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Mark Bornfeld
Mark Bornfeld, Dentist (DDS)
Category: Medical
Satisfied Customers: 5784
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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ive noticed flesh, almost red like bumps on the back sides

Customer Question

i've noticed flesh, almost red like bumps on the back sides of my tongue. they don't hurt at all. could this be cancer or could that be normal for some people?
Submitted: 1 year ago.
Category: Medical
Expert:  911DOC replied 1 year ago.

Almost certainly normal.

 

HERE IS A GOOD LINK.

 

these bumps CAN occur anywhere on the tongue and are usually more prominent towards the posterior aspect of the tongue.

 

taste buds can become larger or smaller for reasons we do not understand, tongue cancer is rare but does occur in smokers and people who use oral tobacco.

 

Certainly worth checking with your doctor when you can but no need to go today.

 

Positive feedback always appreciated.

 

If you have questions about my answer simply ask them below and click 'reply'.

 

thanks for you question and have a great day.

 

911Doc

 

 

911DOC, Board Certified Dr.
Category: Medical
Satisfied Customers: 5093
Experience: Emergency Medicine Physician
911DOC and 5 other Medical Specialists are ready to help you
Customer: replied 1 year ago.

Thank you. Can heavy smokers & somewhat heavy drinkers who don't practice good oral hygiene develop hairy tongue?

Expert:  911DOC replied 1 year ago.

yes. certainly they can.

 

positive feedback always appreciated.

 

best

Customer: replied 1 year ago.
Thank you but I was hoping for a bit more info. If you drink somewhat heavily, even before bed, and don't brush your teeth before bed, and don't practice good oral hygiene, and smoke heavily, don't drink a lot of water, you can develop a coating on your tongue? Can that coating occur anywhere, even on the back of your tongue? It so, is there a way to get rid of it for good or will it always be there somewhat? Thank you
Expert:  Mark Bornfeld replied 1 year ago.
Welcome, and thank you for putting your trust in me!

Your previous expert has opted out of your question. Would you like me to pick up the line of questioning?
Customer: replied 1 year ago.
Yes please.
Expert:  Mark Bornfeld replied 1 year ago.
OK-- I will respond to your latest questions. However, if you still need further confirmation about the tongue bumps to which you originally referred, I invite you to upload photographs of the involved areas. You may use the "paper clip" icon on the text entry form toolbar to upload a digital picture. Alternatively, you may send your picture to a photo hosting site, such as Flickr or Photobucket, and provide a link to the picture in a reply.

"If you drink somewhat heavily, even before bed, and don't brush your teeth before bed, and don't practice good oral hygiene, and smoke heavily, don't drink a lot of water, you can develop a coating on your tongue?"
In fact, there is always a coating on the tongue, whether it is visible or not. The coating varies in visibility and thickness according to changes in the local oral environment. Allow me to clarify...

Much like the skin, the surface of the tongue is composed of tissue called "epithelium". This tissue is in a constant state of "exfoliation" (sloughing off and being carried away by a combination of mechanical friction and salivary flow and swallowing), and also in a constant state of renewal: new epithelium is formed at its bottom layer, and that new epithelium matures and slowly makes its way to the tongue surface as the top layers are swept away. Anything that slows the exfoliation of epithelium, such as diminished chewing, motor impairment of the tongue, or diminished salivary flow, will cause the surface tissues to thicken. Conversely, anything that increases the exfoliation of the tongue, such as increased chewing activity, tongue brushing, or improved salivary flow will tend to diminish the thickness of the tongue coating. In other words, exfoliation and new epithelial growth are in a constant state of "dynamic equilibrium" that can be shifted toward a thickening or a thinning out of the tongue surface, according to changing conditions in the mouth.

