OBJECTIVE: This study aimed to evaluate the effect of antimicrobial photodynamic therapy (aPDT) and the use of probiotics on the treatment of halitosis.
METHODS: Fifty-two participants, aged from 18 to 25 years, exhaling sulfhydride (H2S) ≥ 112 ppb were selected. They were allocated into 4 groups (n = 13): Group 1: tongue scraper; Group 2: treated once with aPDT; Group 3: probiotic capsule containing Lactobacillus salivarius WB21 (6.7 x 108 CFU) and xylitol (280mg), 3 times a day after meals, for 14 days; Group 4: treated once with aPDT and with the probiotic capsule for 14 days. Halimetry with gas chromatography (clinical evaluation) and microbiological samples were collected from the dorsum of the tongue before and after aPDT, as well as after 7, 14, and 30 days. The clinical data failed to follow a normal distribution; therefore, comparisons were made using the Kruskal-Wallis test (independent measures) and Friedman ANOVA (dependent measures) followed by appropriate posthoc tests, when necessary. For the microbiological data, seeing as the data failed to follow a normal distribution, the Kruskal-Wallis rank sum test was performed with Dunn\'s post-test. The significance level was α = 0.05.
RESULTS: Clinical results (halimetry) showed an immediate significant reduction in halitosis with aPDT (p = 0.0008) and/or tongue scraper (p = 0.0006). Probiotics showed no difference in relation to the initial levels (p = 0.7530). No significant differences were found in the control appointments. The amount of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were not altered throughout the analysis (p = 0.1616, p = 0.2829 and p = 0.2882, respectively).
CONCLUSIONS: There was an immediate clinical reduction of halitosis with aPDT and tongue scraping, but there was no reduction in the number of bacteria throughout the study, or differences in the control times, both in the clinical and microbiological results. New clinical trials are necessary to better assess the tested therapies.
BACKGROUND: Clinical Trials NCT03996044.

The tongue supports the upper dental arch and encourages healthy dental arch development when it rests against the roof of the mouth. On the other hand, over time, malocclusion can result from incorrect tongue position, such as lying low in the mouth or thrusting forward during swallowing or speaking. As a muscular organ, the tongue applies forces to the jaws and teeth that may help with malocclusion or hinder it from aligning properly. The dentition and jaws grow and align according to the way the tongue, teeth, and surrounding structures interact. The tongue\'s morphogenetic function includes forming the arches and having an important impact on the maxillary complex\'s development. The tongue frequently assumes a balancing and compensatory function in subsequent phases, functioning more or less like a natural orthodontic bite. In adults, the tongue is able to compensate for problems like open bites, teeth that are out of alignment, or differences in the occlusal and sagittal planes of the spine. In this context, the tongue\'s ability to sustain occlusion during malocclusion can be considered a compensatory response. This is comparable to how lingual dysfunction may contribute to malocclusion or act as a potential source of recurring orthodontic instability. In order to diagnose and treat orthodontic issues, dental professionals must know the connection between tongue position and dental malocclusion. Malocclusion can be prevented or minimized with early intervention, such as myofunctional therapy to correct tongue position and habits, improving dental health and well-being overall.

The study aimed to achieve the following objectives: (1) to perform the fusion of thermal and visible tongue images with various fusion rules of discrete wavelet transform (DWT) to classify diabetes and normal subjects; (2) to obtain the statistical features in the required region of interest from the tongue image before and after fusion; (3) to distinguish the healthy and diabetes using fused tongue images based on deep and machine learning algorithms. The study participants comprised of 80 normal subjects and age- and sex-matched 80 diabetes patients. The biochemical tests such as fasting glucose, postprandial, Hba1c are taken for all the participants. The visible and thermal tongue images are acquired using digital single lens reference camera and thermal infrared cameras, respectively. The digital and thermal tongue images are fused based on the wavelet transform method. Then Gray level co-occurrence matrix features are extracted individually from the visible, thermal, and fused tongue images. The machine learning classifiers and deep learning networks such as VGG16 and ResNet50 was used to classify the normal and diabetes mellitus. Image quality metrics are implemented to compare the classifiers\' performance before and after fusion. Support vector machine outperformed the machine learning classifiers, well after fusion with an accuracy of 88.12% compared to before the fusion process (Thermal-84.37%; Visible-63.1%). VGG16 produced the classification accuracy of 94.37% after fusion and attained 90.62% and 85% before fusion of individual thermal and visible tongue images, respectively. Therefore, this study results indicates that fused tongue images might be used as a non-contact elemental tool for pre-screening type II diabetes mellitus.

