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Green Tongue
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An_224291 posted:
My husband's tongue is green along the center furrow. He was originally diagnosed with fur tongue and was treated with several anti-fungal meds. Nothing has worked. The current treatment is in case the cause is bacterial., and is now taking Cipro, Sucralfate and Peridex. It looks like it's getting worse. After 2 specialists and 13 various prescriptions nothing is touching it and the ENT has run out of suggestions. There is no pain or burning, just a very bad case of dry mouth, and the ugly green stripe down the center of the tongue. The Dr.'s have tried the obvious. Any help in identifying this problem would be greatly appreciated.
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MarkMHB responded:
Dear Anon_8765,

Your husband's condition is almost certainly what is known as "hairy tongue"; the term is often preceded by a qualifier that describes its color, as in "white hairy tongue" or "black hairy tongue" The color is mostly irrelevant, because the condition is fundamentally caused by the same phenomenon, regardless of the color: an overgrowth of the filiform papillae (the numerous tiny bumps) on the dorsal surface of the tongue. Strictly speaking, it is not a disorder per se; its presence simply indicates that the normal exfoliation of keratin (the predominant structural protein of the tongue surface) is not keeping pace with the growth of new keratin. The condition is trivial, albeit cosmetically unappealing.

Treatment is limited to encouraging the dislodgment of the tongue's surface epithelium, usually by frequent brushing of the tongue surface, while avoiding mouthwashes or other products that may stimulate surface tissue growth (hydrogen peroxide and other oxygenating products are particular offenders).

Although candida albicans (yeast) is sometimes associated with hairy tongue, it is not the primary causative factor-- hence the failure of anti-fungal medication to improve matters. However, if fungal infection is found to be present (by exfoliative cytology with PAS staining), it too should be treated. Oral fungal infections are particularly common in cases where the immune system is suppressed (for example, in cases of diabetes, HIV infection, or immunosuppressive therapy for autoimmune disease or organ transplants).

As for the dry mouth: it is more likely that the dry mouth is leading to the hairy tongue rather than the other way around; dry mouth can reduce the rate of surface exfoliation. Dry mouth can also significantly increase the incidence of oral yeast infection. For this reason, the symptom of dry mouth should be the primary focus.

Dry mouth can be a result of primary salivary gland disease, but this is less common in men. More likely suspects are a wide variety of medications that can inhibit salivary secretion: antihypertensives, tranquilizers, antidepressants, muscle relaxants, and corticosteroid inhalants for asthma or COPD, among others. Dry mouth can also result from systemic disease, such as diabetes or kidney disease, or even from mouth breathing due to nasal obstruction.

Aside from addressing the primary cause of hairy tongue, attention should be given to eliminating factors that can make the problem esthetically worse by staining. In this regard, chlorhexidine gluconate rinses ("Peridex") is exactly the wrong thing to prescribe due to its propensity to cause dark staining. Certain coloring agents in toothpaste, mouthwash, chewing gum, and candy are also obvious sources of staining.

Sucralfate is not a bad idea if "GERD" (gastroesophageal reflux disease) is suspected, because GERD is sometimes associated with oral malodor and unhygienic oral condition.

Hope this helps...
 
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Zev Kaufman, DDS responded:
Dear Anon:
I do agree with Dr. Bornstein Peridex and other very strong mouth rinses might be a problem, I'd like to encourage you to find the CAUSE, rather than just empirically treating the intra-oral symptoms. All the conditions, which Dr. Bornstein carefully listed are possible, and the treament for each is different. You must find a dentist (preferrably a pathologist) who can help you investigate your husband's situation, carefully evaluating the facts and history. Only then, can you devise the proper treatment. Until then, unfortunately, you are just "trying things out" randomly.
Best of luck,
Dr. Zev Kaufman
 
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Zev Kaufman, DDS replied to Zev Kaufman, DDS's response:
Sorry Dr. Bornfeld, I mispelled your name.
 
