The Importance of Oral Cancer Screening

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Maria Ambra, RDH

The Importance of Oral Cancer Screening

As health care providers, during a patient’s initial dental visit, we ask if they would like to have an oral cancer screening in addition to their dental evaluation. Unfortunately, a vast majority of the time, the patient’s answer will be “no” or “I don’t have cancer and never have” or “I’m too young and I don’t smoke, therefore, I don’t need one today”. As Registered Dental Hygienists in today’s ever changing health care demands, how can we approach such an important discussion and answer these types of questions?

In the early stages of most forms of oral cancer, the cancer can’t be detected only visually and may not manifest as painful or cause any discomfort. It is possible for perfectly healthy patients of any age to have pre-cancer or oral cancer and be asymptomatic. Oral cancer is considered an epidemic disease in which over the past 6 years, research shows that this epidemic disease is not caused primarily by traditional risk factors any longer such as smoking, drinking or chewing tobacco.

Unfortunately, 40% of our young population (nonsmokers), especially among high school athletes, makes for the majority of new cases of cancer in the oral cavity and pharynx and more that 50% are detected in late age causing death.

In the population of patients over 40, as age increases, the likely hood of disease tends to develop due to the fact that their immune system becomes less efficient and also an excessive amount of unprotected exposure to the sun can increase lip cancer (the most common undetected oral cancer that is often mistaken for chapped lips). People, who live in areas with poor access to health care or don’t visit a dentist or doctor regularly, are considered to be increased risk for malignancies.

In younger adults under 40, a higher risk is contributed by the exposure to the HPV-16 and the HPV 18 viruses known as the human papilloma virus, leading to an increase each year of about 39,000 new cases of cancer which are found in areas of the body where HPV is found. Cervical cancer is the most common HPV associated cancer among women and oropharyngeal cancer which is often located in the back of the throat, on the base of the tongue and tonsils are the most common among men. It can be spread and contract as easy on intimate contact including kissing through saliva or skin-to-skin contact. The CDC (Center for Disease Control) recommends conducting an oral cancer screening at least once a year for all patients age 17 and beyond. Due to the fact that the naked eye may miss even early signs of oral malignancies, we, as dental practitioner’s, must introduce to our patients the state of the art, new technologies such as IDENTAFI, ORAL-ID or VELSCOPE.

All three are revolutionary devices that use multi-spectral technology to identify early morphologic and biochemical changes of the cells in the mouth, throat and tonsil. During the examination, the patient is also educated by the providers to self- examine often at their own. Some of the early indicators are red or white discoloration of tissues or any sore that doesn’t heal within 14 days, with that, advanced indicators such as sensation of something being stuck in the throat, any numbness in the oral cavity or ear or jaw pain, a lump or thickening in their neck need to be reported immediately to professionals to be examined and evaluated forward. Early detection means early treatment and cure of 90% of cases. EARLY DETECTION SAVES LIVES!

 Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

www.oralcancerfoundation.com. Edited on March 2013

Hocking, Stein A,Regan D et.al. Head and neck cancer show increasing incident of potential HPV-associated oropharyngeal cancer.2011 MAR 1

http://www.cancer .org. Can oral cavity and oropharyngeal cancer be found early?

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Dry Mouth

Lacee Hogle RDH

Dry Mouth

How can medications effect my mouth in a negative way? Medications are a necessity in many people’s lives. Unfortunately almost all medications have side effects and one of the most common side effects is dry mouth. Even though dry mouth, or xerostomia (zeer-o-stoe-me-uh), makes it uncomfortable to talk and eat, more importantly it can lead to tooth decay and gum disease. Saliva is the number one protector in the mouth. Not only does it coat and lubricate the tissue in the mouth, it also neutralizes acids produced by bacteria and washes away food debris and plaque. It’s obvious that you can’t discontinue taking medications because it causes dry mouth, but you can start making a few changes in your life that will not only help you cope with dry mouth but will also help you create a healthier environment in your mouth.

