TONGUE

DOVELIN WITTY V
CONTENTS
 Introduction
 Development of tongue
 External features
 Muscles of tongue
 Arterial supply
 Venous drainage
 Lymphatic drainage
 Nerve supply
 Applied anatomy of tongue
 Developmental disturbances of tongue
 Conclusion
 Reference
Introduction

Tongue is a muscular organ situated in

the floor of the mouth. It is associated with the
functions of taste , speech , mastication and
deglutition.
Development of the tongue

 The mucous membrane of the anterior two third of tongue

develops from the fusion of a pair of lingual swellings with
tuberculum impar

 The lingual swellings appear as endodermal thickenings at the

anterior ends of the first pharyngeal arches

 The tuberculum impar appears as a median swelling just behind

the lingual swellings between the 1st and 2nd pharyngeal arches
 The tuberculum impar soon disappears ;thus the oral part
is mostly bilateral in origin

 The lingual swellings fuse in the midline forming median

sulcus

 The mucous membrane of the posterior one third of the

tongue develops from the cranial part of hypobranchial
eminence

 The hypobranchial eminence (copula of His) appears as a

median swelling due to the thickening of endoderm
connecting the ventral ends of 2nd , 3rd and 4th pharyngeal
arches
 Two parts – cranial part related to 2nd and 3rd arches and a
caudal part related to the 4th arch

 The 3rd arch endoderm grows forwards over the 2nd arch to
fuse with the lingual swellings and tuberculum impar and
gives rise to the mucous membrane of the posterior one
third of the tongue .

 The 3rd arch grows forwards in a V shaped manner and

fuses with the anterior two-third of the tongue

 Line of fusion is indicated by sulcus terminalis

 The mucous membrane of the posterior most part of the
tongue is derived from the 4th pharyngeal pouch

 The foramen caecum represents the site of development

of thyroglossal duct forming thyroid gland in the embryo

Vishram Singh . Human Anatomy Head ,Neck & Brain

External features

Root

Tip
Body
 Root - attached to the mandible above and to the hyoid
bone below

 Tip - forms the anterior free and which at rest , lies

behind the upper incisor teeth

 Body - which has a curved upper surface or dorsum and

an inferior surface
 Dorsum of the tongue

 Dorsum of the tongue is convex in all directions

 It is divided into
a) anterior two thirds by oral part
b) posterior one third by pharyngeal part
 by a V shaped groove , the Sulcus terminalis .

 Two limbs of the V meet at a median pit called foramen caecum

 Runs laterally and forwards up to the palatoglossal arches

Parts of the tongue

Pharyngeal part

Oral part

The oral and pharyngeal part are separated by a V

shaped sulcus called Sulcus terminalis
Oral part of tongue

 On the floor of the mouth

 Margins are free and in contact with the gums and teeth

 Superior surface – shows a median furrow and is covered with papillae which
makes it rough

 Inferior surface – covered with smooth mucous membrane which shows a median
fold , frenulum linguae

 On either side of the frenulum , a prominence produced by the deep lingual veins

 Laterally –a fold called the plica fimbriata, directed forwards and medially
towards the tip of the tongue
Pharyngeal part of tongue
 Lies behind the palatoglossal arches and the sulcus terminalis

 Posterior surface forms the anterior wall of the oropharynx

 Has many lymphoid follicles that collectively constitute the lingual tonsil

 Mucous glands present

 Connected to epiglottis by three folds of mucous membrane, median

glossoepiglottic folds.

 Either side of the median fold there is a pouch called vallecula

 Lateral folds separate the vallecula from piriform fossa

BD Chaurasia’s Human Anatomy Regional and Applied Head &Neck
Papillae of the tongue
Projections of mucous membrane which give the anterior two third of
the tongue its characteristic roughness

Vallate Fungiform
papillae papillae

Filiform Foliate
papillae papillae
Vallate papillae
 Larger in size ( 1 to 2 mm)
 8 to 12 in numbers
 Situated in front of sulcus terminalis
 Each papilla is a cylindrical projection surrounded by a circular sulcus
 Walls of papilla raised above the surface.
Fungiform papillae
 Numerous near the tip and margins of the tongue, some scattered over
dorsum
 Smaller than vallate papilla
 Larger than filiform papilla
 Consists of a narrow pedicle and a large rounded head-
Distinguished by their bright red colour
Filiform papillae
(conical papillae)