In the case of the condition "hairy tongue", the equilibrium is shifted toward thickening of the epithelium. The innumerable tiny bumps on the upper tongue surface-- the "filliform papillae"-- tend to lengthen and accumulate organic debris. This coating may increase in thickness significantly, to the point where it appears like a fur coating. It may also become stained to anywhere between a whitish-yellow to a dark brown or even black color. Hairy tongue is best treated by identifying those factors which may be responsible for either diminished exfoliation or increased epithelial growth. Sometimes, the cause is unexpected-- for example, some patients will attempt to treat the condition by rinsing with hydrogen peroxide, not knowing that this practice can even accelerate epithelial growth and worsen hairy tongue. A better strategy is to regularly brush the tongue or scrape the tongue surface with a device made for this purpose (a tongue scraper). Any other contributing factors which may impair salivary flow or stimulate epithelial growth,, such as dehydration, smoking, alcohol consumption, should also be managed if feasible.

"Can that coating occur anywhere, even on the back of your tongue? It so, is there a way to get rid of it for good or will it always be there somewhat?"
Actually, it is more likely to occur on the back of the tongue, where tongue brushing and scraping are more problematic (it is quite difficult to brush or scrape the back of the tongue without provoking severe gagging). However, coatings on the posterior tongue are seldom a functional or cosmetic concern.

As I indicated before, some coating of the tongue is always present. However, proper oral hygiene is usually sufficient to keep it within acceptable bounds.

Hope this helps...
Customer: replied 1 year ago.
Thank you very much for your answer. I do appreciate the level of detail you provided and I hate to be redundant but I want to make sure I'm clear. Last question, I promise.

You said that -

"Hairy tongue is best treated by identifying those factors which may be responsible for either diminished exfoliation or increased epithelial growth."

Can those factors just be a long period of heavy smoking/alcohol consumption(which can cause dehydration) & a long time of poor oral hygiene?
Expert:  Mark Bornfeld replied 1 year ago.
Yes-- those can be contributing factors. Tobacco smoke is a chemical irritant, and the mucous membranes of the mouth tend to respond by increasing the rate of epithelial growth; this will tend to thicken the surface tissues, assuming the rate of exfoliation does not keep pace with the increased growth rate. (Smoking can cause white patches called "leukoplakia", a result of this increased epithelial thickness, on all oral mucous membranes, including the tongue.) Likewise, alcohol can act as a diuretic, which tends toward dehydration, which reduces salivary flow. Reduced levels of oral hygiene also tend to reduce the mechanically induced exfoliation of surface tissues. In this way, both alcohol consumption and poor oral hygiene can slow the exfoliation of epithelium, with the same result of favoring epithelial thickening and hairy tongue formation.

Hope this helps...
Customer: replied 1 year ago.
Thank you! Thought i might be done but have another :) if you stick out your tongue, as far as you can, to the point where you can see your tonsils, way, way back, in the middle of the tongue (and the part of the tongue i'm referring to, at this view, looks like it's under the tonsils), can there be visible bumps/taste buds all the way back there?

also, i've tried to give you a good review but it says i've already submitted a review, which i did for the person who answered my 1st question, but i'd love to give you a good review!
Expert:  Mark Bornfeld replied 1 year ago.
Yes-- the bumps at the very back of the tongue are called the "circumvallate papillae", and are arranged in a single symmetrical row that runs across the back in a somewhat chevron-like orientation. At the center of the row of circumvallate papillae is the "foramen cecum"-- a small depression, which marks the embryonic point of origin of the thyroid gland. In rare cases, some thyroid tissue can sometimes remain at that location as well.

Good luck!
Customer: replied 1 year ago.
sending pics via a link. the subject noticed a flesh colored, not painful, bump in the back of their mouth above the bottom back molar but no where else. could this be cancer? on the pic, it looks like there's a white lining on the right of the bump but that's just the lighting, it's not really white.

the 2nd pic is of the tongue, there's just a little bit more than what you can see in the pic but not much more.

http://s1272.photobucket.com/user/llp5/library/
Expert:  Mark Bornfeld replied 1 year ago.
The first photograph is not sufficiently clear to effectively evaluate the lesion. It appears to be either a hyperkeratosis (the intra-oral equivalent of a callus on the skin, caused by chronic mechanical friction-- perhaps from an upper wisdom tooth?), or perhaps a traumatic ulcer due to minor injury from food. Although there is no way to absolutely rule out the presence of cancer, this is a relatively uncommon location for malignancy, and would almost certainly be something else.