Here are some things you can do to help relieve dryness and to keep your mouth healthy:

• Chew sugar-free gum or suck on sugar-free hard candies to stimulate the flow of saliva. Look for products that contain xylitol, which is a sugar substitute that can help prevent cavities.

• Limit your caffeine intake because caffeine can make your mouth drier.

• Don’t use mouthwashes that contain alcohol because they can be drying.

• Stop all tobacco use if you smoke or chew tobacco.

• Sip water throughout the day.

• Try over-the-counter saliva substitutes

• Try a mouthwash designed for dry mouth — especially one that contains xylitol, such as Biotene Dry Mouth Oral Rinse or ACT Total Care Dry Mouth Mouthwash, which also offer protection against tooth decay.

• Avoid using over-the-counter antihistamines and decongestants because they can make your symptoms worse.

• Breathe through your nose, not your mouth.

• Add moisture to the air at night with a room humidifier.

• Avoid sugary or acidic foods and drinks because they increase your risk of tooth decay.

• Brush with a fluoride toothpaste and floss at least twice a day— ask your dentist if you might benefit from prescription fluoride toothpaste.

• Use a fluoride rinse or brush-on fluoride gel before bedtime. Occasionally a custom-fit fluoride applicator (made by your dentist) can make this more effective.

• Visit your dentist at least twice yearly to detect and treat tooth decay or other dental problems.

So don’t get discouraged if you have dry mouth. As you can see, there are many things that will help you cope with dry mouth. But remember, the key to preventing decay, especially with dry mouth, is to brush and floss daily and to expose your teeth to fluoride at least twice a day. Using a Fluoride rinse in addition to fluoridated toothpaste is ideal. If you have any concerns or questions regarding dry mouth, make sure to discuss these concerns with your dentist or hygienist.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

https://www.mayoclinic.org/diseases-conditions/dry-mouth/symptoms-causes/syc-20356048

https://www.mayoclinic.org/diseases-conditions/dry-mouth/expert-answers/dry-mouth/faq-20058424

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A Conversation About Plaque

Arianna Marsden, RDH

A Conversation About Plaque

Has your hygienist ever recommended that you brush twice daily?  I made this recommendation to a patient recently, and he informed me that because he brushed his teeth at night, he did not need to brush his teeth in the morning.  This patient asked me, “why would I need to brush my teeth in the morning?  I didn’t eat anything while I was sleeping, so my teeth are still clean.”

It became apparent to me that this patient had a misunderstanding of how plaque develops on his teeth, and I think that other people may have the same misconception about how plaque forms.  This patient and I were able to have an educational conversation about how plaque develops, and my patient was surprised to learn something new at the dentist.

So, first of all, what is plaque?  Plaque is the white, fuzzy stuff you feel on your teeth after not cleaning your teeth for a while.  This plaque is filled with bacteria that cause gum disease and cavities.  Seconds after a cleaning, whether from your hygienist or from brushing your own teeth, the plaque starts to come back.  It begins as a protein layer of slime that our mouths produce naturally, called the acquired pellicle.  Bacteria that are always present in our mouths bind to this pellicle and begin to colonize.  When bacteria colonize, they bind together into a film that you can see and feel on our teeth; the white fuzzy stuff we call plaque.  This plaque will form whether or not food is eaten.   It’s important to remove plaque about once every 12 hours, or twice per day, to help reduce the amount of bacteria present in our mouths, and to prevent cavities and gum disease.

During my conversation with my patient about how plaque is formed, we speculated about why he might have had a misunderstanding about plaque.  He asked me, “I thought you were supposed to brush after eating, because the food makes the plaque and the plaque gives you cavities.”  Part of this is true; brushing after meals does help to prevent cavities, but not for the reasons he initially thought.  The plaque that is already present uses the sugars in the foods we eat, and produces an acid, which is what causes the cavities.  By brushing after we eat, we remove the plaque so it doesn’t have the opportunity to produce acid; we also neutralize any acid that may have already been produced, thus preventing cavities.  We also discussed that removing, or disrupting plaque about once every twelve hours prevents the colonized plaque from mineralizing into calculus.  Calculus is the hard stuff that gets stuck on your teeth that you can’t brush off; it most commonly develops on the tongue side of lower front teeth.  This calculus, and the embedded bacteria, are one of the main causes of gum disease.  Calculus can’t be removed with a toothbrush, so it’s important to see your hygienist regularly for professional cleanings to remove the calculus deposits which have formed.

