcal
44:35infection, which causes Scarlet fever.
44:38It also affects the tongue. It causes
44:41the tongue to suffer from glossitis.
44:44Kawasaki disease, if you recall from
44:46the previous lecture, also causes it.
44:49They are similar in that they cause it.
44:57Finally, it can affect and cause anemia
45:07of all types, here anemia. Anemia in
45:12general causes it. We have glossitis,
45:16ranging from the tongue appearing
45:19atrophic with sensations. Or we might
45:24just have a burning sensation without
45:27atrophy. Okay, depending on the degree
45:30of anemia, the severity of anemia. If
45:34it is anemia, if it is anemia. Okay,
45:37the symptoms appear to us. The more
45:40profound the anemia is, the more severe
45:43and stronger the symptoms are. However,
45:46it doesn't mean that if a patient has
45:48anemia, they must have all the symptoms
45:50. The patient might have only a burning
45:52sensation as the sole symptom. My
45:54sister is one of those people who has
45:57iron deficiency anemia. The first
46:00symptom I know that her iron has
46:02dropped again is a burning tongue. She
46:04starts telling me, or I see her while
46:06she is eating, for example, her tongue
46:08burns. I say, it looks like your anemia
46:09has returned. You must go and take the
46:12IV, the iron IV. Okay. Well. Iron
46:19deficiency anemia—three-quarters of
46:21patients with established iron
46:23deficiency anemia suffer from a burning
46:26sensation. And a quarter of people who
46:29have established anemia have atrophic
46:32tongue. What does that mean? It means
46:36you are talking about...what? That the
46:38only symptom of anemia could be a
46:39burning sensation. Do not underestimate
46:42a patient who comes to you. They tell
46:43you, "My tongue is burning." You
46:45examine them and find nothing abnormal
46:47on their tongue. Pale tongue, pink
46:49tongue. We don't have depapillation. We
46:51don't have atrophy. You tell them, "You
46:53have nothing, I don't know what it
46:55could be." No. They could actually be
46:59feeling a burning sensation. And the
47:01burning sensation could be a symptom of
47:03anemia. 15%of the causes of glossitis
47:06are iron deficiency anemia. As you can
47:10see, okay. Iron deficiency anemia, how
47:13do I diagnose it? Hemoglobin might be
47:16low, okay. Iron might be low. The iron
47:20stores in the body might be low.
47:22Ferritin might be low, okay.
47:25>> Ferritin.
47:26>> Yes.
47:26>> Ferritin, okay, which is the precursor
47:29for iron.
47:31>> Doctor, some people's tongues, it's not
47:33just a feeling of burning, but it looks
47:35as if it's bumpy; is this the same
47:36thing?
47:37>> From certain foods, it might be
47:39possible they have glossitis, or
47:41burning mouth syndrome, or they might
47:43have subclinical anemia, and they are
47:45not diagnosed, and the only symptom
47:46they have is atrophic tongue.
47:48>> Does the movement increase the more the
47:51iron is low or...?
47:53>> It could be the more established the
47:55anemia is.
47:57>> The more severe the symptoms are, okay,
47:59persistent, and the pain becomes
48:02constant. Okay everyone, the stronger
48:05the anemia symptoms are, the burning
48:07sensation could reach the point of no
48:10remission. Meaning, it’s not just
48:11that the patient feels pain when they
48:12come to eat. They might have a burning
48:14sensation without anything, even with
48:16water, it's possible. Just by
48:18swallowing water or saliva, they still
48:20have this sensation of pain. It is
48:23glossitis and...Anemic glossitis.
48:32Anemic glossitis is a general term for
48:34all glossitis that occurs due to anemia
48:36. Whether it's iron deficiency anemia,
48:40folate anemia, B12 anemia, okay, anemia
48:43in general.
48:45>> Okay, now we want to detail each anemia
48:48that causes glossitis, wait, okay,
48:51start with glossitis.
48:54>> Yes. Okay. Fine. We want to break down
48:57every disease that causes glossitis.
48:58First, we mentioned anemia. One type of
49:00anemia is iron deficiency anemia. The
49:03good thing about anemia is that to
49:04diagnose it, we don't just look at
49:06hemoglobin. I don't just ask the
49:08patient to do a normal CBC. Okay. A
49:10regular complete blood count. Patients
49:12with anemia might have normal
49:15hemoglobin. But their iron stores are
49:1714 or 13. The minimum is 25, so 13 or
49:2114 is considered iron deficiency anemia
49:24. Iron stores might be normal or at the
49:28lower limit. But the ferritin is very
49:31low in these patients. These are also
49:33considered iron deficiency anemia.
