Gustatory and TongueDisorder

By: Retnayu Pradanie

Consideration

• The tongue is mainly composed of muscles. It iscovered with a mucous membrane. Small bumps(papillae) cover the upper surface of the tongue.Between the papillae are the taste buds, whichallow you to taste. The tongue moves food tohelp you chew and swallow.

• The tongue also helps you form words.• There are many different reasons for changes in

the tongue's function and appearance

Peranan lidah dan air ludah

• Peran Lidah:– pengunyahan makanan di dalam rongga mulut,– proses menelan,– artikulasi (bicara), dan– pengecapan karena mengandung papil pengecap pada

permukaan lidah yang mengandung sel-sel pengecap dan sarafpengecap.

• Suatu zat hanya dapat dinikmati rasanya jika larut dalam air ludah.Melalui pori pengecap suatu zat dapat mencapai sel-sel pengecapdan mempengaruhi ujung-ujung sel-sel pengecap dan sesudahnyamelalui serabut-serabut saraf akan menghasilkan respons sarafsehingga seseorang dapat merasakan rasa makanan (mengecap).

The Organs ofTaste

Taste Buds (Sel Pengecap)

Figure 16.1a, b

TASTE BUDSTASTE BUDS

•• TASTE BUDS:TASTE BUDS: are the sense organs that respond to gustatory (taste)are the sense organs that respond to gustatory (taste)stimulistimuli

•• PAPILLAE:PAPILLAE: are the small elevated projections on the tongueare the small elevated projections on the tongue–– FungiformFungiform,, circumvallatecircumvallate, and foliate papillae contain taste, and foliate papillae contain taste

budsbuds–– FiliformFiliform papillae do not contain taste buds but allow us topapillae do not contain taste buds but allow us to

experience food texture and feelexperience food texture and feel•• It was once thought that the taste buds of the tongue were locatIt was once thought that the taste buds of the tongue were locat eded

in specific regions (bitter in the posterior portion and sweet ain specific regions (bitter in the posterior portion and sweet a t thet theanterior portion) HOWEVER, this is NOT TRUE.anterior portion) HOWEVER, this is NOT TRUE.–– There is no known tasteThere is no known taste ““mapmap”” all tastes can be detected in allall tastes can be detected in all

areas of the tongue that contain taste buds.areas of the tongue that contain taste buds.

Taste bud receptorsTaste bud receptors

•• Taste buds house of theTaste buds house of the chemoreceptorschemoreceptors responsible forresponsible fortaste.taste.

•• Stimulated by chemicals termedStimulated by chemicals termed TESTANTSTESTANTS that arethat aredissolved in salivadissolved in saliva

•• Each grapelike taste bud contains 50Each grapelike taste bud contains 50 --125125chemorecptorschemorecptors termedtermed GUSTATORY CELLSGUSTATORY CELLS which arewhich aresurrounded by supportive capsulessurrounded by supportive capsules–– Tiny ciliaTiny cilia--like structures extend from each gustatorylike structures extend from each gustatory

cell and project into an opening calledcell and project into an opening called TASTETASTEPORESPORES which are bathed in salivawhich are bathed in saliva

Faktor2 yg mempengaruhikemampuan mengecap:

• Banyaknya papil pengecap dan selpengecap

• Gerakan lidah (msal: gg. Gerak lidahpada px stroke)

• Banyaknya air ludah

Gangguan pada hal2 tersebutSering dialami oleh lansia

Gangguan pada hal2 tersebutSering dialami oleh lansia

What can we taste?What can we taste?

•• All taste cells can respond at least to most tasteAll taste cells can respond at least to most taste --producingproducingchemicalschemicals

•• Functionally however, there areFunctionally however, there are fivefive ““primaryprimary’’ tastetastesensation:sensation:–– SourSour–– SweetSweet–– BitterBitter–– SaltySalty–– UmamiUmami (from glutamate)(from glutamate)

•• primary sensation + sense of smell = ability to detect manyprimary sensation + sense of smell = ability to detect manydifferent flavors.different flavors.

All tastes come froma combination of

these basic taste sensations.

•Areas of sensitivity on the tongue• Tip of the tongue: Sweetness• Back of the tongue: Bitterness• Sides of tongues: Saltiness and sourness

•The five taste qualities combine with otheroral sensations, such as texture, spiciness,temperature, and aroma to produce what iscommonly referred to as flavor.•we recognize flavors largely through oursense of smell•Smell and taste are closely linked senses.•It is common for people who lose their senseof smell to say that food has lost its taste.This is incorrect; the food has lost its aroma,but taste remains.