When my patient understood why brushing more than once per day would benefit his oral health, he expressed that he would consider brushing twice daily, and we would observe the results of his efforts at his next cleaning appointment.  Often times understanding why we do something is half the battle.

Sources:

How to Care for Your Infant’s Teeth

Lora Cook, RDH

How to Care for Your Infant’s Teeth

When to start cleaning your baby’s teeth

​You can start before your baby even has teeth, it is best to incorporate mouth cleaning at bath time. This routine will help your baby get used to you cleaning their mouth, which can allow a smoother transition when you do begin to brushing their teeth. This will also help you to know when your babies teeth first start to push through their gum tissue.

​The bacteria that lives in the mouth is not harmful to the gum tissue, but can be harmful to the teeth. The enamel on baby teeth are 50% thinner than adult teeth. Therefore baby teeth are more susceptible to the bacteria that causes cavities.

How to clean your infants teeth

​To clean your babies mouth before tooth eruption use a clean wet wash cloth. Wrap wash cloth around your finger then rub it gently around your babies gums.

When to transition to a tooth brush

​When the teeth have started to erupt, this will be time to transition from a wash cloth to a baby tooth brush. Look for a tooth brush specifically made for infants. This will usually start around six months old. This will also be the time to change from bath time mouth cleaning to brushing two times daily.

​It is fine to just dry brush with just tap water, or a fluoridated tooth paste can be used. When using toothpaste, use the tiniest smear. It is never too early to help create a good brushing routine for your child.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

http://www.myhealthunit.ca/en/livehealthyandprotectyourhealth/Caring-for-Your-Child-s-Teeth.asp

https://www.mambaby.com/en-us/faq/oral-care-teethers/?gclid=EAIaIQobChMI24-c-oih1QIV05d-Ch0rNgnXEAAYAiAAEgL24PD_BwE

 

Dry Mouth (Xerostomia)


Cortney Davis, RDH

 

Dry Mouth (Xerostomia)

            Xerostomia is a medical term meaning dry mouth due to the lack of saliva present in your mouth. Individuals that have a dry mouth don’t have enough saliva to keep their mouth moist. Saliva is important because it is a person’s primary defense against tooth decay and helps maintain the health of hard and soft tissue in the mouth. Saliva also is important because it washes away small food particles and debris that would sit on the teeth, has shown to protect against gum disease, helps carry minerals that help rebuild he enamel surfaces of teeth, and can also help neutralize acids in the mouth during and after eating.

What causes dry mouth? Dry mouth is a common side effect of many non-prescription and prescription drugs including drugs to treat anxiety, pain, allergies, colds, depression, etc.. Another common cause of dry mouth is side effects from certain medical treatments. Many people undergoing radiation to the head and neck and chemotherapy have damage to the salivary glands and it reduces the amount of saliva produced. The last common cause of dry mouth is from side effects from infections and diseases including but not limited to Sjorgrens Syndrome, diabetes, HIV/AIDS, Alzheimer’s disease, Parkinson’s disease, and strokes.

Common symptoms of dry mouth include; frequent thirst, a sticky dry feeling in the mouth, problems speaking, chewing and swallowing, bad breath, and a dry red tongue.

If you have dry mouth make sure you drink plenty of water every day to help stimulate saliva flow, talk to your healthcare provider to find the cause of your dry mouth and what your treatment options are, keep up good dental care by brushing and flossing and going to your dentist for routine check-ups, try over-the-counter saliva substitute’s containing xylitol, and try mouth washes and toothpaste designed for dry mouth such as Biotene.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

http://oralhealth.deltadental.com/Adult/GeneralInformation/22,DD205

http://www.mayoclinic.org/diseases-conditions/dry-mouth/expert-answers/dry-mouth/faq-20058424

http://www.webmd.com/oral-health/guide/dental-health-dry-mouth#1

How do I know which Toothpaste to pick?

