Tongue cleaner

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Tongue cleaner
Tongue scraper
Tongue brush
Tongue Cleaner

A tongue cleaner (also called a tongue scraper or tongue brush) is an oral hygiene device designed to clean the white or colored coating on the dorsum (upper surface) of the tongue. The large surface area and lingual papilla are anatomical features of the tongue that promote tongue coating by retaining microorganisms and oral debris consisting of food, saliva and dead epithelial cells.[1][2][3] The bacteria and fungi (such as Candida) that grow on the tongue are related to many common oral care and general health problems.[4][5] In addition, degradation of oral debris by microorganisms, produce organosulfur compounds (volatile sulphur compounds) on the posterior (rear) of the tongue.[3][6] These molecules account for approximately 80% to 85% of all cases of halitosis (bad breath).[7][8] Halitosis may cause embarrassment and can negatively affect social interactions and communication.[6]


The top surface of the tongue can be cleaned using a tongue cleaner, a tongue brush/scraper or a toothbrush.[1][6] However, toothbrushes are not considered as effective for this purpose because they have a smaller width and are designed for brushing teeth, which have a solid structure unlike the spongy tissue of the tongue.[8] This can reduce its ability to remove debris and microorganisms.[8] Some toothbrush designs have projections on the back of their heads to act as a tongue cleaner.[6] An electric tongue cleaner is also available.[9]

Ergonomic tongue cleaners are shaped in accordance with the anatomy of the tongue, and are optimized to lift and trap the plaque coating and effectively clean the surface of the tongue.[1] There are many different types of tongue cleaners. They can be plastic or metal straps, plastic and/or small brush bristles that form "rakes" or circular devices with handles.[1] Their effectiveness varies widely depending on the shape, dimensions, configuration, quality of the contact surfaces and materials used. Tongue cleaners are mostly inexpensive, small, easy to clean and durable.[1] In addition, tongue cleaning gels can be used in conjunction with tongue cleaners.[10] Its antibacterial agents may enhance the cleaning effects.[10]

Tongue cleaning is an oral homecare procedure that is often missed compared to procedures such as tooth brushing, flossing and using mouthwash.[1][2]

Historical background[edit]

Ayurveda, the practice of traditional Indian medicine, recommends tongue cleaning as part of one's daily hygiene regimen, to remove the toxic debris, known as Ama.[11][12] Tongue cleaning has existing in Ayurvedic practice since ancient times, using tongue scrapers made from copper, silver, gold, tin or brass.[11] In modern time, plastic scrapers are used in India and the Far East.[11]

Tongue hygiene has been practiced for centuries in Africa, Arabia, Europe, South America and many eastern and oriental cultures.[1][3][13] The various materials used for tongue cleaners include thin flexible wood sections, metals, ivory, mother-of-pearl, whalebone, celluloid, tortoiseshell, and plastic.[12]

Western civilizations placed less emphasis on tongue cleaning.[3][12] Between the 15th and 19th century, tongue cleaning was primarily practiced by those who were affluent.[1] It was recorded in Europe in the 18th and 19th centuries that Romans also performed tongue cleaning.[12] In the 20th century, a wide variety of tongue cleaning devices came on the commercial market.[11]

Using and maintaining the tongue cleaner[edit]

Tongue cleaning can be performed in the morning or on an empty stomach to prevent gagging and/or vomiting.[3] This procedure can be done several times during the day depending on the rate and amount of debris accumulated, the type of food eaten and the anatomy of the tongue.[1] It is a quick and simple procedure.[3]

When using a tongue cleaner, first extend the tongue out of the mouth as far as possible.[1] Locate the area of debris accumulation and place the tongue cleaner as far back on the tongue as possible.[1] Apply force with the tongue cleaner to flatten the tongue and then pull it towards the front of the tongue.[1] Some people may experience gagging at this time.[1] Practicing can help to find the positioning of the tongue cleaner that minimizes the gag reflex.[1] The debris removed can appear watery and clear to viscous/mucous-like and pigmented, depending on the type of foods eaten recently.[1] Use running water to remove the debris from the device and then repeat the procedure until debris can no longer be removed.[1] Clean and dry the device.[1]