 Covers the presulcal area of the dorsum of the tongue

 Characteristic velvety appearance
 Smallest and numerous of the lingual papillae
 Histologically , they are pointed and covered with keratin
 Apex is often spilt into filamentous process
Foliate papillae
 Short vertical folds
 Present at the lateral border just in front of circumvallate
papillae
 Leaf shaped
Taste buds
 Microscopic barrel shaped epithelial structure
 Scattered over lingual dorsum , epiglottis , lingual aspect of the soft palate
 Innervated by gustatory nerves
 Most numerous on the sides of the vallate papilla
 Filiform papilla has no taste buds( mid dorsal region)
Structure of taste bud
Taste Discrimination
Taste pathway
 -Anterior 2/3rd of tongue except vallate papillae is carried by chorda tympani
branch till geniculate ganglion . Central process go to the tractus solitarius in the
medulla.

- Posterior 1/3rd of tongue including vallate papillae is carried by

glossopharyngeal nerve till the inferior ganglion . Central process also reach the
tractus solitarius.

- Posteriormost part of tongue and epiglottis travels through vagus nerve till
the inferior ganglion of vagus .

-After relay in tractus solitarius ,the solitario- thalamic tract is formed,

becomes a part trigeminal lemniscus and reaches postero-ventromedial nucleus
of thalamus of opposite side

- Another relay here takes them to lowest part of postcentral gyrus , which
is the area for taste
Ventral surface of tongue
 Mucous membrane lining this surface is thin ,
smooth and purplish

 Reflected on to the floor of the mouth

Features –
 frenulum linguae – median fold mucous membrane connecting the tongue to
the floor of the mouth

 Deep lingual veins – seen on the either side of frenulum linguae

 Plica fimbriata – fringed fimbriated fold of mucous membrane, lateral to

lingual vein directed forwards and medially towards the tip of the tongue
Muscles of the tongue

 Middle fibrous septum divides the tongue into right and

left halves

 Each half contains-

4 Intrinsic muscles

4 Extrinsic muscles
Intrinsic muscles

1) superior longitudinal muscle

2) inferior longitudinal muscle
3) transverse muscle
4) vertical muscle
Ø Occupy the upper part of tongue and attached to the submucous fibrous layer
and median fibrous septum

Ø They alter the shape of tongue

Superior longitudinal muscle –

location – beneath the mucous membrane

actions - shortens the tongue
makes the dorsum concave

Superior
longitudinal
 Inferior
longitudinal
Transverse muscle
location - extends from median septum to the margin
actions - makes the tongue narrow and elongated

Vertical muscle
location - at the border of the anterior part of the tongue
actions - makes the tongue broad and flattened
Extrinsic muscles

 Attach the tongue to the mandible , hyoid , the styloid

process and the palate

1) Genioglossus
2) Hyoglossus
3) Styloglossus
4) Palatoglossus
Genioglossus (fan shaped muscle )

origin – superior genial tubercle

insertion - whole of the tongue

hyoid bone (lowest fibers)

actions – protrudes the tongue when

acting together with its counterpart
of opposite side
Hyoglossus (flat quadrilateral muscle)

origin - greater cornu and

adjacent part of the body of hyoid

insertion - side of tongue between

styloglossus laterally and
inferior longitudinal muscle medially

actions - depresses the sides of the tongue

makes the dorsal surface convex
Styloglossus ( an elongated slip )

origin - tip of styloid process and

adjacent part of styloid ligament

insertion – side of the tongue ,

interdigitating posteriorly with the
fibers of hyoglossus

actions – draws the side of the tongue

upwards and backwards`
Palatoglossus (a slender slip )

origin – oral surface of palatine , aponeurosis of palate

insertion - side of tongue(junction of its oral and pharyngeal parts )

actions - pulls up the root of the tongue approximate palatoglossal arches

Summary of action of muscles

Intrinsic muscles Actions

Superior longitudinal Shortens the tongue makes it
dorsum concave
Inferior longitudinal Shortens the tongue makes it
dorsum convex
Transverse Makes the tongue narrow and
elongated
Vertical Makes the tongue broad and
flattened

Extrinsic muscles Actions

Genioglossus Protrudes the tongue
Hyoglossus Depresses the tongue
Styloglossus Retracts the tongue
Palatoglossus Elevates the tongue
Arterial supply