Sharma Mulqueen, RDH

How do I know which Toothpaste to pick?

When it comes to choosing toothpaste, sometimes it seems like your options are endless. On the drugstore shelves you’ll see dozens of varieties that claim to whiten your teeth, decrease tooth sensitivity, prevent cavities, heal your gums, protect against tartar—even all of the above! But toothpaste doesn’t just polish teeth; it also removes the bacteria that cause dental plaque and bad breath, so it’s important select a brand that is approved by the American Dental Association. Since everyone has different needs, here are some tips that will help you choose a toothpaste to meet your individual needs.

Types of Toothpaste

  • Anti-cavity: This type of toothpaste contains fluoride. Fluoride not only helps to prevent decay, it also actively strengthens tooth enamel.
  • Anti-gingivitis: If have tender, swollen gums that bleed when you irritate them, this is probably an early sign of gingivitis, a mild form of gum disease. Anti-gingivitis toothpaste helps fight oral bacteria and restore gum health, preventing more serious gum disease.
  • Desensitizing: If your teeth hurt when you consume things like ice cream or cold drinks, this toothpaste can help you. It will provide relief by blocking the tooth’s pain signal to the nerve so that sharp changes in temperature aren’t so painful.
  • Tartar-control: This toothpaste will help control tartar. However, the best way to remove tartar is by scheduling a professional dental cleaning with your Dental Hygienist.
  • Whitening: This toothpaste contains chemicals that are able to help whiten and brighten tooth enamel, thus maintaining the natural color of your teeth. If your teeth are sensitive this is a toothpaste you want to avoid.
  • Children’s: Fluoride or Fluoride free?  When making this decision it is important that you are aware if your child is swallowing the toothpaste.  If they have not learned to spit it out, stick with a non Fluoride toothpaste.  Fluoride is a great benefit for children as it helps remineralize teeth and prevent tooth decay.

It is recommended that everyone brush their teeth twice daily for two minutes and floss daily.  You only need a pea size amount of toothpaste. Today there is toothpaste to meet the oral needs of everyone. But while all of the products on the shelf might seem the same, with a little help from your Dentist or Dental Hygienist, you can determine which is right for you. It is important to schedule dental checkups and professional cleanings twice a year to prevent tooth sensitivity, gum disease, tartar buildup, and tooth decay. We hope to see you soon in one of your dental offices.

Sources:

www.colgate.com

www.ada.com

The Truth About Hookah

Lindsay Olsen, RDH

The Truth About Hookah

Myth: Hookah smoke is better for you than cigarette smoke and not addictive.

Reality: Hookah smoke of various fruity flavors, tastes and aromas can be even more harmful than cigarette tobacco smoke. Also, hookah smoke contains four times more nicotine (an addictive drug) than cigarette smoke. Some people can become addicted to nicotine after using any form of tobacco just a few times, this includes hookah.

Myth: Smoking hookah is less harmful than cigarettes because the smoke passes through water, which filters out the chemicals and other carcinogens.

Reality: When hookah passes through water at the base of a hookah pipe it cools the smoke, but does not filter any chemicals out of the smoke. This “cooling” process forces a hookah smoker to inhale twice as deeply as a cigarette smoker, which causes chemicals, cancer causing agents, and other harmful elements to penetrate deeper into the lungs. The charcoal that is uses in hookah pipes adds even more carbon monoxide to the higher levels that already exist in this type of tobacco.

Myth: Smoking hookah is fun, and I only do it socially with friends, its not like I do it every day.

Reality: The reality is 45-60 minutes of hookah smoking is the same as chain smoking 15 cigarettes. Even if you are only smoking hookah for an hour, twice a week, it can lead to nicotine addiction. Something also to consider, when you share the mouthpiece with others you are at risk of getting colds, viruses such as herpes simplex one (cold sores), oral bacterial infections and tuberculosis.

