Tongue Discoloration Research Articles

Drug-induced Tongue Disorders: A Comprehensive Literature Review.

Some drugs cause tongue disorders as adverse effects. Most of the druginduced tongue disorders are benign and will resolve after drug discontinuation. However, the changes in the color or appearance of the tongue may frighten patients and decrease compliance with drug therapy. To review the literature to find all reports of drug-induced tongue disorders, their presentation, management, and outcome of patients Methods: The search was conducted in Google Scholar and PubMed using key words "ageusia," "burning tongue," "coated tongue," "drug-induced taste disturbances," "dysgeusia," "glossitis," "glossodynia," "hairy tongue," "hypogeusia," "stomatodynia," "stomatopyrosis," "swollen tongue" "tongue discoloration," "tongue irritation," "tongue numbness, "tongue oedema," and "tongue ulcer. All reports that were published from 1980 to 2022 in the English language were included in the study. Reports that were not in English language but had English abstracts with adequate data for extraction were also included. A total of 208 case reports and case series were included. The most reported drug classes were antineoplastic and immunomodulating agents and anti-infectives for systemic use, and the most common tongue disorders were tongue discoloration and black hairy tongue. Having good oral hygiene and discontinuing the offending drug could manage and resolve the problem. Drug-induced tongue disorders are not rare adverse drug reactions. They are benign in most cases, and withholding offending agents results in significant improvement or complete resolution of tongue lesions.

Hyperpigmentation on the dorsal tongue

•A 73-year-old man had hyperpigmentation on the dorsum of the tongue.•His-symptoms were consistent with addison's disease from metastatic adrenal tumors.•Hyperpigmentation in addison's disease can occur anywhere due to various stimuli.•Hyperpigmentation could indicate susceptibility to acute adrenal insufficiency. A 73-year-old man diagnosed with brain metastasis from non-small cell lung carcinoma, not otherwise specified (NSCLC-NOS), was hospitalized for 1 week due to anorexia. A computed tomography revealed a 16.5 mm irregular-shaped nodule in the right lung apex, lymphadenopathy of the mediastinum, mesentery, and peri-aorta, and bilateral adrenal enlargement (46.3 and 48.7 mm in diameter). About 1 week before admission, his systolic blood pressure, which was approximately 110 mmHg suddenly dropped to approximately 80 mmHg. Simultaneously, his fasting blood glucose, also decreased to approximately 100 mg/dL from 200 mg/dL with a fever of 38 °C; he had poorly controlled type 2 diabetes. Since he had an electrolyte disorder with hyponatremia of 131 mEq/L and a slightly high serum potassium level of 5.7 mEq/L, he was referred to our department. A physical examination revealed hyperpigmentation on the dorsum of his tongue, which he reported had been present for 3 months prior to admission (Fig. 1A). What is the diagnosis? The symptoms are consistent with Addison's disease due to metastatic bilateral adrenal tumors. His-early-morning fasting blood cortisol (9.98 µg/dL) was inappropriately low against a markedly high adrenocorticotropic hormone (ACTH) level (145 pg/mL). His-dehydroepiandrosterone-sulfate level (11 µg/dL) was disproportionately low. Additionally, his plasma aldosterone concentration was <4.0 pg/mL, which is inappropriately low against the active renin concentration of 14.26 pg/mL, suggesting that his bilateral adrenal metastases impaired adrenal steroidogenesis in all layers of the adrenal cortex. The comparatively lower blood glucose, hypotension, and hyperkalemia are compatible with fever-induced acute adrenal insufficiency, which requires hydrocortisone and fludrocortisone replacement. One month following treatment initiation, the tongue discoloration disappeared (Fig. 1B). The coupling of pro-opiomelanocortin (POMC) peptides, α–melanocyte-stimulating hormone, and ACTH with the melanocortin-1 receptor stimulates melanogenesis [[1]Buscà R. Ballotti R. Cyclic AMP a key messenger in the regulation of skin pigmentation.Pigment Cell Res. 2000; 13: 60-69https://doi.org/10.1034/j.1600-0749.2000.130203.xCrossref PubMed Scopus (664) Google Scholar,[2]Wolf Horrell E.M. Boulanger M.C. D'Orazio J.A Melanocortin 1 receptor: structure, function, and regulation.Front Genet. 2016; 7: 95https://doi.org/10.3389/fgene.2016.00095Crossref PubMed Scopus (136) Google Scholar]. In Addison's disease, decreased negative feedback to the hypothalamus and pituitary due to reduced adrenal cortisol secretion increases POMC peptides, causing hyperpigmentation, which tends to occur in areas exposed to ultraviolet, chronic friction, and pressure [[3]Dunlop D. Eighty-six cases of Addison's disease.Br Med J. 1963; 2: 887-891https://doi.org/10.1136/bmj.2.5362.887Crossref PubMed Scopus (153) Google Scholar]. Furthermore, the pigmentation generally occurs on the side of the tongue touching the teeth. The patient had consistently brushed his tongue with a toothbrush and believed the friction might have caused hyperpigmentation; thus, when hyperpigmentation is observed in high-risk patients, they should be informed that they are susceptible to acute adrenal insufficiency when under intense stress, such as fever or trauma.