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1357924680 replied to MarkMHB's response:
Dr. B
Thank you for the information. I did suggest a culture or gram stain be done, but the ENT does not do pathology of the mouth. My husband is a 69 year old health nut with no ongoing medical issues. He takes no medications. He does take several vitamins a day, but has done so for several years. He goes to the gym 5 days a week and is a jogger. This is his only health issue, and after 6 months of treatment, the condition persists.
I would appreciate it if you could lead me to the correct type of specialist, as we are having a hard time finding someone to do any testing of his tongue.
I would also like to know which toothpastes and mouthwashes are okay to use with this condition. He is currently using "Oasis" mouth wash and standard whitening toothpaste.
Thank you for your help.
 
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1357924680 replied to Zev Kaufman, DDS's response:
Thank you for your help. I agree with you 100%, and have said so to his ENT. We are currently trying to find a Dr. that will either do a culture or a gram stain to get to the cause of the problem. We are having no luck. My husband currently goes to the University of Buffalo's Dental School for treatment, we are hoping they can lead us to a specialist in this area. As I told Dr. B, my husband has no other ongoing medical conditions and is a very active 69 year old health nut.Again, thank you for taking the time to assist us with this frustrating problem.
 
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MarkMHB replied to 1357924680's response:
Dear 1357924680 ,

You've really missed the main intent of my post, which is that you're looking for a disorder when none really exists. Through sheer force of will, you have compelled your doctors to take all manner of diagnostic tests, and they're probably complying just to be polite. Hairy tongue only qualifies as a disorder in the broadest sense, and is really just a cosmetic issue.

Although an ear nose, and throat specialist is the go-to man for disorders of the ear, nose, and throat (what could be more logical?), a dentist is the appropriate professional with whom to consult in manners of oral health. If you would like the assurance of further corroboration, the most appropriate dental specialist in diagnosis and treatment of oral mucous membrane disease is an oral pathologist. Your general dentist can help you with the referral, or you may consult the online directory of the American Academy of Oral & Maxillofacial Pathology .

Oasis products are appropriate for patients who suffer from dry mouth, as are products of the Biotene line. Some patients with oral mucous membrand disorders are sensitive to sodium lauryl sulfate, which is a detergent ingredient found in many toothpastes; if in doubt, use products that are "SLS-free".

Good luck!

Mark Bornfeld

Brooklyn, NY
 
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1357924680 replied to MarkMHB's response:
Dear Dr. B
Although it may seem with my short posts that the green tongue is the biggest problem, it is the dry mouth that has affected the most changes. It has caused problems sleeping as well as changed his eating habits tremendously. He can no longer eat bread or dry foods because it all sticks to the roof of his mouth due to lack of saliva. I mentioned the green tongue because to me, it should narrow down diagnostic problems quicker then just Dry Mouth.
 
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MarkMHB replied to 1357924680's response:
Dear 1357924680 ,

I agree that dry mouth is more potentially problematic than hairy tongue. (As I said above, the hairy tongue is probably at least partially due to the dry mouth, so attention to this matter is likely to be more beneficial on both counts.)

Since your husband does not take any medications, we can safely rule this out as a contributory factor. That leaves several other possible bases for dry mouth:
  1. inadequate fluid intake, leading to sub-clinical dehydration.
  2. dietary constituents that may act as diuretics, also leading to dehydration.
  3. undiagnosed kidney or endocrine disease, possibly leading to dehydration
  4. mouth breathing, leading to drying of the mouth (because interference with sleeping is in evidence, snoring and obstructive sleep apnea should be suspected)
  5. physiologic salivary gland atrophy due to aging
  6. primary salivary gland disease (e.g., Sjogren's syndrome, Miculicz disease) or salivary gland damage secondary to systemic conditions such as granulomatous disorder or hematologic condition.
Important first steps require a determination of whether true dry mouth exists, or merely the perception of dry mouth. Unstimulated and stimulated salivary secretory measurements, as well as sialographic imaging studies, are helpful in assessing salivary gland function.

In situations where salivary gland disease is ruled out, treatment is often directed toward relief of symptoms. This may include the use of artificial saliva, or use of medications that stimulate salivary secretion (e.g., pilocarpine or cevimeline). Again, an oral pathologist would be an appropriate person with whom to consult; an oral surgeon might also be able to provide these services.