Need help quitting? Speak with your dental hygienist, dentist, or call

1-800-55-66-222, or visit http://www.ashline.org

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

Asotra, Kamlesh. Hooked on Hookah? What You Don’t Know Can Kill You. Burning Issues: Tobacco’s Hottest Topics. Tobacco-Related Disease Research Program Newsletter 7, no 3 (2005) 1-10.

What Age Should I Bring My Child for Their First Dental Appointment?

Sharma RDH

Sharma Mulqueen RDH

What Age Should I Bring My Child for Their First Dental Appointment
and What Can I Expect?

Good Pediatric dental care during the first few years of a person’s life is essential to give the proper foundation for overall good health throughout life.  At Signature Dental offices we offer the benefit of preventative care as well as restorative care and diagnostic imaging.  The earlier you bring your child to the Dentist the better off they will be.  The goal is to have every child used to visiting the dentist without fear.

We recommend you bring your child for their first dental appointment between the ages of 2-3.  At that first visit you can expect an introduction to the Dentist and Dental Hygienist.  The goal is to have the patient lay back in the chair and count their teeth so the Dentist and Dental Hygienist can have a look.  Through experience I have had a few at this young age let me polish.  As providers we will do as much as the patient will allow.  Most children will cry at this appointment which is ok.  Crying actually lets us see everywhere in the mouth.

The Dentist and Dental Hygienist will go over some things parents can learn when caring for their children’s teeth.  We ask that the child start drinking from a cup at 1 year old. If they are using a bottle at night, the milk or sugar juice can cause cavities quickly.  Thumb-sucking and pacifiers should be stopped or greatly reduced at age 3.  Lastly, we ask that the parents start brushing or using a washcloth to clean their gums.

Early and regular checkups will prevent cavities in children.  Signature Dental can help you with scheduling your appointment, verifying your Insurance and most important making sure your child has a wonderful experience.  We want our little patients to enjoy going to the dentist at a young age.  Prevention is the key to success.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com


Sources:  
www.deltadentalmn.org
www.aapd.org

Christmas Stocking Stuffers

Sharma RDH

Sharma Mulqueen, RDH

 

Christmas Stocking Stuffers

Christmas is the topic of mostly everyone this time of year.  So many of us love to see what Santa has left for us in our stockings.  When considering stocking stuffers, we have some recommendations to assist in keeping your child’s mouth and teeth at their healthiest.

When parents start thinking of what to place in their child’s stocking, they rarely think to put items that will benefit dental health.  Most parents fill their children’s stockings with candy, nuts, socks, hair bows, lotion or Chap Stick.  The list can be endless with what is placed in stockings.  So this year, why not give them items to help with their dental home care.

A New Toothbrush

Everyone loves a new toothbrush.  For the holidays, pick one that will get your kids excited about brushing their teeth.  There are character brushes, brushes that light up and even brushes that play music while you clean your teeth!  Be sure to choose a soft-bristled brush with the appropriate sized head for smaller mouths.

A Tooth Timer

If brushing the correct amount of time is difficult for your kids, consider getting a small timer to keep in the bathroom.  Most kids brush an average of 14 seconds but in their minds it was for two minutes.  A timer will insure that your child is brushing for the approiate time.   You can even join them by brushing together to make sure the family is brushing for two minutes.

A Fun Toothpaste Flavor

So many people choose mint or bubble gum for their toothpaste flavor.  You can look online and find some fun flavors.  Try giving your kids something silly that you wouldn’t usually pick.  There’s Bacon, Pickle, Cupcake, Oreo, Vanilla and Orange.  The list keeps growing.  Amazon has some great choices.

Flavored Floss

Floss is normally pretty plain, but it doesn’t have to be.  Like toothpaste, there is bacon, cupcake or pickled-flavored floss to match.  If those flavors don’t do the trick, there are banana and cinnamon-flavored options for kids to enjoy.

Sugar-Free Chewing Gum with Xylitol

Did you know that chewing gum can actually be good for your teeth? While not a substitute for brushing, sugar-free gum can help in the production of saliva which washes away trapped food particles.  Further, gum containing xylitol has actually been proven to help reduce cavities.