Abnormal tongue discoloration following radioactive iodine-131 ablation therapy for papillary cancer thyroid

Category: Head and neck

Effect of Electronic Cigarettes on the Gastrointestinal System.

Introduction: In the United States, the use of electronic cigarettes (EC) has seen an exponential rise with 12.6% of adults using an EC at least once in their lifetime, with use differing by age, sex, and race. The level of nicotine exposure of EC is highly variable with its liquids containing 14.8-87.2 mg/ml of nicotine. Its use has been documented to be associated with adverse effects on the respiratory, nervous, cardiovascular, and gastrointestinal (GI) systems. Common adverse effects on the GI system include xerostomia, oral mucositis, tongue discoloration, gingivitis, gum bleeding, nausea, vomiting, gastric burning, and altered bowel habits.Methods: A retrospective review of the National Health and Nutrition Examination Survey (NHANES) data from 2015-16 was conducted. Data regarding the use of EC and a history of vomiting and diarrhea over a period of 30 days was analyzed using SAS 9.4 (2013; SAS Institute Inc., Cary, North Carolin, United States). Additionally, data regarding age, gender, and income were also analyzed. A p-value of <0.05 was considered statistically significant. Continuous variables were analyzed using the two-sample t-test, and categorical variables were analyzed using the Chi-Square test.Results: A total of 944 participants were included in the study. Of these, 261 participants (males 62.84%) used EC at least one day and 683 participants (males 54.76%) never used EC, during the preceding 30 days. Amongst EC users (n=261), 10.73% had a stomach or intestinal illness manifesting as vomiting or diarrhea that started during those 30 days compared to 8.64% who never used EC during the same period (n=683). However, the results did not reach statistical significance (p = 0.3208)Conclusion: Conflicting views exist regarding the effects of EC on the GI tract. Our study demonstrated an association between EC consumption and vomiting and diarrhea. The study results are to be viewed by taking into consideration the limitations of a smaller sample, shorter duration, comorbidities, and undefined nicotine content in the EC. Although recent studies have shown no effect of EC on the oral or gut microbiota, our study findings could be attributed to EC-induced alteration of motility or irritation of the GI tract. However, further studies are required to establish a causal relationship and enunciate the mechanism by which EC components affect the GI tract. Careful consideration and diligence about the health effects of ECs are required before it is assumed to be safe as a cigarette substitute or as a means of smoking cessation.

Oral Tissue Involvement and Probable Factors in Post-COVID-19 Mucormycosis Patients: A Cross-Sectional Study.

The primary goal of this study was to assess the prevalence of oral involvement and, secondarily, the likely variables in patients with confirmed COVID-19 accompanied by mucormycosis infection. The study design was a cross-sectional descriptive sort that was performed at a tertiary centre. The non-probability convenience sampling approach was used to determine the sample size. Between May 2021 and July 2021, all patients who presented to our tertiary care centre with suspected mucormycosis were considered for the investigation. The research only included individuals with proven mucormycosis after COVID-19. The features of the patients, the frequency of intraoral signs/symptoms, and the possible variables were all noted. Of the 333 COVID-19-infected patients, 47 (14%) were diagnosed with confirmed mucormycosis. The mean (SD) age of the patients was 59.7 (11.9) years. Of the 47 patients with confirmed mucormycosis, 34% showed sudden tooth mobility, 34% expressed toothache, 8.5% reported palatal eschar, 34% presented with jaw pain, 8.5% had tongue discoloration, and 17% had temporomandibular pain. About 53% of the patients were known cases of type 2 diabetes mellitus, 89% of patients had a history of hospitalization due to COVID-19 infection, 89.3% underwent oxygen support therapy, and 89.3% were administered intravenous steroids during hospitalization due to COVID-19 infection. About 14% of the suspected cases attending the mucormycosis out-patient department (OPD) had been confirmed with definite mucormycosis. Oral involvement was seen in 45% of cases of CAM (COVID-associated mucormycosis). The most frequent oral symptoms presented in CAM were sudden tooth mobility and toothache. Diabetes and steroids were the likely contributing factors associated with CAM.