49:35Symptoms of glossitis might appear in
49:37them. Okay. Hemoglobin isn't our only
49:39metric. Not just hemoglobin. Ever see
49:42someone eat pineapple and their tongue
49:44burned and started bleeding? Bleeding
49:47as well.
49:48>> Could it be that they have
49:49hypersensitivity?
49:51>> We found out later that they had an
49:53iron deficiency, so maybe.
49:57>> Maybe they had glossitis; you know
49:58pineapples have very strong enzymes, I
50:00mean anyone who has eaten fresh
50:02pineapple.
50:04>> When you eat pineapple, your tongue
50:06tingles, right? Okay, pineapple has
50:09strong enzymes.
50:10>> These enzymes can cause tongue
50:12irritation. Imagine someone already has
50:15subclinical glossitis without very
50:17strong symptoms. Okay, and they went
50:19and ate pineapple, it could progress to
50:21severe depletion. And reach the point
50:24of ulceration. Okay, because of the
50:26enzymatic activity. So, it is. The good
50:31thing about iron deficiency anemia is
50:33that when the patient starts
50:34supplementation, their symptoms improve
50:37a lot. Okay, especially if they have
50:40severe iron deficiency. Once they start
50:42supplementation, in a week or two,
50:44symptoms [improve]. But if the anemia
50:47is mild, not very strong, the anemia
50:50takes time to improve once they start
50:52supplementation. Supplementation can be
50:55pills that the patient takes. It could
50:58be a suspension like Sideral, which is
51:00very famous. That it is. Liposomal.
51:07Iron or Fe-conjugated. So the efficacy
51:10is very high. And it could also be iron
51:13. Okay, iron by IV injection. It
51:19appears clinically, as we said, a
51:21quarter of patients have glossitis.
51:25They have. Look at this tongue, how it
51:32shines, it has lost its [texture]. It
51:35lost the filiform papillae here. A
51:37smooth tongue, if I feel it, it is
51:39smooth, unlike normal tongues. There is
51:42a very important symptom we have here.
51:45>> Angular cheilitis.
51:47>> Inflammation of the corners of the
51:50mouth, angular cheilitis, so why do
51:52these patients with iron deficiency
51:54have it? So it's as if they are biting
52:00here, or it's affected.
52:04>> What is it?
52:06>> No, this is iron deficiency. Okay? Why,
52:10guys? Because iron deficiency is a
52:13factor for Candida infection. These
52:18patients are very prone to getting
52:20Candida infection because of the iron
52:22deficiency. So it's possible they have
52:25it because of the iron deficiency. And
52:30the Candida transferred to the corner.
52:32And caused us. Very well known. Those
52:37who have it, they get. It creates white
52:43. We moved on. Types of Candida
52:48infection. We have candidiasis, okay.
52:54>> Okay, we mentioned the treatment of
52:55iron deficiency, supplementation of
52:57various kinds improves the symptoms,
52:59especially if the patient is severe.
53:01What are the causes of anemia? Why am I
53:03telling you it's important to know the
53:05causes of anemia? Because it helps us
53:07diagnose the patient. Females are more
53:10prone to iron deficiency anemia.
53:12Especially females who suffer from
53:15heavy menses. It happens every month.
53:16They have a trend. After every. The
53:22female might have. She has, okay. What
53:28is the most common cause in males?
53:30Males get iron deficiency. Hemorrhage,
53:34meaning an accident. A fight happened.
53:36There was bleeding in it. He might lose
53:38blood. He gets iron deficiency. Also,
53:44patients who have hemorrhoids, or what
53:46are called piles, these hemorrhoids
53:49might bleed. The patient might not be
53:51aware of this bleeding. Because the
53:54bleeding is actually inside the large
53:56intestines. It comes out with the feces
53:58, with the stool. It shows as, it
53:59doesn't show. Because it is occult
54:01blood. It doesn't show except by a
54:04feces test or a stool test. This could
54:07eventually make the patient anemic.
54:11Imagine you are losing blood 24 hours a
54:13day or an open wound. This could lead
54:16the patient into anemia. What else do
54:19we have? Patients who suffer from
54:21intestinal carcinoma. They might get
54:24anemia. Okay. Why intestinal carcinoma?
