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Hey guys, you 've heard someone say that the tongue is the strongest muscle in the body. That's actually not true but it does hold many secrets about your health so grab a mirror, take a look and let's get into it.
Vitamin B12 deficiency (Glossitis)
okay so first stick out your tongue and see what color it is a normal healthy tongue is pink with little bumps called papillae on the surface but if your tongue looks like this red and smooth we call this glossitis and it can be from a nutritional deficiency so the woman in this photo presented with one month of pain in her tongue and reduced taste and when you look closely you can see that she doesn't have those normal little bumps on her tongue anymore it turns out she had severe vitamin B12 deficiency caused by an autoimmune disease called pernicious anemia that's a condition where your body creates antibodies that prevents the absorption of vitamin B12 and this is her tongue just one month after taking vitamin B12 injections pink and bumpy just the way we like it and a reminder to all those vegetarians and vegans out there you guys are at high risk of B12 deficiency so make sure you take your supplements.
Gorlin Sign (Ehlers-Danlos syndrome)
okay try this can you touch your tongue to your nose so far off if you can it's a rare Talent less than 10 of the population can do this and like most things in medicine someone put their name on it so this is called gorlin sign and it's much more common in people with ehlers-danlos syndrome which is a group of genetic conditions that are characterized by stretchy skin and hypermobile Joints but it could also be a sign of macroglossia.
Macroglossia (Big tongue)
macroglossia literally means big tongue but how do you know if your tongue is too big for the rest of your mouth well check out the sides of your tongue do you see imprints of your teeth on either side that's one sign of macroglossia so if your tongue suddenly gets bigger it's probably an allergic reaction or an infection and if your tongue just keeps getting bigger it's going to make it difficult for you to breathe so you need to get to the hospital right away but if this is happening slowly over time and your tongue is continuing to grow I think about hypothyroidism where your body's not making enough thyroid hormone or a micro omegaly where it's making too much growth hormone and your tongue is literally still growing or amyloidosis where you have amyloid proteins that deposit in your organs including the tongue which makes it grow but if your tongue has always been big ever since you were born it's probably just congenital one of the things that just makes you.
Mallampati Score
so open your mouth as wide as you can and stick out your tongue how much can you see at the back of your mouth the soft palate the uvula the pillars based on what you see you get a score and that's your malum Patty score that's an assessment tool to identify difficult Airways meaning how difficult will it be to intubate a person and put a breathing tube down their throat the higher the score the more difficult the intubation may be and while we try to make these assessments before intubating a patient it's not always possible based on the situation like for me when I'm involved in intubating a patient it's almost always an unexpected life or death situation in the hospital it's usually not realistic to have a patient sit up and open their mouth so I can take a look instead I'm looking at a whole bunch of factors in the moment to help me like do they have a big thick beard or a wide neck are they missing their teeth can they move their neck do they have any trauma to their face like fractures in their skull all these factor into a difficult Airway and sometimes when it looks like an easy Airway it still can be difficult so I always have plan A B and C with the equipment ready to go in the room okay I clearly get really excited about intubation and code Blues but back to the Mal and Patty score now it also tells you about your risk of sleep apnea that's a condition where your breathing stops and restarts many times while you're sleeping so if you have a high melon Patty score and you know that you sleep it's probably a good idea to consider getting a sleep study to see if you have sleep apnea because it's been implicated in car crashes heart attacks stroke and the good news is that you can treat it so you don't want to sleep on that one.
White Tongue (4 causes)
when you look in the mirror if you notice that your tongue is a bit of a thin white coating on it that's really normal and if you brush it it should go away but if you doesn't there are four main causes of a white tongue that I usually think about the first is thrush this is a yeast infection that causes raised white patches that sort of look like milk curds or cottage cheese the key Point here is that you should be able to rub off those white parts and underneath the tongue will look red irritated it can even be bleeding the classic scenario is that it happens after someone took antibiotics which changed the normal bacteria in your mouth giving an opportunity for the yeast to grow but it can also happen if you have a problem with your immune system like uncontrolled diabetes HIV or chemotherapy okay but let's say you try to rub off the patch but you can't and you notice that the patches are more flat and hard well this could be leukoplakia think of it like plaque that develop because the tongue gets irritated usually from tobacco or alcohol and it's important to keep track of these because they can develop into cancer so talk to your dentist or your doctor if you notice something like this but let's say those white patches actually look Lacy and you've got burning sensation in your mouth well that sounds a lot more like a planus now this one's a bit of a mystery but it probably has something to do with the immune system because it tends to get better when it's treated with steroids and finally if those white patches are mainly on the side of the tongue and it looks like this then it could be hairy leukoplakia that's definitely the most rare so it's caused by EBV which is the virus that causes mono the kissing disease but lots of people get mono and they don't get this tongue issue so this is a clue that there's something wrong with the immune system so this picture is of a 29 year old man who went to the doctor because of these white patches even though he felt perfectly healthy his doctor ran tests on his immune system and this is how he was diagnosed with HIV once he started treatments his immune system got stronger and he was able to fight off the virus on its own and the white spots disappeared so definitely a super rare cause of white spots on the tongue okay next I've got some tests I want you to try but first.