Good luck!

Mark Bornfeld

Brooklyn, NY
 
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1357924680 replied to MarkMHB's response:
Dear DR. B.
I have followed your advice and gotten the name of a few OMP's in my area off of the website you suggested. We will be contacting them to see if one of them will be willing to see my husband. At this time the only medication he is going to continue is the Evoxac which I think is suppose to stimulate the salivary glands.
Thank you for all of the valuable information you have provided us with. I will let you know if we actually find the cause of these symptoms.
Sincerely,
 
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talek replied to 1357924680's response:
I have the same condition, green tongue but with a sore throat. My tongue has been green and sore at times (when eating spicy food mostly) and my throat is irritated, my tongue sometimes feels like there's thousands of small cuts on it, and stings really bad.

Anyway i went on a macro diet for only a week, and the symptoms nearly vanished in days. I went back to eating meat and sugar, and it almost immediately came back. So im now going back to macro.

Now im no doctor but i'd have to say that this is definitely tied to candida or some kind of yeast or fungal infection, and is being fed by foods such as meats, sugars, breads, or beer.

Also, im a smoker, and i continued to smoke through eating macro, and my symptoms still went away. (not saying smoking is a genius idea or anything, but alot of people told me it was strictly from smoking, which it wasnt.) obviously smoking cant help the situation regardless.

Either way now im on a path to quit smoking, and to go back to eating macrobiotically, i'll chime in and let you know my final results in the coming months.

best,
tim
 
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1357924680 replied to talek's response:
Tim,
My husband also experiences a sore throat on and off along with what he describes as "feeling like it is coated" with something.

Today he went to an Oral Maxial Facial specialist as suggested on this site. Her diagnosis is Sjogren"s Syndrome, which is a disorder of the immune system. The alteration of white blood cell function is responsible for the effects. These white blood cells may also invade the tear ducts, salivary glands and other moisture-producing glands causing them to stop producing moisture.
The candidas is not the cause, but the side effect. That is why none of the medicine works for any duration.
She gave him some "Biotine" products and some hand outs on the condition. He has another appointment with her in a few weeks. I'm not sure what else they discussed, so when my husband gets home I will ask him if he has any other info he feels would be of help to you.
BTW, my husband is NOT a smoker, so I don't think it is an issue in this regard.
 
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timbalou replied to 1357924680's response:
I also suffer from a green tongue (sometime dry mouth).

I take lisinoprol and allopurinol and I believe my condition is because of those medications.

I also have seen a nutrionist and that person thinks I might have a problem with my system digesting certain nutrients.

Could that be the case?
 
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1357924680 replied to MarkMHB's response:
Dr. B,
Just as an update, we did follow your advice. My husband went to see an Oral specialist at the University of Buffalo Dental School yesterday. She has established that while he does have some saliva under the tongue and on the tongue, the roof of his mouth and the insides of his cheeks are dry. She gave him a packet of Biotine and Oral Balance products as well as some material on the Sjogrens Syndrome. He has another appt. in May when she will have had a chance to get some of his medical history and test results. At that time she will decide if salivary gland imaging or other tests should be done. Thank you again for leading us in the right direction.
 
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1357924680 replied to timbalou's response:
Although I know certain medications cause dry mouth, this was not my husbands case. Certain medications can also cause the tongue to turn green or black (especially antibiotics). This is usually candidis (yeast infection) and clears up when you take anti-fungal meds. My best advice is to talk to your dentist and have him refer you to an oral/maxiofacial pathologist, or go to the website listed by the Dr. in the above discussions. The most important thing you can do while waiting for a diagnosis is to double up on your oral health care. Become obsessive about it. Stay away from sugary and acidic foods. Brush thoroughly after every meal. Rinse out your mouth with warm water several times a day. Do not chew gum or suck on hard candy unless it is sugarless. Dry mouth can cause extreme problems with tooth decay if you are not diligent in your oral health care.
This is the advice given by the specialist. Also, stay away from Peridex.


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