Why Clean Your Tongue?

OBSERVATIONS GORDON J. CHRISTENSEN, D.D.S., M.S.D., PH.D. WHY CLEAN YOUR TONGUE? Dentists, hygienists and man- scrape debris from the tongue. have become the norm among ufacturers of dentifrice, tooth- These are from various locations the majority of Americans. But brushes and floss have long em- including Africa, South filthy tongues have received phasized the need to remove America, India and Arabia.1 only occasional mention by oral dental plaque from tooth sur- However, in most early cultures, health professionals, and this faces to reduce the possibility of tongue cleaning probably was small emphasis has not influ- dental caries formation. not practiced by many people, enced people to clean their Mouthwash advertisements in- since even the body as a whole tongues to any significant de- fluence people to use the prod- was cleaned only occasionally. gree. Recently, tongue cleaning ucts to rinse their mouths and, In some cultures, there were old has received more attention be- therefore, prevent or reduce hal- wives’ tales promoting the idea cause of the development of so- itosis. Fluoride has been placed that cleaning the body of oils called “bad breath” or “clean in many of these vehicles to re- and secretions was harmful. breath” clinics, which empha- duce dental caries formation. From the 15th century to the size the various reasons why This tooth and mouth clean- 19th century, tongue cleaning people have oral malodor and ing has significantly improved was known to be practiced pri- the ways to prevent this dis- the oral health of Americans, marily by the affluent leisure agreeable phenomenon. and it concomitantly created a class. More recently, during the WHY CLEAN THE competitive industry of oral hy- 19th and early 20th centuries, TONGUE? giene products. However, in tongue cleaning was not a popu- spite of significant commercial lar concept, and only a few refer- The dorsal posterior part of and professional emphasis on ences are mentioned in the most tongues has a coating of cleaning plaque from teeth, a dental literature. During this millions of organisms. During surprising omission in hygiene time period, perfumes became swallowing, soft foods that most has been made—the tongue. very popular to disguise body of us eat do not abrade the coat- Why do many Americans pro- odor. Some early settlers in the ing significantly, and the reduce two immaculate, shining American West had themselves sultant whitish-gray layer of rows of teeth separated by an sewn into their undergarments debris and microorganisms re- organ covered with millions of for the winter season to prevent mains intact. During the putre- microorganisms, emitting a the escape of body heat and to faction of debris on the tongue, strong malodor? “protect” the skin. This was defi- hydrogen sulfide and methyl- nitely not the era of clean bodies. mercaptan are produced, both TONGUE CLEANING IN THE PAST As mouth filth and dental of which have been related di- plaque became associated with rectly to oral malodor.2 It has Centuries ago, there was some dental disease, some people ac- been estimated that the debris emphasis directed toward tually started to clean their in the mouth may be responsi- tongue cleaning. Ancient devices mouths. The preventive result ble for up to 90 percent of oral have been found that are was impressive, and attempts malodor.3 Others have stated believed to be implements to to have clean teeth, at least, that about 50 percent of the JADA, Vol. 129, November 1998 1605 Copyright ©1998-2001 American Dental Association. All rights reserved. CHRISTENSEN population will have oral mal- Fresh (IDDS Inc.), Breath Taker the surface of the tongue. Many odor unless tongue cleaning is (Medical Innovations Inc.), The persons gag at this time, and practiced.4 Although it is diffi- Mouth Cleaner (Moelster practice is required to find the cult to prove from a scientific International AS), Oolitt Elite right positioning of the imple- orientation, it has been consid- and Oolitt Original (Oolitt ment and to minimize the gag ered that the many pathogenic Advantage Inc.) and Profession- response. organisms on the tongue can al Tongue Cleaner (The Tongue dPull the cleaner forward slow- contribute significantly to tooth Cleaner Co.). ly to the front of the mouth. and periodontal disease. Depending on the foods eaten IMPEDIMENTS TO The evidence is clear that or- TONGUE CLEANING recently, the accumulation re- ganisms are present on the moved from the tongue will tongue in enormous quantities, Most people do not enjoy range from a waterlike, relative- that these organisms contribute placing an object down their ly clear solution to viscous, pig- to halitosis and tooth decay and throats and causing a gag mented, mucouslike debris. If that tongue scraping or brush- reflex. In fact, some people pigmented foods (chocolate, wa- ing reduces plaque scores in the need definitive instructions