 Branches of lingual arteries ;

the deep lingual arteries to the anterior part and
dorsalis linguae arteries to the posterior part

 Tonsillar branch of the facial artery

 ascending pharyngeal artery

Venous drainage

Deep lingual vein - principal vein of the tongue

- visible on the inferior surface of the tongue near the
median plane through thin mucous membrane

Venae comitantes - accompanying the lingual artery

- joined by dorsal lingual veins

Venae comitantes – accompanying the hypoglossal nerve

 Lymphatic drainage
Apical vessels –
- drain the tip and inferior surface of tongue into submental
lymph nodes after piercing the mylohyoid muscle
- efferents go to the submandibular nodes
- some cross the hyoid bone to reach the jugulo-omohyoid nodes

Marginal vessels –
-drain the marginal portions of the anterior two third of the
tongue, unilaterally into submandibular lymph nodes
- and to the lower deep cervical lymph nodes , including
jugulo-omohyoid
Central vessels -
-drain the central portion of the anterior two third of the
tongue
-pass vertically downwards in the midline of the tongue
between the genioglossus muscle
-drain bilaterally into the deep cervical lymph nodes

Basal vessels –
-drain the root of the tongue and posterior one third of the
tongue bilaterally into upper deep cervical lymph nodes , including jugulo-
digastric
Nerve supply
Motor supply –

-all muscles of tongue (intrinsic

and extrinsic ) are supplied by
hypoglossal nerve

-except palatoglossus
which is supplied by cranial root of accessory
via pharyngeal plexus
Sensory supply –

- Anterior two third of the tongue is supplied by

a) lingual nerve carrying general sensations

b) chorda tympani nerve carrying special

sensations of taste

- Posterior 1/3rd of the tongue is supplied by

a) glossopharyngeal nerve , carrying both general & special sensation of

taste

b) posterior-most part , supplied by internal laryngeal branch of superior

laryngeal carrying special sensations of taste.
Correlation of nerve supply of tongue
with its development
Epithelium –(sensory innervation)
a) anterior 2/3 - develops from 1st pharyngeal arch
- supplied by lingual nerve and chorda tympani nerve

b) posterior 1/3 – develops from 3rd pharyngeal arch

- supplied by glossopharyngeal nerve

c) posterior most part – develops from 4th arch

- supplied by internal laryngeal nerve
Muscles –(motor innervation)

- muscles of tongue develops from occipital myotomes

-at first closely related to developing hindbrain , later migrate

antero-inferiorly around the pharynx and enter the tongue

- supplied by hypoglossal nerve( 12th cranial nerve)

Examination of tongue
 The tongue exam can reflect a number of underlying diagnoses such as
infections, nutritional deficiencies, malignancy and even neurological
dysfunction.

NORMAL FINDINGS

 Color - Pink-red on dorsal and ventral surfaces. The ventral surface may have
some visible vasculature.
 Texture - Rough dorsal surface owing to papillae, which have three types.
There should be no hairs, furrows, or ulceration.
 Size - Should fit comfortably in mouth, tip against lower incisors. Sublingual
glands should not be displaced.
In general, the examination of the tongue should occur in the following steps:

 Touch the tip of the tongue to the roof of their mouth and inspect the ventral
surface.

 Ask the patient to protrude the tongue straight out and inspect for deviation,
color, texture, and masses

 With gloved hands, hold the tongue with gauze in one hand while palpating
the tongue between the thumb and index finger of the other, noting masses
and areas of tenderness.
Applied anatomy

1.Hypoglossal nerve damage

§ Injury to the hypoglossal nerve produces
paralysis of the muscles of the tongue
on the side of the lesion

§ If the lesion is infranuclear ,

there is gradual atropy of the
affected half of the tongue

§ Muscular twitchings are also observed

 Supranuclear lesions of hypoglossal nerve produces
paralysis without wasting

 In Pseudobulbar palsy , tongue is stiff , small and moves

very sluggishly resulting in defective articulation
2. GLOSSITIS

 Glossitis a part of generalized ulceration of the mouth

cavity
 In certain anaemia tongue becomes bald due to atrophy
of the filiform papillae
3. Unconscious patients
 In unconscious patients , the tongue may fall back and
obstruct the air passages .