Health effects[edit]

Fresher breath[edit]

Halitosis and morning breath can be reduced when a portion of the microorganisms, decaying food debris and dead skin cells are removed from the rear upper surface of the tongue.[2][6] Clinical studies have shown that using a tongue cleaner on a daily basis is able to help reduce anaerobic bacteria and decrease oral malodor.[6][14] The effect may be further enhanced when tongue cleaning is used in conjunction with tooth brushing and prevents relapse.[6] Brushing alone does not prevent relapse.[6]

Some studies have shown that it is the bacteria on the tongue which often produce malodorous compounds and fatty acids that may account for 80% to 85% of all cases of bad breath.[7][8] The remaining 15% to 20% of cases originate in the stomach, from the tonsils, from decaying food stuck between the teeth, gum disease, dental caries (cavities or tooth decay) or plaque accumulated on the teeth.[3]

Taste acuity[edit]

Tongue cleaning improves taste sensation (taste acuity) because the major source of halitosis or bad taste is removed.[2][15]


The tongue is normally pink in appearance.[3] It may acquire a white or colored coating due to diet, reduced salivary flow, reduced oral hygiene or tongue anatomy.[1][3] The thickness of the tongue coating can also vary.[1][2] Tongue cleaning can reduce this coating to make it cleaner and to help return it to its natural pink color.[2][6]

Dental caries and periodontal disease[edit]

The tongue surface can be a reservoir for tooth pathogens and periodontal pathogens.[16] It can contribute to the recolonization of tooth surfaces.[16] People with periodontal disease are more likely to have a thicker tongue coating and a microbial flora that produces more volatile sulphur compounds compared to those who have healthy periodontal tissues.[3][6] Tongue cleaning might help to reduce halitosis, dental caries and periodontal disease.[1]

Side effects[edit]

Tongue cleaning can cause discomfort.[2] Improper use of a tongue cleaner may induce the gag reflex and/or vomiting.[1][6] Overuse of a tongue cleaner may also cause damage to the taste buds.[8] Some people have inappropriately used the tongue cleaner to scrape or brush the lingual tonsils (tongue tonsils).[17]

There has been one reported case where a woman possibly had infective endocarditis from bacteremia following the use of a tongue cleaner.[19] Individuals with previous infective endocarditis and high-risk cardiac valves may be at a higher risk from bacteremia.[13]

See also[edit]