54:27They also have ulcers. Bleeding might
54:30occur there. Okay. They lose blood.
54:33These patients have absorption problems
54:35. They have malnutrition. They cannot
54:38eat well. Okay.
54:40>> Meaning they have a failure to absorb
54:42iron coming from food.
54:45>> It's possible, and they might have
54:46bleeding from the ulcers that occur in
54:48them, and they might not be able to eat
54:50, they lack appetite.
54:53>> And if they take nutritional
54:55supplements, it means, like, a pill.
54:57>> You have to treat the cancer.
54:59>> Ah, it still won't be absorbed.
55:02>> You have to treat the cancer. We have a
55:04syndrome associated with. Chronic iron
55:09deficiency anemia called Paterson
55:11syndrome or Plummer-Vinson syndrome.
55:14Plummer-Vinson syndrome, Plummer. What
55:17does Plummer mean in English? Plumber,
55:19do you know it? In the Emirates we used
55:22to call them pipe fitters.
55:24>> What does plumber mean?
55:25>> The plumber, the pipe guy.
55:27>> Ah, okay.
55:28>> In our Palestinian language, "mowasarji
55:31," okay.
55:32>> Plummer, the mowasarji, the plumber and
55:35the pipe fitter. The first people who
55:39discovered it or the first people
55:41diagnosed with Plummer-Vinson syndrome
55:43in America was Plummer. He was a
55:46plumber or a pipe guy. That's why it's
55:48named. The syndrome in other literature
55:53outside the planet America is called
55:56Paterson syndrome. Okay, what is in
55:58this syndrome? The symptoms of this
56:00syndrome share a group of symptoms.
56:02First of all, chronic iron deficiency
56:04anemia. As a result of this, the
56:06patient always has glossitis in
56:08addition to angular cheilitis. And the
56:11patient is. They also have constriction
56:13in the esophagus. In the esophagus, or
56:18a narrowing in the, what, the esophagus
56:21. These patients, it's not easy for
56:23them to swallow all the food.
56:24Unfortunately, these patients are more
56:27prone to developing pharyngeal cancer.
56:30Okay, they have a high risk of
56:32developing pharyngeal cancer. Look at
56:35the mowasarji. The plumber has
56:38glossitis. He has angular cheilitis.
56:40And he has iron deficiency anemia. In
56:42addition to esophageal webs or
56:44constriction. Look at the esophagus,
56:46how. There is a constricted area. Then
56:48it's expanded. Then it goes back.
56:50Constricted, this is the reason why
56:53pharyngeal cancer might occur.
56:57>> It is associated with pharyngeal cancer
56:58, it is not the reason he gets
57:00pharyngeal cancer. These people are
57:03more prone because of the syndrome they
57:05have, because of the genetic mutation
57:06they have, they are predisposed to
57:08getting pharyngeal cancer, okay.
57:10>> Pharyngeal.
57:12>> Pharyngeal.
57:12>> What is the cause of this syndrome? A
57:15genetic mutation, okay.
57:17>> Meaning it has nothing to do with work
57:19stress?
57:20>> No, no.
57:21>> No, but when they discovered it,
57:26>> that is why they called it
57:26Plummer-Vinson. Alright, B-group
57:29vitamin deficiency, we are finished
57:31with that. Anemia, iron deficiency
57:33anemia. We want to look at other
57:35deficiencies that cause different
57:37anemias. The most famous one of the B
57:39vitamin deficiencies, vitamin B12
57:41deficiency. Okay. We have a group of
57:44people who lack the intrinsic factor
57:46that helps with vitamin B12 absorption;
57:48they have a type of anemia called
57:50pernicious anemia. Okay. These patients
57:53lack...the factor that helps absorb
57:58vitamin B12, but there are other
58:01reasons that cause patients to have
58:03vitamin B12 deficiency. Like patients
58:06who undergo bariatric surgery. Okay.
58:09Weight loss surgeries, bypasses,
58:12gastric sleeve. All of these affect
58:15what? The absorption of vitamin B12
58:19from food. Also, alcoholic patients who
58:23drink; alcohol affects B12 absorption
58:26greatly, as well as those with colitis,
58:29inflammatory disease, and patients who
58:32also have Graves 'disease, it is known
58:34to be associated with vitamin B12
58:37deficiency. One of the most important
58:41symptoms of vitamin B12 deficiency is
58:43that 50%of people develop glossitis,
58:46okay. Along with glossitis, we have a
58:49burning sensation. However, it has a
58:52key, a key that distinguishes vitamin
58:54B12 deficiency. Which is the tongue;
58:57the texture of the tongue becomes "
58:59beefy" in appearance, and its texture
59:01becomes beefy. What does beefy mean?