Efficacy of Chitosan and Chlorhexidine Mouthwash on Dental Plaque and Gingival Inflammation: A Systematic Review.

Mouthwash is the effective chemical plaque control mechanism being practiced globally. Teeth and tongue discoloration, a temporary change in taste perception, an increase in calculus deposits, a burning sensation, and genotoxicity of buccal epithelial cells are all possible side effects. This review evaluates the efficacy of chitosan mouthwash in comparison to chlorhexidine mouthwash in combating plaque accumulation and gingival inflammation. Electronic databases such as Medline, Cochrane, LILACS, TRIP, Google scholar, and clinical trial registries (CTRI) for ongoing trials were searched with appropriate medical subheadings (MeSH) and search terms. Randomized clinical trials comparing the efficacy of chitosan mouthwash and chlorhexidine mouthwash on dental plaque accumulation and gingivitis were included. The outcome variables of interest were plaque index, gingival index, gingival bleeding index, and colony-forming unit (CFU/ml). All data from the included studies were extracted in a customized extraction sheet. The risk of bias across the studies was assessed using the Cochrane tool for intervention (ROB-2), which consisted of six domains. Of the included three studies, we found one study with an overall low risk of bias and two studies with an overall high risk of bias across the domains. Though there was a significant reduction in plaque accumulation, gingival inflammation, and colony-forming units on the use of chitosan mouthwash and chlorhexidine mouthwash separately, all three included studies reported that a combination of both be more effective.

Vitamin D Toxicosis in a Blue-Tongued Skink (Tiliqua scincoides) Presented with Epistaxis and Tongue Discoloration

A 10-yr-old intact blue-tongued skink (Tiliqua scincoides) of unknown sex presented for epistaxis and dyspnea. On physical examination, dysecdysis, necrosis of the tip of the tail, and a pink discoloration of the proximal third of the tongue were noted in addition to epistaxis, dyspnea, and tachypnea. Clinical pathology findings included marked polychromatophilia, moderate heterophilia with signs of toxicity, a regenerative left shift, and moderate hyperglycemia. Because of the suspicion of an infectious etiology, antibiotics were prescribed. Meloxicam was also administered without clinical improvement. Swelling of the pharyngeal area was noted on whole-body computed tomographic and magnetic resonance imaging. Oro-pharyngeal endoscopic-guided biopsies were performed under general anesthesia. Histology was consistent with moderate erosion and goblet cell hyperplasia. Plasma 25-hydroxyvitamin D3 concentration was 768 nmol/L and was interpreted as possible vitamin D toxicosis. Prednisolone was prescribed to enhance calciuresis and treat potential vasculitis, but the skink was ultimately euthanized. Histopathologic examination was consistent with vitamin D toxicosis. The diet of this skink mostly consisted of greens dusted with a supplement containing calcium and vitamin D3. This case report describes the challenges associated with antemortem diagnosis of a vitamin D toxicosis, even with current imaging techniques. It highlights that specific reference intervals should be established for 25-hydroxyvitamin D3 and ionized calcium concentrations in various reptile species. Clinicians presented with a blue-tongued skink displaying a pink tongue or tail necrosis should consider vitamin D toxicosis in their differential diagnosis.

Design and characterization of digluconate and diacetate chlorhexidine loaded-PLGA microparticles for dental applications

Chlorhexidine solutions are widely used in dentistry, from caries prevention to endodontic disinfection. This biguadine presents a broad spectrum and can be bacteriostatic/bactericide depending on the concentration and time-lapse used. Chlorhexidine diacetate (CDA) and digluconate (CDG) are the most common salts used in dental practice. While CDA saturation occurs at 2%, CDG presents higher solubity and is therefore used as diluted solutions or gels. CDG is the antiseptic of choice for oral rinses because it is less likely to irritate mucous membranes. Although it is very efficient in bacterial control, it presents some drawbacks such as teeth and/or restoration staining, taste alterations and tongue discoloration. Therefore, technological improvement is very desirable to promote its sustained release and avoid those issues. This study aimed to develop and characterize microparticles of chlorhexidine loaded poly (D,L-lactide-co-glycolide) (PLGA) for dental applications. CDA and CDG microparticles were prepared by spray-drying technique and characterized in terms of particle size, polydispersity (pdI), morphology, stability, yield of production, encapsulation efficacy (EE), drug loading (DL), cumulative release and antibacterial response. The yield of production showed the best result for CDA (over 71.56%). Morphological appreciation showed homogenous, spherical and non-aggregated microparticles. Particle size ranged from 1.01 to 3.07 μm, while pdI remained below 0.3. The microencapsulation process resulted in EE in the range of 7.05–34.72% and DL between 0.41 and 4.08%. The microencapsulation resulted in a controlled release pattern for both salts. CDA microparticles presented a more sustained pattern, while CDG presented a more pronounced burst effect. Finally, CDA and CDG content of the microparticles were able to inhibit Streptococcus mutans in vitro. Accordingly, the PLGA-based microparticles represent a suitable alternative for oral health applications where CDA and CDG in the solid-state and a controlled release pattern of chlorhexidine up to 120 days is strategic, such as in the composition of new dental materials with anti-caries properties.

