Gustatory and Tongue

Disorder
By: Retnayu Pradanie

Consideration
The tongue is mainly composed of muscles. It is
covered with a mucous membrane. Small bumps
(papillae) cover the upper surface of the tongue.
Between the papillae are the taste buds, which
allow you to taste. The tongue moves food to
help 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 saraf
pengecap.

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

The Organs of
Taste

Taste Buds (Sel Pengecap)

Figure 16.1a, b

TASTE BUDS
TASTE BUDS: are the sense organs that respond to gustatory (taste)
stimuli
PAPILLAE: are the small elevated projections on the tongue
Fungiform , circumvallate , and foliate papillae contain taste
buds
Filiform papillae do not contain taste buds but allow us to
experience food texture and feel
It was once thought that the taste buds of the tongue were locat ed
in specific regions (bitter in the posterior portion and sweet a t the
anterior portion) HOWEVER, this is NOT TRUE.
There is no known taste map all tastes can be detected in all
areas of the tongue that contain taste buds.

Taste bud receptors

Taste buds house of the chemoreceptors responsible for
taste.
Stimulated by chemicals termed TESTANTS that are
dissolved in saliva
Each grapelike taste bud contains 50 -125
chemorecptors termed GUSTATORY CELLS which are
surrounded by supportive capsules
Tiny cilia -like structures extend from each gustatory
cell and project into an opening called TASTE
PORES which are bathed in saliva

Faktor2 yg mempengaruhi
kemampuan mengecap:
Banyaknya papil pengecap dan sel
pengecap
Gerakan lidah (msal: gg. Gerak lidah
pada px stroke)
Banyaknya air ludah

Gangguan
Gangguanpada
padahal2
hal2tersebut
tersebut
Sering
Seringdialami
dialamioleh
olehlansia
lansia

What can we taste?

All taste cells can respond at least to most taste -producing
chemicals
Functionally however, there are five primary taste
sensation:
Sour
All tastes come from
a combination of
Sweet
these basic taste sensations.
Bitter
Salty
Umami (from glutamate)
primary sensation + sense of smell = ability to detect many
different flavors.

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 other
oral sensations, such as texture, spiciness,
temperature, and aroma to produce what is
commonly referred to as flavor.
we recognize flavors largely through our
sense of smell
Smell and taste are closely linked senses.
It is common for people who lose their sense
of smell to say that food has lost its taste.
This is incorrect; the food has lost its aroma,
but taste remains.

The Gustatory
Pathway

Neuronal pathway for taste

Begins with creation of a receptor potential
in the gustatory cells of a taste bud
It is then transmitted via sensory input to
the brain
anterior 2/3 of the tongue cells travel over
the facial VII nerve. The posterior 1/3 are
conducted by the fibers of the
glossopharyngeal IX nerve
The III cranial nerve and the vagus X nerve
plays minor role in taste except form the
taste buds located on the walls of the
pharynx and epiglottis
The three cranial nerves carry impulses into
the medulla, into the thalamus and then into
the taste area of the cerebral cortex in the
parietal 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 t
is normally pleasant tasting.

Hypogeusia: a reduced ability to taste sweet,

sour, bitter, salty, and umami
Ageusia: Can detect no taste (can't detect taste
at 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 that

interrupts the transfer of taste sensations to the
brain, or by conditions that affect the way the brain
interprets 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 (Bells Palsy, Parkinsons 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 lose
their ability to taste or can no longer perceive
taste in the same way
The most common taste complaint is "phantom
taste perception" -- tasting something when
nothing is in the mouth.
a specific ageusia of one or more of the five
taste categories: sweet, sour, bitter, salty, and
umami, 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 and

smell. Certain chemicals made to produce the four
major tastes sour, sweet, bitter, salty can be
applied to areas of your tongue. Or you may be asked
to take a taste test. In this test, you will sip certain
liquids and try to identify their tastes. The chemicals or
liquids used to test taste have no odor.
A "scratch and sniff" test can be used to check out your
sense of smell. The test uses special cards. Each one
contains an odor that is released when scratched. You
will 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 problem
disappears once the cause is removed.
This can occur if the cause is gum
disease, plaque, a medicine you are
taking for a short time or a short -term
condition such as a cold.
If the cause is a yeast infection, the
dysgeusia should disappear after the
yeast infection is properly treated. In
some cases for example, if nerves
have been damaged the dysgeusia
may 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 this
condition will be. In some cases, idiopathic dysgeusia
may go away on its own. In others, it will not. It is
important to be evaluated so that the known causes of
dysgeusia can be ruled out.

