Advice
Tongue Cleaning Advice (2006)
The benefits of tongue cleaning
Tongue coating can be the cause of bad breath. When the tongue is cleaned, the tongue coating on the back of the tongue is removed. This is shown by a comparison of international studies into the effects of daily cleaning of the tongue. Daily brushing or scraping of the tongue normally has no additional beneficial effect on the health of the mouth and gums. Tongue cleaning is therefore not considered part of daily oral hygiene.
Many types of microorganisms reside on the tongue. They, like bacteria in the gingival pocket, can play an important role in the production of volatile sulfur compounds. These compounds can cause bad breath (halitosis). Removing the tongue coating on the back of the tongue is useful for bad breath. Tongue cleaning has not been shown to contribute to the prevention of caries, gum or periodontal problems.
Introduction
The tongue is normally pink and sometimes covered with a thin white coating. In the elderly, this can be discolored due to changed diet, reduced salivary flow and insufficient oral hygiene.
Sometimes the tongue is covered with a thin white coating (tongue coating). Its thickness can vary. People with periodontal disease may have a thicker tongue coating than healthy people.
The surface of the tongue consists partly of papillae. Due to this structure, the tongue provides a large, ecological surface for the accumulation of microorganisms and their secretions. Staphylococci and streptococci can account for up to 90% of the number of bacteria on the tongue.
Cleaning the tongue has been a custom for centuries in Eastern cultures. Inscriptions from the 16th century BC indicate that the inspection of the tongue was an important diagnostic tool in Chinese medicine. In many ancient religions, the cleanliness of the entire mouth, including the tongue, occupies an important place. In the daily ritual of Indians, not only were the teeth brushed, but the tongue was also scraped and the mouth rinsed with preparations of betel leaves, cardamom, camphor and other herbs. All kinds of populations in Africa, the Arab world, India and South America have the habit of cleaning their tongues. Tongue scrapers were made from thin, flexible wood chips, various metals, whale whalebone, and tortoise shell. In the Western world, cleaning the tongue is not a daily habit until now.
Tongue coating
Tongue coating contains large amounts of bacteria, desquamated epithelial cells, blood products, nutritional components and leucocytes from inflamed gums and gingival pockets.
Older people have more tongue coating than young people. Changes in eating habits, reduced oral hygiene, a decrease in the amount and composition of saliva and a decrease in the multiformity of the papillae of the tongue can contribute to this. It is believed that tongue coating is more common in patients with periodontal disease. In them, the number of leucocytes in the saliva is increased and they accumulate on the surface of the tongue. But it is unclear whether a coated tongue contains more bacteria than a non-coated tongue.
Micro organisms
The tongue harbors and spreads all kinds of microorganisms, thus influencing the flora of the entire mouth. Some bacterial species can permanently settle on the tongue, while others are transient on the tongue. Table 1 briefly describes the relationship to oral health of various micro-organisms that can be found on the tongue.
Table 1 microorganisms on the tongue
Microorganism |
Relationship with oral health |
| Porphyromonas gingivalis | Can be detected in saliva, on the back of the tongue, the tonsils, the oral mucosa in patients with periodontal problems. This micro-organism is usually absent or present in small numbers in periodontally healthy people. |
| Prevotella intermedia | Can be isolated from oral mucosa, saliva, and supra- and subgingival plaque. Occurs in relatively high numbers in the majority of tongues and tonsils of patients with periodontal breakdown. However, in a Western population with no clinical attachment loss, P. intermedia was also present in 80% of the tongue samples. |
| A. actinomycetem comitans | Generally found subgingival and on the tongue in patients with juvenile periodontitis; however, on the tongue, the frequency is much lower compared to the deep periodontal pocket. In 55% of adult patients with periodontal disease, A. actinomycetemcomitans was found on the dorsal tongue, while the microorganisms were also present in subgingival sites. |
| Prevotella melaninogenica, P. loescheii and P. denticola | Occur on the tongue of both healthy people and people with periodontal disease and are considered normal colonists of the oral cavity. |
| Oakella corrodens | Often isolated in subgingival plaque samples from adult patients with periodontal disease. E. corrodens also settles in other places in these patients, such as on the tongue. |
| Capnocytophage | Grow on the tongues of healthy people more often than on those of patients with periodontal defects. |
| Streptococcus mutans | Is present on the tongue as a passerby. Their presence in dental plaque is correlated with dental caries. |
| Streptococcus salivarius | Makes up a large proportion of streptococci in saliva and on the tongue, while they only account for a small percentage of streptococci in dental plaque. |
| Actinomyces viscosus | Habitat between the filiform ('filiform)' papillae of the tongue, and deposits as a viscous, white, loose coating of the tongue. |
| Spirochetes and other motile organisms | Spirochetes and other motile organisms grow on the tongue of patients with periodontal disease, while these species do not multiply on the tongue of healthy people. |
| Neisseriae, Bacteroides and Veillonellae | Fewer Neisseriae were found on the tongue of smokers, but more Bacteroides and Veillonellae than on the tongue of non-smokers. |
| Candida albicans | This yeast is also found on the tongue and is a member of the commensal mouth microbiota; population prevalence is estimated at 30-40%. |
Bad breath
Bad breath has several causes (Table 2), but the most common is the breakdown of protein and protein compounds on the tongue and in dental plaque. Fatty acids, volatile sulfur compounds (H2S) and methyl mercaptan are formed.