The second photograph shows one of the previously mentioned circumvallate papillae in side-profile, toward the right side of the picture, (i.e., the left side of your tongue), just to the right of your uvula.

Hope this helps...
Customer: replied 1 year ago.
The subject has been known to suck in and lightly bite down (that area) occasionally to prevent yawning but again, it doesn't hurt, not red or irritated, just a small, flesh colored bump there, but unlikely cancer? and is it highly possible that it would just be what you said it appeared to be? and not dangerous? a dentist will be seen but i'm just looking for as much info as i can to try to put the subject at some ease.

the 2nd pic wasn't about those big side bumps on the tongue but to clarify, those weren't the bumps i was asking about before. the bumps i was talking about are in the middle (slide like part) of the tongue all the way in the back and when you stick your tongue out as far as you can, you can see them. they look like they're under the tonsils when your tongue is out that far. those are the bumps i was asking if were normal like taste buds or something. the pic was more about the coating on the tongue. i wanted you to see it, there's a bit more there than what you can see but not much more
Expert:  replied 1 year ago.
As I said previously, the area behind the third lower molar is an uncommon site for malignancy. That is not sufficient to unequivocally eliminate the possibility that it is cancer, and if there is any doubt as to its identity, the area should be kept under surveillance by your dentist. Any increase in size, change in color, or ulceration would justify more aggressive diagnostic efforts, including the possibility of biopsy.

The photograph of your tongue looks normal, as does the circumvallate papilla that is visible.

Good luck!
Mark Bornfeld, Dentist (DDS)
Category: Medical
Satisfied Customers: 5784
Experience: Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
Mark Bornfeld and 5 other Medical Specialists are ready to help you
Customer: replied 1 year ago.
OK, i have a couple of other pics of the tongue and wonder what you think. if this could still be due to yrs of excessive drinking, smoking and poor oral health. or maybe it could be dehydration? also, i don't remember if i asked this and if you answered but can you get rid of the coating, how? and how long would it take before you see results?

http://s1272.photobucket.com/user/llp5/media/New/photo_zps90dc0168.jpg.html?sort=3&o=0

what color should the roof of the mouth be? is the whole thing red/pink or can it be different?
Expert:  Mark Bornfeld replied 1 year ago.
In these photographs, your tongue appears to be normal. Therefore, whatever drinking and smoking you might have done does not seem to have had a conspicuous effect on the appearance of your tongue.

If your tongue develops a white coating simply due to dehydration or thickening of its top surface, restoring proper fluid balance and regular brushing or scraping of the tongue will keep any coating in check. Based on the grossly normal condition of your tongue now, no real change will result from improved oral hygiene, but it will reduce the probability of a coating re-forming in the future.

Hope this helps...
Customer: replied 1 year ago.

another question, i've noticed a purple vein on the inside of cheek. and also on the roof of my mouth i notice on the right and left side some purple coloring, almost looks like purple veiny, not swollen or painful. could that be from the years of heavy smoking, heavy drinking and poor oral health or something worse like something chronic and deadly? or could that be something normal. and if you could answer asap i'd really appreciate it cause i'm imagining the worst like hiv and can't sleep. i haven't heard of anyone i've been with being diagnosed w/ that but who knows. i know it's hard to tell from a pic but i'm adding one. in the pic it looks like a solid purple where the arrows are but from looking at it in the mirror, it could almost look veiny or maybe it is purple, i don't really know.

