Tongue wagging

The misfortune of the woman recently featured in this column with yellow discolouration of the tongue associated with a bitter taste in the mouth and unpleasant odour to her saliva has prompted much interest. Her family doctor’s original diagnosis of oral thrush was probably correct, advises consultant oral and maxillofacial surgeon Neil Attenborough. But the standard dosage of antifungal drugs he prescribed may have been inadequate because, with the tongue being “warm, wet and constantly mobile”, it can be difficult to achieve the concentrations required to eliminate the fungal infection on its surface.

He recommends a more intense combination of antifungal medicines which involve sucking amphotericin B lozenges continuously for a fortnight together with ketoconazole 200mg three times daily. Some doctors, he acknowledges, may be reluctant to prescribe this as the regime is not standard practice – warranting referral to a specialist in oral medicine. Other possible remedies recommended include daily application of the vitamin A derivative tretinoin, followed by brushing the tongue with a soft toothbrush, eating fresh pineapple, which contains the tongue-cleaning enzyme bromelain, and a twicedaily warm saltwater mouthwash.

Patients are spared traipsing off to the surgery to have their minor complaints dealt with