Oral adverse effects: drug-induced tongue disorders.

ObjectivesDue to a worldwide increase in drug consumption, oral healthcare professionals are frequently confronted with patients using one or more drugs. A large number of drugs can be accompanied with adverse drug reactions in the orofacial region, amongst others of the tongue. This paper aims to give an overview of drugs that are known to be accompanied with tongue disorders.Materials and methodsThe national drug information database for Dutch pharmacists, composed of scientific drug information, guidelines and summaries of product characteristics, was analysed for drug‐induced tongue disorders. “MedDRA classification” and “Anatomical Therapeutic Chemical codes” were used to categorize the disorders.ResultsThe database comprises of 1645 drugs of which 121 (7.4%) are documented to be accompanied with tongue disorders as an adverse effect. Drug‐induced tongue disorders are predominantly observed in the following drug categories: “nervous systems,” “anti‐infectives for systemic use” and “alimentary tract and metabolism”. The most common drug‐induced tongue disorders are glossitis, tongue oedema, tongue discoloration and burning tongue.ConclusionHealthcare professionals are frequently confronted with drugs that can cause tongue disorders. The overview of drugs reported in this article supports clinicians in their awareness, diagnosis and treatment of drug‐induced tongue disorders.

Asymptomatic Transient Lingual Hyperpigmentation

A 77-year-old woman incidentally was noted to have black discoloration of the tongue during a routine dermatologic examination. The patient was unaware of the tongue discoloration and reported that her tongue appeared normal the day prior.

Asymptomatic Transient Lingual Hyperpigmentation

A 77-year-old woman incidentally was noted to have black discoloration of the tongue during a routine dermatologic examination. The patient was unaware of the tongue discoloration and reported that her tongue appeared normal the day prior.

2995 Gastrointestinal Upset: Could E-Cigarettes Be the Cause?

INTRODUCTION: In the United States, use of electronic cigarette (EC) has seen an exponential rise with 12.6% of adults using an EC at least once in their lifetime, with use differing by age, sex, and race. The level of nicotine exposure with EC is highly variable with its liquids containing 14.8 to 87.2 mg/ml of nicotine. Its use has been documented to be associated with adverse effects on the respiratory, nervous, cardiovascular, and gastrointestinal (GI) system. Common adverse effects on the GI system include xerostomia, oral mucositis, tongue discoloration, gingivitis, gum bleeding, nausea, vomiting, heartburn, and altered bowel habits. METHODS: A retrospective review of the National Health and Nutrition Examination Survey (NHANES) data between 2015-16 was conducted. Data regarding the use of EC and a history of vomiting and diarrhea over a period of 30 days were analyzed. Additionally, data regarding age and sex were analyzed. A P-value of &lt; 0.05 was considered statistically significant. Continuous and categorical variables were analyzed using the two-sample t-test and the Chi-Square test, respectively. All the analyses were done in SAS 9.4 (SAS Institute, Cary, NC). RESULTS: A total of 944 participants were included in the study. Of these, 261 participants (males 62.84%) used EC at least one day and 683 participants (males 54.76%) never used EC, during the preceding 30 days. Amongst EC users (n = 261), 10.73% had a stomach or intestinal illness manifesting as vomiting or diarrhea that started during those 30 days compared to 8.64% who never used EC during the same period (n = 683). However, the results did not reach statistical significance (P = 0.3208). CONCLUSION: Conflicting views exist regarding the effects of EC on the GI tract. Our study demonstrated an association between EC consumption and vomiting and diarrhea. The study results are to be viewed taking into consideration the limitations of a smaller sample, shorter duration, existing comorbidities, and undefined nicotine content in the EC. Although recent studies have shown no effect of EC on the oral or gut microbiota, our study findings could be attributed to EC induced alteration of motility or irritation of the GI tract. However, further studies are required to establish a causal relationship and enunciate the mechanism by which EC components affect the GI tract. Careful consideration and diligence about the health effects of EC is required before it is assumed to be safe as a cigarette substitute or as a means of smoking cessation.