 A distorted sense of taste can be a serious risk

factor for heart disease, diabetes, stroke, and
other illnesses that require sticking to a specific
diet. When taste is impaired, a person may
change his or her eating habits. Some people
may eat too little and lose weight, while others
may eat too much and gain weight.
This can be a problem for people with certain
medical conditions, such as diabetes or high
blood pressure. In severe cases, loss of taste
can lead to depression.

Tongue Disorder

Injury
Traumatic injury is the most common cause of
tongue discomfort.
The tongue has many nerve endings for pain
and touch and is more sensitive to pain than
most other parts of the body.
The tongue is frequently bitten accidentally but
heals quickly. A sharp, broken filling or tooth can
do considerable damage to this delicate tissue.

Hairiness
An overgrowth of the normal projections on the
top of the tongue (villi) can give it a hairy
appearance.
The tongue may also appear hairy after a fever,
after antibiotic treatment, or when peroxide
mouthwash is used too often.
These "hairs" on the top of the tongue should
not be confused with hairy leukoplakia. Hairy
leukoplakia forms on the side of the tongue and
is characteristic of AIDS.

Discoloration

The tongue's villi may become discolored if a person smokes or

chews tobacco, eats certain foods, or has colored bacteria growi ng
on the tongue.
The top of the tongue may look black if a person takes bismuth
preparations for an upset stomach. Brushing the tongue with a
toothbrush or scraping it with a tongue scraper can remove such
discoloration.
Iron deficiency (anemia) & Pernicious anemia (deficiency of vita min
B12) may make the tongue look pale and smooth.
A strawberry-red tongue maybe the sign of scarlet fever, Kawasaki
disease, pellagra (a type of malnutrition caused by a deficiency of
niacin/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, or
early-stage syphilis.
Although small bumps on both sides of the tongue
are usually harmless, a bump on only one side may
be cancerous.
Unexplained red or white areas, sores, or lumps
(particularly when hard) on the tongue especially
if painlessmay be signs of cancer and should be
examined by a doctor or dentist
Most oral cancers grow on the sides of the tongue
or on the floor of the mouth. Cancer almost never
appears on the top of the tongue, except when the
cancer occurs after untreated syphilis.

Discomfort

Tongue discomfort can result from irritation by

certain foods, especially acidic ones (for
example, pineapple), or by certain ingredients in
toothpaste, mouthwash, candy, or gum. Some
drugs can cause tongue discomfort, as can injury
and infection.
A common infection causing tongue discomfort is
thrush (candidiasis) in which an overgrowth of
fungi forms a white film that covers the tongue.
Intense pain of the entire mouth can be caused
by burning mouth syndrome.

Usually, it is a process of elimination to find out

just what is causing the discomfort.
Tongue discomfort not caused by an infection is
usually treated by eliminating the cause. For
example, the person may try changing brands of
toothpaste, discontinue irritating foods, or have a
sharp 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 by

nerve damage.
Problems moving the tongue may also be caused by
ankyloglossia, a disorder where the band of tissue that
attaches the tongue to the floor of the mouth is too short.
Tongue movement disorders may result in speech
difficulties or difficulty moving food during chewing and
swallowing.

ENLARGEMENT OF THE TONGUE

Tongue swelling occurs with Down

syndrome, acromegaly, myxedema,
amyloidosis, rhabdomyoma, and other
disorders.
The tongue may get wider in persons who
have 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 gangguan
resepsi/transmisi/integrasi sensori sekunder terhadap
proses penuaan/ penyakit pada sistem persyarafan/ efek
medikasi
Resiko nutrisi kurang dari kebutuhan tubuh b.d penurunan
nafsu makan sekunder terhadap
disgeusia/ageusia/hipogeusia
Resiko penatalaksanaan regimen terapeutik inefektif b.d
gangguan stimulus sensori rasa
Cemas b.d kurang pengetahuan

Tujuan & Kriteria Hasil

Mengetahui faktor penyebab perubahan
sensori-persepsi
Mengetahui tingkat gangguan sensoripersepsi
Mengusahakan keadaan normal untuk
merespon stimulus
Meningkatkan pengetahuan dan
kesejahteraan
Mencehag terjadinya komplikasi

Thank You