Tongue Movements
looking in the mirror again and see how agile your tongue is so in general there are five movements that your tongue can make we've got rolling Cloverleaf folding and then twisting left and right I've got to say doing this makes me feel like a kid again how many can you do so believe it or not researchers in the Netherlands actually studied this and they found that most people can roll their tongue that the Cloverleaf was the hardest and that only five percent of people could do all the movements and it seems like the ability to move your tongue may at least be partially genetic but I'm sure you can practice to make it better like I need to work my tongue folding so what does it mean for your health well probably not too much unless you were able to do the movements now and let's say in a year you can't do those movements you'd wonder is it a neurological issue where you're having weakness or is there a lesion there you're not able to move the tongue around it.
Raynaud's Phenomenon
I see people with Raynaud's phenomenon all the time now this is a condition where a person has an exaggerated response to the cold where their blood vessels constrict and clamp down too much causing their fingers toes and sometimes their tongue to change color due to lack of blood supply so this is a 29 year old woman with Reynolds in her fingers as well as her tongue which is pretty rare so every time she got cold or ate something cold her tongue would change colors and it would become numb making it difficult for her to speak this was her first symptom of the autoimmune disease called Scleroderma which causes thickening and tightening of the skin and also sometimes the internal organs too but there are other causes for Reynolds at the tongue like this woman who had cancer in her right tonsil which was treated with radiotherapy and ever since then every time she would get cold her tongue would turn blue so now she's cancer-free but she's had to give up ice cream and slushies to prevent the raynaudes from coming back.
Strawberry Tongue
take a look at this tongue does it remind you of anything if you said strawberry you're right we actually call this strawberry tongue when it's red with these prominent bumps this is classic for scarlet fever caused by group a strep the same bacteria that causes strep throat it can also happen with Kawasaki disease a serious illness that causes blood vessel inflammation in kids under the age of five as you guys know I don't treat kids so the last time I saw this was in Pediatrics rotation in medical school but these kids can get really sick with fever rash they get red eyes their hands and feet get swollen and they can get enlarged lymph nodes.
Geographic Tongue
we don't quite know why this happens but it's more common in people with skin psoriasis and Asthma so it's probably related to the immune system maybe it's the immune system trying to communicate with us although you might think this looks really serious luckily this is a harmless condition that goes away without any treatment.
Dry Mouth (Sjogren's Syndrome)
I don't I think about Sjogren's syndrome it's an autoimmune disease that can affect the whole body but classically it causes very dry eyes and very dry mouth and we can test patients by having them sit in a room for a period of time and then spit out all the saliva that they make into a container super high tech right some people with Sjogren's barely make any saliva and you can just imagine how uncomfortable that would be and it causes major issues with their Dental Health Plus their tongue gets so dry that it becomes painful dry and cracked okay so now that I've unlocked a new fear for you I just want to remind you that so Shogun syndrome is very rare and they're much more common causes for having a dry mouth I think one of the most common is side effects to medications okay.
Hairy Tongue
let's move on to hairy tongue now these photos are a little more dramatic so if you're eating or you have a weak stomach you might want to skip ahead this is caused by a buildup of the protein keratin on the small little bumps of your tongue and keratin is actually the same protein that makes up your hair but don't worry that actually isn't real hair on the tongue and this hair can take on different colors depending on what's going on in your mouth what did you recently eat what bacteria are natural to your mouth but I've gotta say the most dramatic is the black hairy tongue this is a 55 year old man who spent 11 days in the Intensive Care Unit intubated hooked up to life support and when he woke up this is what his tongue looked like so why did this happen well it's probably a combination of things he's a smoker which is a risk factor he received lots of different antibiotics in the ICU so that changed the bacteria in his mouth and he wasn't eating so there wasn't any food to naturally scrape his tongue so there was time to have build up but luckily it's reversible with a lot of brushing and scraping his tongue went back to normal but it doesn't just happen to adults in the ICU here's an eight week old baby who's perfectly healthy with a black tongue it was dramatic enough that they did a biopsy to make sure it wasn't cancer but it was just a mix of bacteria and fungi and within a few weeks without treatment it just went away.
Canker sores (Oral Ulcer)
have you ever had a canker sore the medical term is after stomatitis and their small painful ulcers that are not contagious and they go away without any treatment in about one to two weeks one in five people get them in North America that's a lot and we still don't know the root cause of them we know there's probably a genetic component definitely true for me I get them my mom gets them my grandmother used to get them and my medical opinion is they suck but as a rheumatologist if I see a patient that has recurrent oral ulcers then there's a long list of conditions that come to mind that we have to think about so if you've never had ulcers in the past and then all of a sudden you start getting them then it's worth talking to your doctor to make sure that it's not related to one of these conditions.
Tongue Cancer
if you have an ulcer that isn't going away like it's not going away in a couple of weeks like you expect or you feel a new lump on your tongue you have to think about cancer you got to go in and get checked out by your doctor right away this is a man who had a mass on his tongue for for six months and you can see it's actually pretty small it'd be easy to overlook this luckily he saw his doctor it got removed and he was cured of cancer this man smoked for most of his life so that's probably the cause but there are other risk factors like human papillomavirus or HPV for short and the exciting thing is that we have a vaccine to protect against HPV so we have a vaccine that can prevent cancer how cool is that so just remember tongue cancers normally don't hurt or cause any issues early on so if you notice something just go and get it checked out to be safe.
Thanks for reading and trust in Fitness Tribe.
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