 

and i'm not sure if i asked this before but in the back of my mouth by the back teeth, on each side, there appears to be a bit of raised skin and on one side the raised skin is about the size of a pin head and is white, on the other side the raised portion is white and less than an inch and a half. there is no pain. i feel like that's been there for a long time, could that be something horrible or do some people have that with it being nothing?

 

http://s1272.photobucket.com/user/llp5/media/New/photo_zps355a0f1a.jpg.html

Expert:  Mark Bornfeld replied 1 year ago.
Please provide a photograph of the involved areas-- you may use the "paper clip" icon on the text entry form toolbar to upload a digital picture. Alternatively, you may send your picture to a photo hosting site, such as Flickr or Photobucket, and provide a link to the picture in a reply to this information request. This will allow me to provide a more accurate and relevant response...
Customer: replied 1 year ago.

please look at my question again as there is a link in there for a pic however don't rely on the pic as it's not really great and please re-read my question above before looking at the pic and answering.


 


also, i know it's hard to tell from a pic. in the pic it looks like a solid purple where the arrows are but from looking at it in the mirror, it could almost look veiny or maybe it is purple, i don't really know.

Expert:  Mark Bornfeld replied 1 year ago.
The appearance of your palate is normal. The areas to which you refer typically take on this color; it is the result of the thin, translucent nature of the palatal mucosa, which allows the fatty and glandular tissue to shine through a bit. If a dentist had the opportunity to examine the area, he probably would not think to raise the issue at all, because that is what a normal palate looks like.

You do not include photographs of either the "purple vein on the inside of cheek" or the "bit of raised skin" to which you refer, but these descriptions likewise evoke the picture of normal anatomic features. There are several veins and arteries which run beneath the surface of the oral mucous membrane, and they can be conspicuous when they are superficially positioned, as they frequently are. The "raised skin" is consistent with a white line that normally runs horizontally, front to back, at the level where the upper and lower teeth meet when closed together. This line, the "linea alba", is the result of mechanical friction against the tooth surfaces. Occasionally, the linea alba becomes thickened, or "hypertrophic", especially if it has been accidentally bitten a few times. If it is not uncomfortable, this can be safely ignored.

Of course, I'm working from a verbal description here. I would welcome additional photographs to confirm my speculative answers.

Hope this helps...
Customer: replied 1 year ago.
Thank you. It is really difficult to get pics inside the mouth but I can try later as I'm serving jury duty today. What about the roof of the mouth aside from the purple coloring or veiny look I see. Can the roof of the mouth vary in color or should it always be pink? Is such a discoloration normal or indicative of something terrible?
Expert:  Mark Bornfeld replied 1 year ago.

The roof of the mouth varies in color from place to place; this is due to varying concentrations of salivary glands, varying thicknesses of the surface epithelium, and other factors, including scatterings of lymphoid tissue which are normally found distributed around the mouth, the tongue, the throat, and the tonsils. Some dark-complexioned individuals also have patches of melanin pigment over the palate and gum tissue; this is also normal.

As I said previously, the appearance of your palate is normal, based on the photograph you provided.

Hope this helps...

Customer: replied 1 year ago.

adding a link to more pics. and the rest of the roof of the mouth is not all pink.

 

also, i know you had mentioned that there can be bumps all over the tongue. what about under the tongue, can there be pin sized bumps under there?

 

http://s1272.photobucket.com/user/llp5/library/New2?sort=3&page=1

Expert:  Mark Bornfeld replied 1 year ago.
The photographs of your palate display a normal appearance; the white areas on the cheeks represent a normal thickening of the mucous membrane at the level where the upper and lower teeth meet; this is due to mechanical friction with the teeth during chewing activity.

There are a variety of bumps under the tongue-- due to blood vessels, lymphoid tissue, and salivary gland ducts. The underside of the tongue has the linearly arranged "fimbriated folds", and the floor of the mouth has the "plica sublingualis". These are all normal anatomic features.

Hope this helps...

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