Holidays are such a special time to share with your family and friend’s.  Signature Dental would like to wish you all a Merry Christmas and a Happy New Year.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

http://www.xlear.com

http://www.colgate.com

http://www.oralanswers.com

Basic Tongue Problems

AnnC

Ann Clark, RDH

Basic Tongue Problems

The tongue is often known as the “strongest muscle in the body”.  It is made up of a group of muscles and allows us to swallow, talk, taste, and clean the mouth.  A healthy tongue is pink and covered with small bumps we call taste buds or papillae.

When your tongue experiences soreness or discoloration it can be frustrating due to its constant use.  The majority of tongue problems are not serious and most can be cared for quickly; however, sometimes a discolored or painful tongue can be something more serious like a vitamin deficiency, oral cancer, or AIDS.  Any persisting concerns should have medical advice.

White tongue:
-Leukoplakia: this condition causes excessive cell growth in the mouth causing white patches to grow.  Although not always dangerous they can be a precursor to cancer so let your dentist be the judge.  It can develop from irritation and is more often found in those using tobacco products.
-Oral thrush: also known as candidiasis.  This is a yeast infection of the mouth.  It shows up as white patches like cottage-cheese.  It is more common in infants and the elderly, especially denture wearers or those with weakened immune systems.  Medical conditions like diabetes, or inhaled steroids for asthma or lung disease can increase your risk.  Antibiotics can kill off “good” bacteria resulting in this condition.  Eating plain yogurt and medications can combat this infection.
-Oral lichen planus: this manifests itself as lacey-white lines on your tongue.  Although hard to determine the cause, it often resolves on its own.  Keeping up good hygiene and avoiding tobacco can help the healing process.
Other Conditions: 
-Scarlet fever: contact a doctor if you have a red tongue along side a high fever.  An antibiotic is necessary for this condition.
-Geographic tongue: this is known dentally as benign migratory glossitis and looks like a map pattern of reddish spots with a white border;  their location often shifts.  They are usually harmless and acidic foods can often sting.  If discomfort persists you can be prescribed a topical medication.
-Red or strawberry tongue: many factors can cause a normally pink tongue to turn red or even look strawberry-like with enlarged, red taste buds.  Vitamin deficiencies like B12 and folic acid can cause such an appearance.
-Black hairy tongue: although this looks scary it is typically non-serious.  The small bumps on your tongue grow continually in your lifetime and in some people become excessively long, making it easier to harbor bacteria and cause a dark “hair-like” appearance to form.  This is more commonly found in those with poor hygiene, individuals on antibiotics or chemotherapy and those with diabetes.
-Sore or bumpy tongue:
*Trauma can usually occur from biting or burning your tongue. Grinding and clenching can irritate the sides
your tongue.
*Canker sores or ulcers cause soreness.  Their cause is unknown but stress can aid their development.
*Burning tongue syndrome can occur in post menopausal women.
*Smoking is an irritant to the tongue manifesting in soreness.
*Medical conditions like diabetes and anemia can result with a sore tongue.
*Enlarged papillae can result from irritated taste buds.
*Oral cancer- a spot that doesn’t resolve in a 2 week period needs to be checked.  Many oral cancers do not
hurt in the early stages so don’t assume a lack of pain means you are okay.

Please consult your friendly dental office for an evaluation if any of these conditions arise.  It’s better to be safe.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:
http://www.webmd.com/oral-health/guide/tongue-problem-basics-sore-or-discolored-tongue-and-tongue-bumps?page=3
University of Maryland Medical Center: “Tongue Problems”
University of Maryland Medical Center: “Oral Cancer”
American Dental Association: “Common Mouth Sores”
Familydoctor.org: “Mouth Problems”
Familydoctor.org “Canker Sores:  What they are and what you can do about them”
Columbia University College of Dental Medicine:  “Black Hairy Tongue”
Columbia University College of Dental Medicine:  “Painful Papillae of the Tongue”