Salivary Glands

Excessive Salivation

• high Iodine

Sialadenitis (inflammation)

• high Iodine

Teeth

Caries

• low Calcium

• low Fluorine

• low Phosphorus

• low Protein-Calorie

Loose

• low Vitamin C (scurvy)

Mottling of Enamel

• high Fluorine (fluoride)

Periodontal Disease

• low Calcium

Tongue

Ignore tongue color in evaluating patients whose hemoglobins are below 8 g/dl because severe anemia will make tongue color normal (Friedman PJ, Hodges RE.  Tongue colour and B-vitamin deficiencies.  Letter. Lancet i:1159-60, 1977).

Acute Glossitis (bright scarlet red, painful, inflamed tongue with prominent papillae)

• low Folic Acid (mild)

• low iron (mild)

• low Niacin (pellagra) (mild)

• low Riboflavin (mild)

• high Vitamin B6 (mild)

• low Vitamin B12 (mild)

Atrophic Glossitis (smooth, small, glistening, non-painful tongue with atrophy of the filiform papillae)

Patients tend to have multiple nutritional deficiencies (Drinka PJ, Langer EH, Voeks SK, et al.  Nutritional correlates of atrophic glossitis: possible role of vitamin E in papillary atrophy.  J Am Coll Nutr 12 (1);14-20, 1993).

"The thin epithelium of the 'bald' tongue seems to be a poor veil over the capillary bed, thereby yielding an abnormally blue or cyanotic tongue.  Patients with severe anaemia and papillary atrophy may retain a normal tongue colour because the capillary bed is pale rather than cyanotic" (Friedman PJ, Hodges RE.  Tongue colour and B-vitamin deficiencies.  Letter. Lancet i:1159-60, 1977).

There is an 80% chance of a niacin or riboflavin deficiency in a patient without hypoxemia or severe anemia whose tongue shows papillary atrophy along with an abnormal color (Leevy CM, Baker H, TenHove W, et al.  Am J Clin Nutr 16:339, 1964

• low Biotin (rare)

• low Folic Acid (chronic or in remission)

• low Iron (chronic)

• low Niacin (chronic)

• low Protein

• low Riboflavin

• low Vitamin B6

• low Vitamin B12 (chronic or in remission)

• low Vitamin C

• low Vitamin E

-with Magenta color (deep, purplish-red tongue)

"The cyanotic tongue colour in hypoxaemia cannot be distinguished clinically from that produced by nutritional deficiencies.  Hypoxaemia, however, does not lead to papillary atrophy, so a bald tongue is a clue to underlying B-vitamin deficiencies" (Friedman PJ, Hodges RE.  Tongue colour and B-vitamin deficiencies.  Letter. Lancet i:1159-60, 1977).

• low Biotin (rare) - also swollen and painful

• low Niacin (pellagra) (more common) - also swollen, raw and fissured

• low Pantothenic Acid - usually painless

• low Riboflavin (more common) - also dry; painless or sore; may be swollen

with Black color

• low Niacin (pellagra) (less common)

• low Riboflavin (less common)

References