Background: Primary malignant melanoma rarely occurs in the oral cavity. The tongue is a particularly unusual primary site; lesions may be pigmented or amelanotic. Primary malignant melanoma is frequently mistaken for squamous cell carcinoma. Case Report: A 27-year-old male presented with a large, painless, ulceroproliferative mass on the dorsal surface of the tongue for 6 months. Squamous cell carcinoma was suspected, and the lesion was biopsied. Histopathology was compatible with primary amelanotic malignant melanoma. The patient had no cutaneous lesions consistent with malignant melanoma, and no definitive metastatic lesions were found. Ultrasound and computed tomography did not reveal any evidence of regional draining lymph node metastasis or suspicious lesions anywhere else in the body. The patient underwent composite resection of the tongue tumor and bilateral neck lymph node dissection, had an uneventful postoperative recovery, but was lost to follow-up. Conclusion: Primary oral amelanotic malignant melanoma is a highly aggressive, potentially fatal tumor and because of its rarity, presents a diagnostic challenge. The ideal treatment modality for primary malignant melanoma of the tongue is poorly defined, but surgery is regarded as the most effective course of therapy.

Adenoid cystic carcinoma (ACC) is a rare malignant tumor that affects the salivary glands. Its notable characteristics include aggressive local growth, infiltration of nerves (perineural invasion), a propensity to disseminate to other parts of the body (metastasize), and a high likelihood of recurrence. Here, we present the case of a 71-year-old male patient who presented with swelling on the posterior left side of his tongue, which had been causing him difficulty in chewing for the past six months. The parotid gland is frequently impacted in the head and neck area, with the tongue being comparatively uncommon. While distant metastasis is frequent, metastasis to nearby lymph nodes is not as common. However, if it does occur, it is associated with a poor prognosis and reduces the average survival age of the patient. The preferred treatment for ACC is surgical removal with wide resected margins. If it metastasizes to lymph nodes, then adjunct therapy is the treatment modality for the lesion. ACC exhibits three histopathological patterns: solid, tubular, and cribriform. The solid type is associated with a poorer prognosis compared to cribriform type, which typically has a better prognosis. This case, occurring on the tongue, is rare.

This study aimed to explore the relationship between international commission on illumination (CIE) L*a*b* color value of tongue and type 2 diabetes mellitus (T2DM). We used restricted cubic spline method and logistic regression method to assess the relationship between CIE L*a*b* color value of tongue and T2DM. A total of 2439 participants (991 T2DM and 1448 healthy) were included. A questionnaire survey and tongue images obtained with tongue diagnosis analysis-1 were analyzed. As required, chi-square and t tests were applied to compare the T2DM and healthy categories. Our findings suggest the 95% confidence interval and odds ratio for body mass index, hypertension, and age were 0.670 (0.531-0.845), 13.461 (10.663-16.993), and 2.595 (2.324-2.897), respectively, when compared to the healthy group. A linear dose-response relationship with an inverse U-shape was determined between CIE L* and CIE a* values and T2DM (P < .001 for overall and P < .001 for nonlinear). Furthermore, U-shaped and linear dose-response associations were identified between T2DM and CIE b* values (P = .0160 for nonlinear). Additionally, in adults, the CIE L*a*b* color value had a correlation with T2DM. This novel perspective provides a multidimensional understanding of traditional Chinese medicine tongue color, elucidating the potential of CIE L*a*b* color values of tongue in the diagnosis of T2DM.

Patients with dementia may forget to take their oral medications or may accidentally take too much. Furthermore, there are cases where people lick the medicine without recognizing it as a medicine or accidentally ingest it. An 88-year-old woman with a history of insomnia presented to the hospital, complaining of her weakness and mild loss of consciousness. Although her blood tests, imaging studies, and neurological findings were unremarkable, we noticed that her tongue was blue and determined that she had mistakenly taken flunitrazepam. This accidental ingestion was diagnosed as the cause of the symptoms. Patients with dementia report that they may take medicine by licking it, and some oral medicines have a coloring effect.