  1. ^ a b c d e f g h i j k l m n o p q r s t u Christensen, G. J. (1998-11-01). "Why clean your tongue?". Journal of the American Dental Association (1939). 129 (11): 1605–1607. ISSN 0002-8177. PMID 9818580. 
  2. ^ a b c d e f g Bordas, Alice; McNab, Rod; Staples, Angela M.; Bowman, Jim; Kanapka, Joe; Bosma, Marylynn P. (2008-04-01). "Impact of different tongue cleaning methods on the bacterial load of the tongue dorsum". Archives of Oral Biology. 53 Suppl 1: S13–18. doi:10.1016/S0003-9969(08)70004-9. ISSN 0003-9969. PMID 18460399. 
  3. ^ a b c d e f g h i j Danser, M. M; Gómez, S. Mantilla; Van der Weijden, G. A (2003-08-01). "Tongue coating and tongue brushing: a literature review". International Journal of Dental Hygiene. 1 (3): 151–158. doi:10.1034/j.1601-5037.2003.00034.x. ISSN 1601-5037. 
  4. ^ Slavkin, Harold C. (2000-09-13). "Relationship of Dental and Oral Pathology to Systemic Illness". JAMA. 284 (10). doi:10.1001/jama.284.10.1215. ISSN 0098-7484. 
  5. ^ Garcia, Raul I.; Henshaw, Michelle M.; Krall, Elizabeth A. (2001-02-01). "Relationship between periodontal disease and systemic health". Periodontology 2000. 25 (1): 21–36. doi:10.1034/j.1600-0757.2001.22250103.x. ISSN 1600-0757. 
  6. ^ a b c d e f g h i j k Van der Sleen, Mi; Slot, De; Van Trijffel, E; Winkel, Eg; Van der Weijden, Ga (2010-11-01). "Effectiveness of mechanical tongue cleaning on breath odour and tongue coating: a systematic review". International Journal of Dental Hygiene. 8 (4): 258–268. doi:10.1111/j.1601-5037.2010.00479.x. ISSN 1601-5037. 
  7. ^ a b Van Den Broek, Amwt; Feenstra, L; De Baat, C (2008-01-01). "A review of the current literature on management of halitosis". Oral Diseases. 14 (1): 30–39. doi:10.1111/j.1601-0825.2006.01350.x. ISSN 1601-0825. 
  8. ^ a b c d e Pedrazzi, Vinícius; Sato, Sandra; de Mattos, Maria da Gĺoria Chiarello; Lara, Elza Helena Guimarães; Panzeri, Heitor (2004-07-01). "Tongue-cleaning methods: a comparative clinical trial employing a toothbrush and a tongue scraper". Journal of Periodontology. 75 (7): 1009–1012. doi:10.1902/jop.2004.75.7.1009. ISSN 0022-3492. PMID 15341360. 
  9. ^ "Electric Tongue Cleaner". Retrieved 2016-12-14. 
  10. ^ a b Wilhelm, Dorothea; Himmelmann, Agnes; Axmann, Eva-Maria; Wilhelm, Klaus-Peter (2012-09-01). "Clinical efficacy of a new tooth and tongue gel applied with a tongue cleaner in reducing oral halitosis". Quintessence International (Berlin, Germany: 1985). 43 (8): 709–718. ISSN 1936-7163. PMID 23034424. 
  11. ^ a b c d Rupesh, S; Winnier, Jj; Nayak, Ua; Rao, Ap; Reddy, V; Peter, J (2012-05-01). "The comparative evaluation of the effects of tongue cleaning on salivary levels of mutans streptococci in children". International Journal of Dental Hygiene. 10 (2): 107–112. doi:10.1111/j.1601-5037.2011.00522.x. ISSN 1601-5037. 
  12. ^ a b c d Beekmans, Dg; Slot, De; Van der Weijden, Ga (2016-02-01). "User perception on various designs of tongue scrapers: an observational survey". International Journal of Dental Hygiene: n/a–n/a. doi:10.1111/idh.12204. ISSN 1601-5037. 
  13. ^ a b Redmond, Andrew M.; Meiklejohn, Cathryn; Kidd, Timothy J.; Horvath, Robert; Coulter, Christopher (2007-09-01). "Endocarditis after use of tongue scraper". Emerging Infectious Diseases. 13 (9): 1440–1441. doi:10.3201/eid1309.070544. ISSN 1080-6040. PMC 2857304Freely accessible. PMID 18252139. 
  14. ^ Almas, Khalid; Al-Sanawi, Essam; Al-Shahrani, Bander (2005-03-01). "The effect of tongue scraper on mutans streptococci and lactobacilli in patients with caries and periodontal disease". Odonto-Stomatologie Tropicale = Tropical Dental Journal. 28 (109): 5–10. ISSN 0251-172X. PMID 16032940. 
  15. ^ Ralph, W. J. (1988-06-01). "Oral hygiene — why neglect the tongue?". Australian Dental Journal. 33 (3): 224–225. doi:10.1111/j.1834-7819.1988.tb01318.x. ISSN 1834-7819. 
  16. ^ a b Faveri, Marcelo; Feres, Magda; Shibli, Jamil Awad; Hayacibara, Roberto F.; Hayacibara, Mitsue M.; de Figueiredo, Luciene Cristina (2006-09-01). "Microbiota of the dorsum of the tongue after plaque accumulation: an experimental study in humans". Journal of Periodontology. 77 (9): 1539–1546. doi:10.1902/jop.2006.050366. ISSN 0022-3492. PMID 16945032. 
  17. ^ Yaegaki, K.; Coil, J. M. (2000-05-01). "Examination, classification, and treatment of halitosis; clinical perspectives". Journal (Canadian Dental Association). 66 (5): 257–261. ISSN 1488-2159. PMID 10833869. 

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