Table 2
Possible causes of bad breath
- Inflammation in the mouth
- Dry mouth
- Starvation
- Use of certain foods
- Use of certain medications
- To smoke
- Alcohol
- Some systemic diseases
- Infections in the respiratory tract
- Psychogenic Causes
As many as 82 types of mouth bacteria, including Porphyromonas gingivalis, the fusobacteria, Prevotella intermedius and the capnocytophages can produce these substances, but no single organism can be designated as the main cause of bad breath.
In people with good oral hygiene, clean and intact teeth and healthy gums, bad breath is produced by the bacteria on the back of the tongue. In the elderly, there is an increase in the number of Actinomyces viscosus organisms on the tongue. These form a viscous batter and cause a bad smell.
In a study at a bad breath clinic, it was found that 87% in patients with bad breath was caused by the mouth. Tongue coating was the cause in 51%, gingivitis in 17%, other periodontal causes in 15%, and a combination of these factors in 17%.
Results from a study in a sample of the general population of 2672 subjects between the ages of 18 and 64 suggested that bad breath was caused by tongue coating in young people and by periodontal abnormalities in combination with tongue coating in the elderly.
Tongue cleaning methods
Tongue cleaning can be performed using a tongue cleaner or scraper:
- Stick the tongue out of the mouth as far as possible
- Place the tongue cleaner as far as possible towards the posterior part of the tongue and apply force to the scraper so that the tongue is flattened; make sure that the tongue cleaner makes good contact with the tongue. Many people are gagging right now; experience is needed to position the instrument to minimize the gag response.
- Slowly pull the tongue cleaner forward into the mouth.
- Clean the cleaner under running water.
- Repeat the procedure several times.
- Rinse mouth well with water.
- Clean and dry the instrument and keep it until next use.
Tongue cleaners
When the tongue is cleaned in connection with halitosis, it is advisable to do this twice a day. Research shows that cleaning the tongue with a tongue cleaner is more effective than with a toothbrush.
When to, when not to tongue clean:
Tongue Cleaning to Reduce Plaque Accumulation?
There is research showing that tongue cleaning in combination with other oral hygiene methods was effective in reducing plaque buildup. However, another study found no difference in plaque accumulation over a four-day period with or without tongue cleaning. Even when brushing teeth was compared to the combination of tooth brushing and tongue cleaning, no difference was found in plaque accumulation after one week. One reason why no effect was found on plaque formation may be that the hard-to-reach posterior part of the tongue was insufficiently cleaned.
Tongue cleaning and gingivitis?
Studies have found no significant reduction in gingivitis after cleaning the tongue and palate, in combination with regular oral hygiene. During this study, the condition of the gums did improve, but this was explained by an increased frequency of brushing teeth by the participants.
Tongue cleaning and bad breath?
Research shows that tongue cleaning reduces both the amount of volatile sulfur compounds and the H2S/methyl mercaptan ratio in patients with bad breath decreases.
Tongue cleaning and the taste sensation?
It is suggested that tongue cleaning is important in geriatric patients with a prosthesis to increase taste sensation. However, only one study is available that investigated taste sensation after tongue cleaning. In this study, each subject took part in a number of sessions to test different tastes (sugar, salt, citric acid and caffeine). In one session, the participants' tongues were cleaned with a toothbrush without toothpaste and in another session with a toothbrush with toothpaste. In young subjects, both tongue cleaning procedures reduce sensitivity to citric acid. Tongue cleaning alone lowered the threshold of caffeine and raised that of salt. The use of toothpaste decreased the taste perception of sugar. In elderly subjects, taste sensation was similarly affected by both tongue treatments. Toothpaste had an important influence on the threshold values for caffeine. It was concluded that tongue cleaning with or without toothpaste influences the threshold values for taste perception.
Conclusion
The question of whether regular cleaning of the tongue should be part of daily oral hygiene has been studied. Based on the literature, there seems to be no need to clean the tongue as part of daily oral hygiene. An exception should be made for patients with bad breath. In such cases, regular tongue cleaning is recommended.
Sources:
- Tongue coating and tongue brushing: a literature review. MM Danser, S. Mantille Gómez, GA Van der Weijden. Int. J. Dent. Hygiene 1, 2003;151-158
- Tongue scraping for treating halitosis (review). The Cochrane Collaboration, John Wiley & Sons, 2006.