Tongue Coating: Medical History

Medical history (history of illness) represents an important component in the diagnosis of tongue coating. Family history

Social history

• Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

• Do you have any tongue coating?
• Do you have any discoloration of the tongue?
• Do you have burning of the tongue?
  • If so. In addition to burning tongue, have you noticed any other symptoms such as itching, tingling or stabbing pain on the tongue, dry mouth, disturbances in taste sensation, white coating, etc.?
• How long have these symptoms been present?

Vegetative anamnesis including nutritional anamnesis.

• Do you smoke? If yes, how many cigarettes, cigars or pipes per day?
• Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
• Do you use drugs? If yes, what drugs and how often per day or per week?

Self history including medication history.

• Pre-existing conditions (anemia (anemia), autoimmune diseases, skin diseases (eg, mycoses (fungal infections)) – also elsewhere: eg, vaginal fungus, athlete’s foot, etc.), immunodeficiency, infectious diseases, liver disease, stomach disease, oral cavity disease, metabolic diseases (eg, diabetes mellitus)).
• Operations
• Allergies
• Radiation therapy to the head?

Medication history

Medications that may cause discoloration of the tongue.

• Antibiotic administration, prolonged
• Mouth rinse with chlorhexidine (antiseptic used mainly in dentistry).

Medications that can cause xerostomia (dry mouth).

• ACE inhibitors (benazepril, captopril, cilazapril, enalapril, fosinopril, imidapril, lisinopril, moexipril, perindopril, quinapril, ramipril, spirapril, trandolapril, zofenopril).
• Alpha-2 agonists (apraclonidine, brimonidine, clonidine).
• Alpha-1 receptor blockers (bunazosin, doxazosin, prazosin, terazosin).
• Anorectic (sibutramine).
• Anti-allergic (H1 antihistamines)
• Anticholinergics (ipratropium bromide) [via peripheral receptor blockade]; aclidinium, biperiden, darifenacin, glycopyrronium, metixene, methanthelinium bromide, oxybutynin, phenoxybenzamine, propiverine, scopolamine, solifenacin, tiotropium, tolterodine, trihexyphenidyl, trospium chloride, umeclidinium
  • Methanthelinium bromide
  • See also under “Anticholinergic effects due to drugs” if applicable.
• Antidepressants [via central receptor blockade].
  • Noradrenergic and specific serotonergic antidepressants (NaSSA) – mirtazapine.
  • Selective norepinephrine reuptake inhibitors (NARI) – reboxetine, viloxazine.
  • Selective serotonin–norepinephrine reuptake inhibitors (SSNRI) – duloxetine, venlafaxine.
  • Selective serotonin reuptake inhibitors (SSRI) – trazodone
  • Tricyclic antidepressants (TCAs) – amitriptyline, butriptyline, cianopramine, clomipramine, desipramine, doxepin, imipramine, iprindole, melitrace, nortriptyline, opipramol, protriptyline, trimipramine).
• Antiemetics (dimenhydrinate, scopolamine).
• Antiepileptic drugs (gabapentin)
• Antihistamines (clemastine, dimetindene, ketotifen).
• Antiparkinsonian drugs
  • Anticholinergics (belladonna whole extract, benzatropine, biperiden, bornaprin, metixen, pridinol, procyclidine, scopolamine, trihexyphenidyl).
  • Dopaminergic substances (amantadine, apomorphine, bromocriptine, cabergoline, alpha-dihydroergocryptine, levodopa, lisuride, memantine, pergolide, pramipexole, ropinirole).
• Antipsychotics (neuroleptics).
  • Conventional (Classical) antipsychotics (neuroleptics).
    • Phenothiazine-type drugs (levomepromazine, triflupromazine).
• Antisympathotonics (α-methyldopa).
• Anxiolytics (azapirone, hydroxyzine).
• SS-3-mimetic (mirabegron)
• Beta-blocker (metoprolol)
• Bronchodilators (β2-mimetics) – sulbutamol, terbutaline).
• Carboanhydrase inhibitors, local (brinzolamide, dorzolamide).
• Diuretics
  • Loop diuretics (azosemide, bumetanide, etacrynic acid, etozolin, furosemide, piretanide, torasemide).
  • Thiazide diuretics (benzthiazide, chlorothiazide, hydrochlorothiazide (HCT), hydroflumethiazide, methyclothiazide, polythiazide, trichloromethiazide).
• Dopamine agonists (bromocriptine, cabergoline, lisuride).
• Dopamine antagonists (butyrophenones: haloperidol).
• Drugs (amphetamines, tetrahydrocannabinol).
• Hypnotics
• Magnesium sulfate
• Narcotics, centrally acting analgesics.
• Opioid antagonists (nalmefene, naltrexone).
• Parasympatholytics (atropine).
• Perchlorates (perchlorate)
• Psychotropic substances such as modafinil
• Sedatives
• Spasmolytics (butylscopolamine)
• Sympathomimetics
  • Indirect sympathomimetics (amphetamines).
• Cytostatics

Drugs that can cause burning of the mouth

• Mouthwashes
• Reserpine

Medications that can lead to mycosis (fungal disease) of the oral cavity

• Antibiotics
• Asthma sprays containing cortisone