59:03Meat. If it is a piece of meat, okay,
59:06the tongue is not a piece of meat.
59:08>> It does not look like meat. But in
59:10vitamin B deficiency, actually, its
59:13texture and shape become like beef. If
59:18we want to test our patient, or if we
59:21suspect they have vitamin B12, I
59:23perform a vitamin B12 test, and I can
59:26also see it in the CBC. High. I would
59:32have...some vitamin. We looked here...
59:48he ended up with...feeling pain. And it
59:57looks like a piece of meat. Okay. Here
1:00:00I also have a vitamin B12 deficiency.
1:00:05Like this one did not turn into beefy.
1:00:08But look here in this area. And we have
1:00:12...what is it called?
1:00:19>> What does it mean that...
1:00:24>> like glass.
1:00:25>> Ah, okay.
1:00:27>> Okay.
1:00:28>> Doctor, should we say elongated? No.
1:00:32>> Elongated?
1:00:34>> No.
1:00:36>> No, God created this tongue of his long
1:00:38.
1:00:38>> But, no, it does not happen at all.
1:00:43>> Alright, there is a name you mentioned
1:00:46in the slide before, what was the name
1:00:48for microcytosis? MCV, Mean Corpuscular
1:00:53Volume, MCV, this shows up in the CBC.
1:00:58>> Okay, it is high. This indicates that I
1:01:01have microcytosis. Alright, we have
1:01:03another deficiency, which is folic acid
1:01:05or folate. Also one of the vitamins, or
1:01:10vitamin B9, it is not as common as
1:01:12vitamin B12 deficiency. 2 to 4%of
1:01:16patients have folic acid or folate
1:01:19deficiency. It is also accompanied by
1:01:22glossitis with a burning sensation. How
1:01:25do we test for it? Serum folate or red
1:01:28blood cell folate. The most affected
1:01:33people are alcoholics. Okay, as soon as
1:01:36the patient starts taking folic acid,
1:01:39their symptoms improve. Riboflavin or
1:01:44vitamin B2 deficiency. Vitamin B2
1:01:47deficiency can also cause glossitis. It
1:01:50is very rare for a patient to have
1:01:52riboflavin deficiency. But when it does
1:01:55occur, we get glossitis. And what is
1:01:58characteristic of it, along with the
1:02:00glossitis, is angular cheilitis.
1:02:04>> Like any other deficiency. And, um.
1:02:14There is also, Okay. We also have
1:02:20niacin or Vitamin B, which is often
1:02:23associated with it. Or it must be
1:02:32according to the specific deficiency. I
1:02:35don't just treat the patient by giving
1:02:38them multivitamins or B-complex
1:02:40vitamins, okay. That is not enough. I
1:02:43go and perform a panel for every test,
1:02:45a panel for all the Vitamin Bs. I see
1:02:47what is missing. I start giving them
1:02:50the missing vitamin in high doses so
1:02:52their deficiency improves. Then, I
1:02:54might give them maintenance, which is
1:02:57the multivitamins or B-complex.
1:03:00Otherwise, they won't benefit. Because,
1:03:02in reality, the percentages of B
1:03:04vitamins in complexes and multivitamins
1:03:06are not very high. They don't resolve
1:03:08the deficiencies, okay. We must focus
1:03:11on what is missing and treat what is
1:03:13missing. There is also another disease
1:03:16that can affect the tongue besides
1:03:18glossitis. We have now almost covered
1:03:20the diseases that can cause glossitis.
1:03:23It involves glossitis, macroglossia.
1:03:26>> Macroglossia, by definition. Okay. We
1:03:31have two causes. We have macroglossia.
1:03:37We have false macroglossia. True
1:03:40macroglossia means the tongue is truly
1:03:42larger than the normal size. Okay.
1:03:45False macroglossia is when the tongue
1:03:48size is normal. But because the muscle
1:03:51tonicity decreased, it appears larger.
1:03:55When the tongue is normal, it is tense.