The GustatoryPathway

Neuronal pathway for tasteNeuronal pathway for taste•• Begins with creation of a receptor potentialBegins with creation of a receptor potential

in the gustatory cells of a taste budin the gustatory cells of a taste bud•• It is then transmitted via sensory input toIt is then transmitted via sensory input to

the brainthe brain•• anterior 2/3 of the tongue cells travel overanterior 2/3 of the tongue cells travel over

the facial VII nerve. The posterior 1/3 arethe facial VII nerve. The posterior 1/3 areconducted by the fibers of theconducted by the fibers of theglossopharyngealglossopharyngeal IX nerveIX nerve

•• The III cranial nerve and theThe III cranial nerve and the vagusvagus X nerveX nerveplays minor role in taste except form theplays minor role in taste except form thetaste buds located on the walls of thetaste buds located on the walls of thepharynx and epiglottispharynx and epiglottis

•• The three cranial nerves carry impulses intoThe three cranial nerves carry impulses intothe medulla, into the thalamus and then intothe medulla, into the thalamus and then intothe taste area of the cerebral cortex in thethe taste area of the cerebral cortex in theparietal lobeparietal lobe

Taste Disorder

• Dysgeusia (altered sense of taste)– the system may misread and or distort an odor, a taste, or a

flavor. Or a person may detect a foul taste from a substance tha tis normally pleasant tasting.

• Hypogeusia: a reduced ability to taste sweet,sour, bitter, salty, and umami

• Ageusia: Can detect no taste (can't detect tasteat all)

True taste loss is rare; perceived loss usually reflects a smell loss,which is often confused with a taste loss.

Causes

Problems with taste are caused by anything thatinterrupts the transfer of taste sensations to the

brain, or by conditions that affect the way the braininterprets the sensation of taste.

Causes

The most common causes of taste disorders are– Certain medications (anti -thyroid, zinc preparations, antibiotics,

neurologic drugs and others)– Chemotherapy or radiation treatment– Aging (decreased ability to taste and smell)– Medical conditions (Bell’s Palsy, Parkinson’s Disease, diabetes, GERD

and others)– Injuries to the mouth, nose or head– Poor oral hygiene– Fungal infections on the tongue or in the mouth area– Head and neck cancers

Symptoms

• People who have taste disorders usually losetheir ability to taste or can no longer perceivetaste in the same way

• The most common taste complaint is "phantomtaste perception" -- tasting something whennothing is in the mouth.

• a specific ageusia of one or more of the fivetaste categories: sweet, sour, bitter, salty, andumami, or savory.

How to diagnose?• Ask about the medical history:

– How long has the taste problem been going on?– What kind of taste change has occurred?– What medications is she/he currently, or was

recently, taking?– Does she/he smoke, use recreational drugs or drink

alcohol?– When was her/his last dental visit?– How is her/his appetite?– Are there any foods that taste normal?– Has there been any recent change in smell?– Any recent injury or illness?– Did she/he recently change her/his brand of

mouthwash or toothpaste?

• Tests can be used to evaluate your senses of taste andsmell. Certain chemicals made to produce the fourmajor tastes — sour, sweet, bitter, salty — can beapplied to areas of your tongue. Or you may be askedto take a taste test. In this test, you will sip certainliquids and try to identify their tastes. The chemicals orliquids used to test taste have no odor.

• A "scratch and sniff" test can be used to check out yoursense of smell. The test uses special cards. Each onecontains an odor that is released when scratched. Youwill be asked to identify the odor on each card.

• Other tests that may be performed include imaging(MRI, CT scans), blood tests or saliva flow rate.

Prognosis• How long dysgeusia lasts depends on

the cause. Sometimes the problemdisappears once the cause is removed.This can occur if the cause is gumdisease, plaque, a medicine you aretaking for a short time or a short -termcondition such as a cold.

• If the cause is a yeast infection, thedysgeusia should disappear after theyeast infection is properly treated. Insome cases — for example, if nerveshave been damaged — the dysgeusiamay be permanent.

Prevention• Practice good oral hygiene,• keep up to date with your dental

appointments,• tell your doctor if you notice any problems

with your sense of taste.• Avoid contact with insecticides and

solvents• Quit smoking

Treatment

• dysgeusia is treated by treating the cause.• If no cause can be found, this is called "idiopathic

dysgeusia." It's hard to say what the outlook for thiscondition will be. In some cases, idiopathic dysgeusiamay go away on its own. In others, it will not. It isimportant to be evaluated so that the known causes ofdysgeusia can be ruled out.

• A distorted sense of taste can be a serious riskfactor for heart disease, diabetes, stroke, andother illnesses that require sticking to a specificdiet. When taste is impaired, a person maychange his or her eating habits. Some peoplemay eat too little and lose weight, while othersmay eat too much and gain weight.

• This can be a problem for people with certainmedical conditions, such as diabetes or highblood pressure. In severe cases, loss of tastecan lead to depression.

Tongue Disorder

Injury

• Traumatic injury is the most common cause oftongue discomfort.