 Prevented either by lying the patient on one side with

head down or by keeping the tongue pulled out
mechanically
4. Grandmal epilepsy
 In patients with Grandmal epilepsy the tongue commonly
bitten between the teeth during the attack

This can be prevented by putting in a mouth gag at the

onset of seizure
5. Carcinoma of tongue
 Carcinoma of the tongue is quite common
 It is better treated by radiotherapy than by surgery
 Carcinoma of the posterior one third of the tongue is more dangerous
due to bilateral lymphatic spread
6.Candidiasis
- Oral thrush , moniliasis
- Common fungal infection caused by Candida albicans
Lehner et al (1967) classified oral candidiasis ;

Ø Acute pseudomembranous candidiasis –

- Most common form
- Soft , white plaques resembling milk curds on buccal mucosa
tongue, palate , gingiva, floor of mouth
- Removal of white plaques reveals an erythematous area

Ø Acute Atropic Candidiasis –

- Erythematous lesions
- Consistently painful

Ø Chronic Hyperplastic form –

- Leukoplakic candidiasis
- Firm , white persistent plaques
- Have possible premalignant potential

Shobha Tandon Textbook of Paediatric Dentistry vol 2

Ø Chronic mucocutaneous candidiasis-
- Hyperplatic
- Localized or diffuse
- Familial trait has also been seen
- Associated with candidiasis endocrinopathy syndrome
Ø Chronic atropic candidiasis –
- Denture sore mouth
- Commonly occurs with angular cheilitis
Treatment –
- Nystatin
- Fluconazole
- Itraconazole
- Iodoquinol
7.Scarlet fever
- ∝ ℎ���������  streptococci
- Rare , highly contagious specific bacterial disease
- Commonly affects children
- Incubation period is 2 – 4 days
clinical features –
- Involvement of pharynx, tonsils,
soft palate and tongue
- Palate appears congested and inflamed
- Tongue covered by milky white or grey fur
with enlarged fungiform papillae projecting like
tiny red knobs called Strawberry tongue
- Later becomes deep red nodular tongue
- Nodular appearance because of swollen
fungiform papillae ;termed Raspberry tongue

Treatment –
- Penicillin or Erythromycin
8.Papilloma
-Benign epithelial neoplasm arising from the stratified squamous
epithelium of the oral cavity.

-Caused by Human Papilloma Virus( HPV 6 ,11 , 16).

- Types – mucosal & cutaneous
- Modes of transmission – vertical transmission , auto &
heteroinoculation by genital , sexual or casual social contact.

- In children >1 age , maternal-fetal transmission.

-Neonates acquire HPV infection due to aspiration of amniotic fluid .
- In children <1 age , transmission by auto & heteroinoculation .
 CLINICAL FEATURES –
- Site of occurrence – palate ( 34%) , uvula,tongue , lips and gingiva
-Exophytic , painless , well delimited growth
-Numerous small digitiform projections on the surfaces gives
cauliflower like appearance
- Single , whitish lesions measuring few millileters in diameter

Treatment –
- Surgical excision
9.Nutritional deficiencies
 Vitamin B1 deficiency(Thiamine) –
-Accumulation of pyruvic & lactic acid
in serum and tissues causes oedema of tongue
- Loss or atrophy of the lingual papillae & glossodynia
- Intracellular oxidation

 Vitamin B3 deficiency (Niacin)-

- Causes pellagra
- Red , depapillated with bald surface
 Vitamin B2 deficiency (Riboflavin)-
- Magenta and depapillation
- Becomes cyanotic –bluish- purple-magenta
glossitis

 Vitamin B12 deficiency (cobalamin)-

- Leads to decreased gastric secretion of intrinsic factor ,which is
essential for absorption of vitamin B12
- Beefy tongue- bright red ,oedematous , raw , tender
- Fissures or furrows on the dorsal surface of tongue
- Atrophy of papillae
- Followed by flabby , smooth , glazed and
ulcerated tongue
10.Miscellaneous lesions
Apthous ulcer –
- Multifactorial aetiology
- No prodromal period
- Affects non – keratinized mucosa
- Primary lesion is a papule
- Appear in crops and are painful
- Heal within 10 – 14 days
Major apthous ulcers - larger , deeper , take longer
to heal and heal with scarring
Herpetiform ulcers – 1 – 2mm diameter and multiple