BACKGROUND: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a prevalent condition affecting a substantial portion of the global population, with its prevalence increasing over the past 2 decades. OSAHS is characterized by recurrent upper airway (UA) closure during sleep, leading to significant impacts on quality of life and heightened cardiovascular and metabolic morbidity. Despite continuous positive airway pressure (CPAP) being the gold standard treatment, patient adherence remains suboptimal due to various factors, such as discomfort, side effects, and treatment unacceptability.
OBJECTIVE: Considering the challenges associated with CPAP adherence, an alternative approach targeting the UA muscles through myofunctional therapy was explored. This noninvasive intervention involves exercises of the lips, tongue, or both to improve oropharyngeal functions and mitigate the severity of OSAHS. With the goal of developing a portable device for home-based myofunctional therapy with continuous monitoring of exercise performance and adherence, the primary outcome of this study was the degree of completion and adherence to a 4-week training session.
METHODS: This proof-of-concept study focused on a portable device that was designed to facilitate tongue and lip myofunctional therapy and enable precise monitoring of exercise performance and adherence. A clinical study was conducted to assess the effectiveness of this program in improving sleep-disordered breathing. Participants were instructed to perform tongue protrusion, lip pressure, and controlled breathing as part of various tasks 6 times a week for 4 weeks, with each session lasting approximately 35 minutes.
RESULTS: Ten participants were enrolled in the study (n=8 male; mean age 48, SD 22 years; mean BMI 29.3, SD 3.5 kg/m2; mean apnea-hypopnea index [AHI] 20.7, SD 17.8/hour). Among the 8 participants who completed the 4-week program, the overall compliance rate was 91% (175/192 sessions). For the tongue exercise, the success rate increased from 66% (211/320 exercises; SD 18%) on the first day to 85% (272/320 exercises; SD 17%) on the last day (P=.05). AHI did not change significantly after completion of training but a noteworthy correlation between successful lip exercise improvement and AHI reduction in the supine position was observed (Rs=-0.76; P=.03). These findings demonstrate the potential of the device for accurately monitoring participants\' performance in lip and tongue pressure exercises during myofunctional therapy. The diversity of the training program (it mixed exercises mixed training games), its ability to provide direct feedback for each exercise to the participants, and the easy measurement of treatment adherence are major strengths of our training program.
CONCLUSIONS: The study\'s portable device for home-based myofunctional therapy shows promise as a noninvasive alternative for reducing the severity of OSAHS, with a notable correlation between successful lip exercise improvement and AHI reduction, warranting further development and investigation.

Lingual osteoma, a rare, benign bone tumor that primarily affects the posterior tongue, can be difficult to diagnose. This study aims to report a case of osteoma affecting the tongue in a 17-year-old female. The patient had a foreign body sensation and a progressively growing lesion for 3 years and underwent clinical examination and diagnostic procedures. A well-defined, smooth-surfaced, white mass was discovered in the posterior third of the tongue. The 1.5 × 1 × 0.4 cm mass was completely excised under local anesthesia and histopathologically confirmed as a benign lingual osteoma. The 2-month post-operative outcome was uneventful. The rarity of lingual osteoma, as well as the fact that it is often asymptomatic, makes diagnosis difficult. The diagnosis entails a proper clinical examination, imaging studies, and histopathological analysis. Surgical intervention, primarily aimed at complete excision while preserving tongue function, remains the primary treatment option. Successful excision entails educating healthcare professionals about this rare benign bony tumor to ensure the best possible patient outcomes.

The oral and suprahyoid muscles are responsible for movements of swallowing. Our study aimed to determine the reproducibility of static and dynamic measurements of these muscles using bedside ultrasound equipment. Forty healthy participants were recruited prospectively. Primary outcomes were evaluation of mass measurements of the anterior bellies of the digastric, mylohyoid, geniohyoid and tongue in B-mode ultrasound. Secondary outcomes were evaluation of geniohyoid muscle layer thickness and function using M-mode. Muscle mass measurements demonstrated little within-participant variability. Coefficient of Variance (CoV) across muscles were: anterior belly digastric (5.0%), mylohyoid (8.7%), geniohyoid (5.0%) and tongue (3.2%). A relationship between sex (r2 = 0.131 p = 0.022) was demonstrated for the geniohyoid muscle, with males having higher transverse Cross Sectional Area (CSA) (14.3 ± 3.6 mm vs. 11.9 ± 2.5 mm, p = 0.002). Tongue size was correlated with weight (r2 = 0.356, p = 0.001), height (r2 = 0.156, p = 0.012) and sex (r2 = 0.196, p = 0.004). Resting thickness of the geniohyoid muscle layer changed with increasing bolus sizes (f = 3.898, p = 0.026). Velocity increased with bolus size (p =  < 0.001, F = 8.974). However swallow time and slope distance did not, potentially influenced by higher coefficients of variation. Oral and suprahyoid muscle mass are easily assessed using bedside ultrasound. Ultrasound may provide new information about muscle mass and function during swallowing.