• The tongue has many nerve endings for painand touch and is more sensitive to pain thanmost other parts of the body.

• The tongue is frequently bitten accidentally butheals quickly. A sharp, broken filling or tooth cando considerable damage to this delicate tissue.

Hairiness

• An overgrowth of the normal projections on thetop of the tongue (villi) can give it a hairyappearance.

• The tongue may also appear hairy after a fever,after antibiotic treatment, or when peroxidemouthwash is used too often.

• These "hairs" on the top of the tongue shouldnot be confused with hairy leukoplakia. Hairyleukoplakia forms on the side of the tongue andis characteristic of AIDS.

Discoloration

• The tongue's villi may become discolored if a person smokes orchews tobacco, eats certain foods, or has colored bacteria growi ngon the tongue.

• The top of the tongue may look black if a person takes bismuthpreparations for an upset stomach. Brushing the tongue with atoothbrush or scraping it with a tongue scraper can remove suchdiscoloration.

• Iron deficiency (anemia) & Pernicious anemia (deficiency of vita minB12) may make the tongue look pale and smooth.

• A strawberry-red tongue maybe the sign of scarlet fever, Kawasakidisease, pellagra (a type of malnutrition caused by a deficiency ofniacin/vitamin B3 in the diet) accompanied with painful mouth,inflamed (glossitis)—the tongue is red, painful, and swollen.

Sores and Bumps• Sores on the tongue can be caused by allergic

reactions, oral herpes simplex virus infection,canker sores, tuberculosis, bacterial infections, orearly-stage syphilis.

• Although small bumps on both sides of the tongueare usually harmless, a bump on only one side maybe cancerous.

• Unexplained red or white areas, sores, or lumps(particularly when hard) on the tongue —especiallyif painless—may be signs of cancer and should beexamined by a doctor or dentist

• Most oral cancers grow on the sides of the tongueor on the floor of the mouth. Cancer almost neverappears on the top of the tongue, except when thecancer occurs after untreated syphilis.

Discomfort

• Tongue discomfort can result from irritation bycertain foods, especially acidic ones (forexample, pineapple), or by certain ingredients intoothpaste, mouthwash, candy, or gum. Somedrugs can cause tongue discomfort, as can injuryand infection.

• A common infection causing tongue discomfort isthrush (candidiasis) in which an overgrowth offungi forms a white film that covers the tongue.

• Intense pain of the entire mouth can be causedby burning mouth syndrome.

• Usually, it is a process of elimination to find outjust what is causing the discomfort.

• Tongue discomfort not caused by an infection isusually treated by eliminating the cause. Forexample, the person may try changing brands oftoothpaste, discontinue irritating foods, or have asharp or broken tooth repaired by a dentist.

• Warm salt-water rinses may help.• Thrush can be treated with an antifungal drug,

such as nystatin or fluconazole.

DIFFICULTY MOVING THE TONGUE

• Tongue movement problems are most often caused bynerve damage.

• Problems moving the tongue may also be caused byankyloglossia, a disorder where the band of tissue thatattaches the tongue to the floor of the mouth is too short.

• Tongue movement disorders may result in speechdifficulties or difficulty moving food during chewing andswallowing.

ENLARGEMENT OF THE TONGUE

• Tongue swelling occurs with Downsyndrome, acromegaly, myxedema,amyloidosis, rhabdomyoma, and otherdisorders.

• The tongue may get wider in persons whohave no teeth and do not wear dentures.

Asuhan Keperawatan

Anamnesa

• Data demografi umum• Keluhan utama• Riwayat penyakit saat ini• Riwayat penyakit terdahulu• Riwayat alergi• Pola makan• Personal higiene

Pemeriksaan Fisik

• Pemeriksaan fisik pada lidah– Warna: merah, putih, kuning, hitam, pucat– Bentuk: pembengkakan, luka, benjolan,

simetris atau tidak, tekstur,– Pergerakan lidah– Produksi air ludah– Kelembaban mukosa

Diagnosa Keperawatan

• Perubahan sensori-persepsi: pengecapan b.d gangguanresepsi/transmisi/integrasi sensori sekunder terhadapproses penuaan/ penyakit pada sistem persyarafan/ efekmedikasi

• Resiko nutrisi kurang dari kebutuhan tubuh b.d penurunannafsu makan sekunder terhadapdisgeusia/ageusia/hipogeusia

• Resiko penatalaksanaan regimen terapeutik inefektif b.dgangguan stimulus sensori rasa

• Cemas b.d kurang pengetahuan

• Mengetahui faktor penyebab perubahansensori-persepsi

• Mengetahui tingkat gangguan sensori-persepsi

• Mengusahakan keadaan normal untukmerespon stimulus

• Meningkatkan pengetahuan dankesejahteraan

• Mencehag terjadinya komplikasi

Tujuan & Kriteria Hasil

Thank You