Treatment -
- chlorhexidine mouthwash
- Triamcinolone
 Traumatic ulcers
- Self inflicted trauma from manifestation of stress ,anxiety or
psychological disturbances
- Mechanical trauma from biting , sharp tooth , malaligned teeth ,
ill fitting intraoral appliances
- Heal within 10 days
-Biopsy indicated when a presumed traumatic ulcer
does not show signs of healing within 10 days
Treatment –
-Cause of trauma is removed
- Topical analgesic
- Anesthetic gel application
- Chlorhexidine rinse
-Vitamin B complex & vitamin C
 Riga-Fede disease
- Early eruption of teeth causes ulceration on the ventral surface of the
tongue
- Due to sharp edges of the teeth
- Mild to severe ulceration interfere with the infants feeding& suckling
 Elzay (1983) proposed the name
traumatic ulcerative granuloma with stromal eosinoplilia ( TUGSE)
According to him , ulceration is followed by
ingress of microorganism , toxins or
foreign protein into the connective tissue
 Treatment -
Excision of the lesion
Removal of the cause
- Smoothening the incisal edge
- Placement of a smooth & rounded composite
Developmental disturbances of tongue
1.Aglossia and Microglossia syndrome –
- Malformation is very rare
- Failed embryogenesis of the lateral lingual swellings
& tuberculum impar from 4th to 8th gestational weeks
- Observed as a small , rudimentary tongue
- No predliction for gender
- Speech and swallowing are affected

Shafer-Hine-Levy Textbook of Oral Pathology 7th edt

2.Macroglossia –
- Tongue hypertrophy, enlarged tongue , pseudo macroglossia
observed as large tongue
- In infants , can lead to difficulty in breathing ,drooling of saliva , difficulty in
feeding
- Noisy breathing and rarely airway obstruction
- Open bite , lisping speech , crenated tongue

Treatment –
surgical debulking of tongue tissue
3.Ankyloglossia and tongue tie –
- Inferior frenulum attaches to the bottom of the tongue
and subsequently restricts free movement of the tongue

- Male predliction

- Partial ankyloglossia is more common

- tongue tie causes persistent gap

between the mandibular incisors
•Breast-feeding problems. Breast-feeding requires a baby to keep his or her tongue over 
the lower gum while sucking. This can  interfere with a baby's ability to get breast milk. 

•Speech difficulties. Tongue-tie can interfere with the ability to make certain sounds — 
such as "t," "d," "z," "s," "th," "r" and "l.“

•Poor oral hygiene. For an older child or adult, tongue-tie can make it difficult to sweep 

food debris from the teeth. This can contribute to tooth decay and inflammation of the gums 
(gingivitis). 

•Challenges with other oral activities. Tongue-tie can interfere with activities such as 

licking an ice cream cone, kissing or playing a wind instrument.

Diagnosis
 It is revealed when the patient is asked to move the tongue upwards or
outwards

 It results in eversion of lateral margins and heaping up of middle portion of

the tongue
Classification
Kotlow in 1999 , classified into 4 classes

class 1 – Mild ankyloglossia ( 12-16 mm)

class 2 – Moderate ankyloglossia ( 8-11 mm)

class 3 - Severe ankyloglossia (3-7 mm)

class 4 – Complete ankyloglossia ( <3 mm)

Clinically acceptable , normal range of free tongue greater than 16 mm

Treatment –

-Preventing speech defects or improving a child’s

articulation , surgical intervention can be done
- Lingual frenectomy / frenulectomy – is the removal
of band of tissue connecting the underside of the tongue with the
floor of the mouth

-Complications of a frenectomy are rare — but could

include bleeding or infection, or damage to the tongue or salivary
glands. It's also possible to have scarring or for the frenulum to
reattach to the base of the tongue.

-Frenuloplasty -A more extensive procedure known as

a frenuloplasty might be recommended if additional repair is
needed or the lingual frenulum is too thick for a frenectomy.
4.Cleft tongue –

-Completely cleft or bifid tongue is a rare condition that is

apparently due to lack of merging of the lateral lingual swellings

-Partial cleft results because of incomplete merging and

failure of groove obliteration by underlying mesenchymal proliferation .