to termelon, foods containing color- mouth.5,6 Today, when body accomplish tongue cleaning ing) have been eaten, the pig- cleanliness is almost a fetish adequately without gagging. ment can still be removed from with many people, tongue (Some people with bulimia use the tongue even hours after the cleaning certainly should be a objects similar to tongue clean- food was ingested and the teeth routine procedure. ers to elicit vomiting.) As were brushed. This observation tongue cleaning is practiced on lends credibility to the idea that TONGUE-CLEANING IMPLEMENTS a daily basis, the process be- food debris and the organisms comes easier and less objection- contained therein possibly could The last few years have brought able. Eventually, the person cause more dental disease, and forth scores of devices and gad- feels unclean when tongue de- that tongue cleaning may re- gets to clean the tongue. The bris has not been removed. duce this potential. concept is so logical and so sim- dRemove the debris from the THE TONGUE-CLEANING ple that prevention-oriented PROCEDURE cleaning device by placing it people should need only mini- under a stream of running water. mal encouragement to incorpo- The dorsal surface of most dRepeat the scraping proce- rate tongue cleaning into their tongues usually has significant dures several times until fur- oral hygiene routine. observable debris. Greasy foods ther debris cannot be removed. Implements for tongue clean- rich in fat contribute signifi- dClean and dry the cleaning ing range from straplike pieces cantly to accumulation of device and store it until the of plastic or metal held in one tongue debris. Until more con- next use. hand and scraped across the trolled clinical research guides Clinical research is necessary tongue surface, to razorlike recommendations on methods to determine the optimum num- “rakes” with plastic scraping and frequency of tongue clean- ber of times per day for tongue surfaces or small brush bristles, ing, the following suggestions cleaning. People with halitosis to circular devices with handles appear to be logical: are well-advised to repeat the designed to scrape the surface of dPlace the tongue as far out of tongue-cleaning procedure sever- the tongue. Research has shown the mouth as possible. al times during the day. that toothbrushes are inferior to dObserve the location of debris Depending on the anatomy of the scraping débridement imple- accumulation. Unfortunately, tongue and the foods eaten, some ments in their ability to remove the debris is usually on the people do not accumulate debris debris and organisms.4 Most most posterior aspect of the on their tongues. These people tongue cleaners are small, easy tongue. may need little or no tongue to clean and inexpensive and do dPlace the tongue cleaner/ cleaning, while others have large not wear out rapidly. Examples scraper as far posterior as pos- accumulations of debris to be re- of brands rated high in a recent sible, and place force on the im- moved several times per day. Clinical Research Associates plement to flatten the tongue, Dentists should consider pa- evaluation7 were Breath-So- making the scraper conform to tients’ oral characteristics and 1606 JADA, Vol. 129, November 1998 Copyright ©1998-2001 American Dental Association. All rights reserved. CHRISTENSEN needs when ad- that the “disgusting” material The views expressed are those of the author and do not necessarily reflect the opinions or vising them they will remove from their official policies of the American Dental about tongue- tongues is even more repugnant Association. cleaning fre- to others when it is left in place Educational information on topics discussed quency. and able to create oral malodor. by Dr. Christensen in this article is available through Practical Clinical Courses and can be Some people obtained by calling 1-800-223-6569. Dr. Christensen is find the con- CONCLUSIONS co-founder and sen- 1. Christen AG, Swanson BZ. Oral hygiene: ior consultant of cept of tongue The debris present on the dorsal a history of tongue scraping and brushing. Clinical Research cleaning to be posterior aspect of the tongue JADA 1978;96(2):215-9. Associates, 3707 N. 2. Tonzetich J. Production and origin of oral Canyon Road, Suite disgusting psy- accounts for a significant por- malodor: a review of mechanisms and methods of analysis. J Periodontol 1977;48(1):13- No. 7A, Provo, Utah chologically. It tion of oral malodor. Tongue 20. 84604, and is a is not clear cleaning removes organisms and 3. Prinz H. Offensive breath: its causes and member of JADA’s why debris debris from the tongue. It also prevention. Dent Cosmos 1930;72:700. editorial board. He 4. Tonzetich J, Ng SK. Reduction of malodor has a master’s de- from the might reduce tooth and perio- by oral cleansing procedures. Oral Surg Oral gree in restorative mouth should dontal disease.

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