The tongue is home to more than half of the oral germs, and patients frequently complain about having bad breath. But how frequently do dental hygienists talk to their patients about this important organ? I'd argue for an alternative way of thinking (and explains why using a toothbrush to brush the tongue is ineffective).
I recently ran a non-scientific "research" in which I posed the following queries to 20 healthy individuals: "During your most recent dentist visit, were you instructed on how to properly care for your tongue? Has someone brought up the bacteria that lives on your tongue? Did they mention your tongue in any way?” None of them could think of a time when their dentist or doctor had discussed regular tongue care with them. All of them had generally decent dental health.
This begs the question: Do we even discuss the tongue at the appointment if the patient is healthy, has no coating on their tongue, and has no offensive odor coming from their mouth? I don't remember learning how to clean my tongue in oral hygiene class. Even so, I don't recall ever receiving a score for my ability to evaluate the tongue or to properly care for it. We are all aware that the area of the mouth in question is a breeding ground for germs that might cause further complications. Why aren't we talking more about how to take care of our tongues? We shouldn't ignore this responsibility that is placed on our shoulders as qualified dental hygienists, just as we do when caring for teeth and the surrounding tissues. There are a lot of patients who don't take care of this very substantial section of the mouth, even if my unscientific study is only partially accurate. This is why I call it "neglected duty."
Why it needs to be addressed
I am aware that "neglect" is a strong word and that we don’t ignore the tongue on purpose. But crucial information about a patient's general health can be gathered from their tongue. In addition, eating, breathing, speaking, and swallowing may be difficult if our tongues are not in good shape. It is simply time to learn some new techniques for taking care of this highly significant organ. We must be careful to pay attention to healthy tongues in general rather than just those with evident problems because the tongue can easily become unhealthy, much like teeth and gums. On the tongue are more than half the germs in the mouth. This may potentially exacerbate other problems. At the moment, when we discuss the tongue, we typically discuss foul breath. Many of us are aware of the link between the tongue and odor, but malodor's underlying causes result in problems beyond just poor breath. The odor is caused by the bacteria's emission of volatile sulfur compounds (VSCs), which are also associated with the development of gum disease and sluggish wound healing. The tongue is the area of the mouth where plaque builds up the most, making it the perfect place for germs to flourish.
Starting the conversation
There are two schools of thought on how to clean the tongue. The first is to either perform the action on behalf of the patient during the visit or let the patient perform the action on their own. You can clean your tongue however you please, but in order to make it a priority, we need to start talking about it during the appointment, just like we do with brushing and flossing.
The intention is for patients to take care of their tongues daily at home. The past is the past, but because we now understand the value of tongue cleansing, we must inform our patients. Everybody should have a tongue scraper nearby, just like they do a piece of floss. Be sure to explain to patients that even though their tongues may seem clean right now, bacteria will repopulate, necessitating daily repetition of this procedure. Realistically, the entire mouth is affected by this. Patients should think of their cleanings as a new beginning on the road to better health.
The Right Tools
Some patients make an effort to take care of their tongues by brushing them with their toothbrush. This does little in the way of eradication and largely just pushes the bacteria and other germs on the tongue around. They might spread germs that cause additional problems if they clean their teeth with the same toothbrush. For this reason, a tongue scraper ought to be utilized both at home and at the office. Just as floss is used to clean the surfaces between teeth, a tongue scraper should be used to clean the tongue. Specialized areas demand unique equipment. When compared to simply brushing, scraping the tongue can eliminate 30% more bacteria. Furthermore, a tongue scraper does not exacerbate a bad gag reflex as much as a toothbrush does.
The dorsal and lateral regions of the tongue, in particular, can be quite challenging for patients to access. Therefore, taking care of these delicate places will require more than just using a tongue scraper. Here's where picking a rinse becomes important. Rinses assist with both the tongue's unbrushed parts as well as the regions that brushing and flossing miss. For both a healthy mouth and fresh breath, choosing a rinse that removes the VSCs on the tongue is crucial.
If you are now wondering, "What are the right tools to use to clean the tongue?" I have a few suggestions. For a couple reasons, I like the OraCare Tongue Sweep. First, I contributed to its design, so that undoubtedly has an impact. However, the main reason I would pick the Tongue Sweep over alternatives is that it was made to remove debris from the tongue quickly and easily. It comes in a three-pack with different colors, so it can be sufficient to cover a patient in between appointments or be enough for the whole family. The tongue scraper and OraCare Health Rinse, in my opinion, offer the best plaque removal and VSC eradication. This helps with foul breath, a common patient issue. OraCare offers a "30-day Bad Breath Challenge" to encourage patients to experiment with new routines.
Talking about the entire mouth and not just the teeth is the most crucial lesson I want hygienists to learn from this article. Starting the discussion and eliminating the neglect can only improve our care as experts because the tongue is a significant component of the mouth that needs regular care.
Kristin Goodfellow RDH
Kristin is Chief Clinical Officer of OraCare, a practicing Registered Dental Hygienist