-Partial cleft is usually of little significance

Except for accumulation of food debris and
Local irritation
5.Fissured tongue –
-Scrotal tongue , lingua plicata , plicated tongue

-Characterized by grooves that vary in depth and are

noted along the dorsal and lateral aspects of the tongue
- Common asymptomatic congenital abnormality
- Feature of Melkerson –Rosenthal syndrome and Downs
syndrome
6.Median rhomboid glossitis –

- The posterior dorsal point of fusion is occasional

defective , leaving a rhomboid shaped , smooth , erythematous mucosa
lacking in papilla and taste
- Rhomboid or oval area of red depapillation is in
anteroposterior direction
- Midline soft palate erythema in the area of routine
contact with the underlying tongue called kissing lesion
7.Benign migratory glossitis –
-Geographic tongue , wandering rash of tongue

-Multifocal , patchy,sharply demarcated ,irregular areas

of surface erosions on the dorsal surface

-Constantly changing pattern of serpiginous white line

surrounding areas of smooth ,depapillated mucosa

- Usually aymptomatic ,but some may have burning

sensation or sensitivity to hot & spicy food

Treatment –
Antihistamines
Anxiolytic drugs
steroids.
8.Hairy tongue –
- Black hairy tongue , lingua nigra , lingua vilosa , lingua vilosa nigra

- Defective desquamation of the filiform papilla

rarely symptomatic and may result in glossopyrosis (burning tongue)

- Complains of tickling sensation in the soft palate and the oropharynx

during swallowing

- Bacterial and fungal overgrowth play a role in the colour of the tongue

Treatment –
- Reduction or elimination of
predisposing factors
- Desquamation of papilla is
done by Constant scraping of tongue
9.Lingual varices –
-Lingual/sublingual varicosities

-A varix is a dilated , tortuous vein ,most commonly a vein which is

subjected to increased hydrostatic pressure but poorly supported by surrounding
tissue

- Varices involving the lingual ranine veins are relatively common

appearing as red or purple shotlike clusters of vessels on the ventral
surface ,lateral borders of the tongue and floor of mouth
10.Lingual thyroid nodule –
-An anomalous condition in which follicles of thyroid tissue are
found in the substance of the tongue

-Arising from a thyroid anlage that failed to migrate to its

predestined position or from anlage remnants that become detached and were
left behind
- Dysphagia , dysphonia ,
dyspnea , hemorrhage with pain or a feeling
of tightness or fullness in the throat

Treatment –
-In symptomatic cases surgical excision
with hormonal replacement therapy
Tongue scrapers
-Flat , flexible , plastic sticks which help in
cleaning the rough dorsal surface of the tongue

- Additionally , a gauze piece can also be

used as tongue scraper
Advantages –

- Cleans toxins and bacteria from the tongue

- Helps remove coating on the tongue that leads to embarrassing

halitosis (bad breath)

-Helps eliminate undigested food particles from the tongue

- Cleans the taste buds to enhance the sense of taste

- Promotes overall oral and digestive physical well-being

Disadvantages –

Gag reflex stimulation-

This is a concern as it could lead to vomiting.

Cutting the tongue surface-

Using an uneven or the tongue scraper with rough edges
could accidentally cut the surface of your tongue.

Application of pressure during use –

Failure to be gentle could harm your tongue badly by
either; break the skin or alter and harm your taste buds.
The comparative evaluation of the effects of
tongue cleaning on salivary levels of mutans
streptococci in children – S Rupesh et al 2012

 Present study shows that tongue scraping and tongue brushing demonstrated
statistically significant reductions in salivary mutans streptococci counts after
10 days and also after 21 days.

 It was also noted that tongue scraping and tongue brushing were equally
effective in reducing colony counts.
Conclusion

- Tongue is a vital organ in the body. It helps

in speech , mastication and is used in the act of swallowing.
It has importance in the digestive system and is the primary
organ of taste in the gustatory system

- It can reflect a number of underlying

diagnoses such as infections, nutritional deficiencies, malignancy
and even neurological dysfunction.
References

Ø B D . Chaurasia .Human anatomy Regional and Applied .dissection and clinical

Head & Neck .vol 3
Ø Singh V. Anatomy of Head ,Neck and Brain. published by Elsevier 2009;206-214
Ø Shafer’s. Textbook of Oral Pathology . Published by Elsevier 2012;7:27-34
Ø Tandon S. Textbook of Pedodontics .Paras Medical Publisher 2008;2:251-254.
Ø The comparative evaluation of the effects of tongue cleaning on salivary
levels of mutans streptococci in children
S Rupesh 1, J J Winnier , U A Nayak, Ap Rao, V Reddy, J Peter