Inspection of dorsal (top) of tongue – Have patient stick tongue out. Normal tongue should be pink, moist, and have evidence of papillae. Can inspect sides of the tongue by using a piece of gauze to manipulate during exam. An enlarged tongue (macroglossia) is nonspecific and associated with a variety of pediatric and adult conditions, including Down’s syndrome, amyloidosis, and myxedema. Painless patches of the tongue that appear at intermittent times are referred to as migratory glossitis (geographic tongue) and are non-pathologic. Black hairy tongue can be seen in smokers and those with xerostomia (dry mouth) and are also non-pathologic.
Inspection of ventral (bottom) of tongue – Have the patient touch the roof of their mouth with their tongue. Note the prominent ventral tongue veins and frenulum. Early signs of jaundice are first seen through discoloration of the frenulum. Monitor for any masses, especially in smokers and tobacco users, as early signs of tongue carcinoma.
Example of Candidiasis - Oral Thrush - Important distinguishing feature from leukoplakia is that the lesion can be scraped off
Leukoplakia – hyperkeratosis of tongue (can be a pre-malignant lesion)
Atrophic glossitis – AKA bald tongue – smooth painful tongue with loss of papillae that can be seen in iron deficiency anemia, B vitamin deficiencies, and celiac disease