The effect of a tooth/tongue gel and mouthwash regimen on morning oral malodour: A 3-week single-blind randomized clinical trial.

To compare the effects of a regimen consisting of a tooth/tongue gel, tongue cleaner and mouthwash with the effects of using standard fluoride dentifrice on the organoleptic oral malodour score (ORG) and volatile sulphur compounds (VSCs). A total, 66 non-dental students participated in a 3-week parallel, single-blind, randomized, controlled clinical trial. The test group used a tongue cleaner, a tooth/tongue gel and mouthwash containing amine fluoride/stannous fluoride and zinc lactate as oral malodour counteractive. The control group used a standard fluoride dentifrice. Measurements were taken in the morning at baseline, at days 1, 7 and 21. The primary outcome was the ORG score. The secondary outcome, the VSC measurement, was assessed using OralChroma™ (H2 S, CH3 SH, (CH3 )2 S) and Halimeter® . Tongue coating thickness and tongue discoloration were scored. At baseline and day 21, the participants' self-perceptions were assessed. At day 1 for the ORG, H2 S, CH3 SH and Halimeter® readings, a significant decrease was observed in the test group. At day 21, the decrease in H2 S and the Halimeter® outcomes were maintained for the test group, and a significant increase in tongue surface discoloration was observed. The test group evaluated their "morning breath upon awakening" as significantly better (P=.001) after 21days. A significant overnight effect on morning oral malodour was observed for most of the parameters in favour of the test group. At day 21, the effect of prolonged use was significant for H2 S and the Halimeter® readings, although not for the primary ORG outcome parameter.

Teeth and Tongue Discoloration After Linezolid Treatment in Children

We describe 3 children who developed teeth and tongue discoloration while receiving intravenous linezolid for 2 to 3 weeks. Linezolid was coadministered with piperacillin-tazobactam or meropenem. Teeth and tongue discoloration was reversible with dental cleaning after discontinuation of linezolid. We review the published pediatric and adult cases regarding teeth and tongue discoloration after linezolid administration.

Black Tongue Associated With Linezolid

Darkening of the tongue and oral mucosa is a reaction pattern that can be related to a number of physiologic, metabolic, and toxic disorders, and medications and exogenous substances. Black discoloration of the tongue should be distinguished from black "hairy" tongue, which is characterized by hypertrophy of the filiform papillae. We report a case of a 42-year-old man presented with a black discoloration of his tongue during treatment with linezolid for spondylodiscitis. So in conclusion, tongue discoloration is a benign and reversible condition and a probable adverse event associated with linezolid. We present this case to increase clinicians' awareness of a new potential adverse effect of linezolid.

Does linezolid-induced tongue discoloration need further investigation?

Does linezolid-induced tongue discoloration need further investigation?

Teeth and Tongue Discoloration During Linezolid Therapy

Teeth and Tongue Discoloration During Linezolid Therapy

Tongue discoloration in an elderly kidney transplant recipient: Treatment-related adverse event?

Background: With the increased occurrence of methicillin-resistant staphylococcus aureus infections, linezolid treatment might be administered more often. New rare adverse events are likely tofollow. Case Summary: A 65-year-old man (weight, 91 kg; height, 185 cm) presented to the emergency department at the University of Virginia-affiliated Salem Veterans Affairs Medical Center, Salem, Virginia, after a recent (8 weeks) kidney transplantation with a 24-hour history of fatigue, chills, arthralgias, increased urinary frequency, and onset of tongue discoloration. Two days before admission, he completed a 14-day course of linezolid 600 mg PO BID for ampicillin-resistant enterococcal urinary tract infection. He was afebrile on admission and the dorsal aspect of his tongue was blackened centrally, browner peripherally, with normal pink mucosa on the periphery. Based on the Naranjo probability scale, the calculated score for tongue discoloration as a drug-related adverse event was 7 out of a maximum score of 13 points, designating it as a probable cause. The patient's tongue discoloration improved moderately during the hospital stay and resolved 6 months after the discontinuation of linezolid. Conclusions: We report a rare association of linezolid and tongue discoloration in an elderly kidney transplant recipient that improved with discontinuation. We present this case to increase clinicians' awareness of the potential adverse event.