1:03:59It takes this shape. When the nerve
1:04:02supply is affected and the tongue tone
1:04:06decreases, it spreads out. Okay. So it
1:04:10grows laterally. Now, its size isn't
1:04:12actually larger. But because its
1:04:14tonicity decreased, it spreads out and
1:04:17looks larger to me.
1:04:18>> What does tonicity mean?
1:04:20>> Tongue tonicity means the muscle
1:04:22tension.
1:04:23>> Normally, our tone is always tense.
1:04:25>> Now, if it is hypotonic, it relaxes—
1:04:28look, it was tense.
1:04:30>> It relaxed, okay, and it appears larger
1:04:32to me. My hand spreads out more—
1:04:34it’s the same size, right? But while
1:04:36it is here, it takes up less space, and
1:04:38while it is relaxed, it takes up more
1:04:40space laterally. What else for patients
1:04:43who have hypotonicity? What else?
1:04:46>> They have a protruded tongue; they keep
1:04:48their tongue moved forward like this.
1:04:53>> We see this a lot in patients who have
1:04:54Down syndrome.
1:04:56>> Okay.
1:04:58>> But this was a matter of debate last
1:05:01year between me and the students. I
1:05:04will get to that. Okay, let's go back
1:05:06to this picture. This patient has a
1:05:09hemangioma, a congenital hemangioma.
1:05:12Hemangioma, which is vessels, and we
1:05:14get a collection of blood flow. This
1:05:17blood actually creates a true
1:05:19macroglossia for me. Size, but it's
1:05:23ventral.
1:05:25>> That was glossitis, that was something
1:05:27else.
1:05:28>> Varicosities are something else. No,
1:05:30here I have an enlargement of the
1:05:32tongue. Okay. More blood starts to
1:05:36collect in it. So it actually gives us
1:05:38a true macroglossia. The tongue size
1:05:40increases as you can see. Okay. Well,
1:05:43we also have syndromes with
1:05:45macroglossia like Down syndrome. This
1:05:48is where the disagreement was between
1:05:50me and the previous class. I gave them
1:05:52a question on the midterm. Down
1:05:53syndrome and macroglossia. A group of
1:05:57people put true. A group of people put
1:06:00false. They said to me, "Why, Doctor?"
1:06:01No. Those with Down syndrome have
1:06:04hypotonicity. It is written in the book
1:06:07that those with Down syndrome have
1:06:09hypotonicity. Okay. And it is noted
1:06:11here that I have true macroglossia.
1:06:13What happened?
1:06:14>> There are two.
1:06:15>> Now, he has true macroglossia and he
1:06:17has hypotonia, but he does have true
1:06:19macroglossia.
1:06:20>> So, the correct answer is that it is
1:06:22true; okay, she put it for them at the
1:06:24end, the reason is. The muscle size is
1:06:28equal to.
1:06:29>> No, the true one, its size is large.
1:06:31>> Ah.
1:06:31>> Its size is large; now, in Down
1:06:33syndrome, the size is large and also
1:06:35the tonicity is low, so the patients'
1:06:37tongues are always large and always
1:06:39what?
1:06:40>> Retro.
1:06:40>> It protrudes forward.
1:06:42>> Does it cause an open bite, or?
1:06:44>> They have many problems, not because of
1:06:45that, meaning, yes, correct.
1:06:48>> They don't have an open bite. Because
1:06:51they have a protruded tongue, okay. But
1:06:53they might have problems. Problems,
1:06:57they have hypodontia. Okay, they have
1:07:00spacing. They also have impacted teeth.
1:07:06They have other problems, okay, which
1:07:08are there for them. Originally, for it
1:07:11to be large. It has a cause. For
1:07:17example, a hemangioma could make the
1:07:20tongue, as we saw now in the picture,
1:07:22Down syndrome, the tongue is large,
1:07:24cretinism, guys. It is from. It is.
1:07:32They are born with a problem in the
1:07:35gland. They get macroglossia. Those who
1:07:39have, okay. Or acromegaly, okay. They
1:07:43get enlargement in the hands, feet,
1:07:45skull, and mandible. And in addition to
1:07:49that, they have true macroglossia, okay
1:07:51. Also, patients who have lingual
1:07:54thyroid, part of it is present on the
1:07:56tongue. So the tongue size appears and
1:07:59there is actually extra tissue, okay. I
1:08:02have mucopolysaccharidosis. Also one of
1:08:06the diseases where the tongue gets
1:08:08larger in it. And we have a disease now
1:08:11we will study extensively, which is
1:08:13amyloidosis, okay. These patients have
1:08:16acromegaly, okay. That patient has
1:08:18cretinism.
1:08:20>> Doctor, we said earlier that the glands
1:08:24are at the tongue base then they
1:08:27migrate.
1:08:29>> These, meaning sometimes part of it is
1:08:32true.
1:08:33>> A part of the thyroid remains on the
1:08:35tongue, extended in the tongue.
1:08:38>> Part no, it is here and part is also
1:08:40present on the tongue, part of it
1:08:41remains on.
1:08:44>> That is not active, but the one that is
1:08:47not active, but it gives you that
1:08:48macroglossia, okay, Down syndrome, we
1:08:50consider it true, true, true hypotonia.
1:08:53>> What do you want with the hypotonia? He
1:08:55has a large tongue. But he also has
1:08:57hypotonia. Okay. You can't say true or
1:09:00false. It is true only when the size is
1:09:02large. He has a large size. Okay.
1:09:04Alright, amyloidosis. Amyloidosis.
1:09:08Amyloidosis is a condition or a disease
1:09:11. It happens with the deposition of an
1:09:14abnormal protein called amyloid.
1:09:17Amyloid. Amyloid is not a normal
1:09:20protein in the blood or in the body.
1:09:23Okay. It is secreted by plasma cells.
1:09:26In some diseases like malignancy of the
1:09:28plasma cell. Amyloid is secreted.
1:09:31Amyloid is part of the light chain
1:09:33secreted by the plasma cell. Naturally,
1:09:37amyloid does not undergo deposition in
1:09:39tissue. But in amyloidosis, I find that
1:09:43amyloid has undergone deposition on the
1:09:45tongue. Okay. When it undergoes
1:09:48deposition on the tongue, the tongue
1:09:50size increases and it becomes
1:09:52macroglossia. Amyloidosis can also
1:09:55undergo deposition on the kidneys.
1:09:57Amyloidosis can undergo deposition on
1:10:00the salivary glands. Of course, any
1:10:02deposition in an abnormal area might
1:10:05affect the function. In the kidney, it
1:10:08can cause kidney failure or reduced
1:10:10kidney function. In the salivary glands
1:10:12, it can cause hyposalivation. Okay. It
1:10:15has a color.
1:10:17>> It has a color; I know its natural
1:10:19color, but I know it's eosinophilic
1:10:22when I examine it under the microscope.
1:10:25It likes eosin, so it stains red.
1:10:27>> Okay, I don't know the natural color.
1:10:31>> Well, we have a panel of amyloid
1:10:34proteins. I care about the top one; I
1:10:37care about the AL. The AL or the
1:10:39immunoglobulin light chain. It is
1:10:42secreted by plasma cells in certain
1:10:44neoplasms. It causes deposition on the
1:10:47tongue. It leaves me with a
1:10:49macroglossia effect. Okay. How can I
1:10:55manage a patient who has it? It is done
1:11:00through a biopsy. I take a sample from
1:11:02the tongue. I see if I have amyloid
1:11:05protein inside the tongue. Okay. How
1:11:09else can I diagnose a patient with
1:11:11amyloidosis? Through a blood test. Okay
1:11:15. I check for the presence of amyloid
1:11:17or light chains in the blood. If they
1:11:20are very high, it means we can confirm
1:11:23the amyloid. Where is amyloid found? An
1:11:27important point. Where is it found?
1:11:28Amyloidosis occurs in two places. On
1:11:33the cell, okay, and around the vessels,
1:11:38and around. It likes to stain red. Okay
1:11:47. Let's come and see. In histopathology
1:11:51, the presence of amyloid. I have here
1:11:54three samples of the tongue from a
1:11:56patient with amyloidosis. In patients
1:11:59with amyloidosis, I see in the
1:12:01connective tissue a deposition of
1:12:03abnormal protein. It is not normal for
1:12:05this to be in the connective tissue.
1:12:07What is connective tissue made of?
1:12:09Collagen, okay, elastin, and ground
1:12:12substance. I don't have amyloid. So
1:12:14when I, and amyloid likes eosin. So
1:12:17when I take a sample from a patient
1:12:20with amyloid and stain it, I find that
1:12:22I have samples or places in the
1:12:24connective tissue stained more red than
1:12:27others. I know that I have amyloid here
1:12:30. Here I have another stain, the Congo
1:12:33Red stain. Do you see this that is
1:12:35stained red? This is all amyloid
1:12:38deposited in the connective tissue of
1:12:40the tongue. And here I have
1:12:41immunofluorescence. This visible or
1:12:44fluorescent green light is the antibody
1:12:46against the amyloid. So when I got a
1:12:49positive result or it gave me this
1:12:51signal, surely I have amyloid and
1:12:53amyloidosis here. Doctor, we said it's
1:12:56on the tongue, how do we treat it?
1:13:00>> No, it's in the blood; it spreads to
1:13:02several tissues, to the tongue, the
1:13:05kidneys, the salivary glands.
1:13:09>> Clinically, how does a patient with
1:13:11amyloidosis appear? Amyloidosis can be
1:13:13florid, spread over the whole tongue
1:13:15like this patient. Okay, it could be
1:13:18like this patient in a large area. It
1:13:21could be nodular like this patient and
1:13:23this patient. Okay, what is the
1:13:25management for a patient with
1:13:27amyloidosis? If the patient is bothered
1:13:30by the size, and it starts affecting
1:13:33speech and swallowing. Okay, and the
1:13:36resting position, and he is unable to
1:13:38breathe, I do a reduction for them.
1:13:40Okay, but we actually have to do what?
1:13:44The underlying cause. If it is due to a
1:13:46malignancy in the plasma cell, the
1:13:49patient must treat the plasma cell
1:13:51malignancy. Okay. It causes
1:13:58inflammation. Okay, because I have
1:14:01erosion in the tongue. How do I
1:14:04distinguish it? I find I have
1:14:06reticulation. Do you remember lichen
1:14:09planus? Its key is Wickham striae, like
1:14:13a football net. Okay, lichen planus
1:14:19with. White lines like lace that are
1:14:25present in. I find it, or. Or it helps
1:14:39me in the treatment. Okay, median
1:14:45rhomboid glossitis is also a fungal
1:14:47infection that affects the mid-portion
1:14:50of the tongue. Okay, unfortunately, it
1:14:53causes scarring and does not heal. But
1:14:55how can I differentiate it from other
1:14:58types of glossitis or depletion? I
1:15:00would have. Okay, the thrush, which is
1:15:04candidiasis, is easily wiped off or a
1:15:07membrane. Candida. We also mentioned
1:15:17infection. Okay. Okay, it causes
1:15:25infection for us. Accompanying it. In
1:15:31most cases.
1:15:33>> Xerostomia or hyposialia, depending on
1:15:36its grade: mild, moderate, or severe.
1:15:40Mild and moderate result in dryness,
1:15:43okay. Severe, with glossitis, results
1:15:46in cracking and fissuring. This is what
1:15:50I see most in Sjögren's syndrome, it
1:15:53is severe, yes.
1:15:56>> Do you see the cracking?
1:15:58>> Do you see the fissuring? But it is
1:15:59also accompanied by a glossy tongue. We
1:16:02have depletion. Okay, regarding
1:16:06ulceration, the most common site for
1:16:09trauma is the lateral borders, and the
1:16:11inner border is the carcinoma. The last
1:16:15thing for today, it causes us
1:16:16ulcerations. Most of them are on the
1:16:19lateral borders of the tongue. The
1:16:24characteristic of carcinoma is
1:16:26non-healing. Raised, its borders are
1:16:29rolled. And we might have necrosis in
1:16:31the middle. Thank you, I will take
1:16:33attendance. No.

About this transcript

This page contains the full transcript of Tongue Disorders by DentalScholar, generated from the public captions YouTube serves with the video. The transcript has 10,044 words across 1,632 segments, with the original timestamps preserved so you can click any line to jump to that moment in the embedded player.

What you can do with it

Use the transcript to take notes, quote the speaker, build a study guide, generate a summary with ChatGPT or Claude via the YouTube Summary tool, or export it as a timed subtitle file with YouTube to SRT. You can also re-open it in the transcriber to choose a caption track available on the video.

Free YouTube transcript tool

YouTube2Text is a free YouTube transcript generator — no signup, no daily limit. Paste any YouTube link and get the full transcript instantly, with timestamps, click-to-jump, caption language selection, AI prompts for ChatGPT, Claude, and Gemini, and exports to TXT, SRT, VTT, or Markdown.