Objectives: This study aimed to evaluate the safety of different tongue cleaning devices and scraping frequencies in elderly individuals requiring nursing care, using microbleeding of the tongue mucosa as an objective indicator. Associations with oral and systemic conditions were also examined. Subjects and Methods: Thirty elderly residents (mean age 89.4 ± 7.9 years) underwent tongue cleaning under six conditions: toothbrush (3 and 10 strokes), tongue brush (10 and 30 strokes), and sponge brush (10 and 30 strokes), with pressure standardized at 100 g. Microbleeding was assessed using a urine test strip method. Clinical variables included Geriatric Nutritional Risk Index (GNRI), tongue coating index (TCI), oral dryness (clinical criteria and moisture meter), and number of present teeth. Results: Microbleeding occurred under all conditions and increased significantly with greater numbers of strokes for toothbrush and tongue brush use. At 10 strokes, the toothbrush induced significantly more microbleeding than the tongue brush and sponge brush. At 30 strokes, the tongue brush caused significantly more microbleeding than the sponge brush. The sponge brush demonstrated the lowest incidence overall. Lower TCI values were significantly associated with microbleeding in sponge brush groups. Moderate to severe oral dryness (clinical criteria) and fewer present teeth were also associated with higher microbleeding incidence. No significant associations were found with medical history, medication use, or GNRI. Conclusions: Tongue cleaning safety in elderly individuals depends on both device type and stroke frequency. Sponge brushes appear less invasive, and individualized approaches considering tongue coating, oral dryness, and dentition are essential for safe practice.
References
[1]
Kojima, K. (1985) Clinical Studies on the Coated Tongue. JapaneseJournalofOral&MaxillofacialSurgery, 31, 1659-1678. https://doi.org/10.5794/jjoms.31.1659
[2]
Tosa, H., Shimada, Y., Terasawa, K., Mitsuma, T. and Tanaka, M. (1987) Study on Relationship between Tongue Coating and Gastric Lesion. Gastrointestinal Endoscopy, 30, 303-310.
[3]
Takahashi, K., Tosa, H., Shimada, Y., Shintani, T. and Terasawa, K. (1988) On the Relationship between Tongue Inspection and X-Ray Findings of the Stomach. KampoMedicine, 39, 1-8. https://doi.org/10.3937/kampomed.39.1
[4]
Shimada, Y., Tosa, H. and Terasawa, K. (1994) A Study on the Relationship between Thickness of Tongue Coating and Pancreas Exocrine Function by Pancreatic Function Diagnostant. KampoMedicine, 44, 451-454. https://doi.org/10.3937/kampomed.44.451
[5]
Shimada, Y., Kohta, K., Shibahara, N., Takahashi, K. and Terasawa, K. (1995) A Study of the Relationship between the Fur of the Tongue and Dysfunction of Ki, Blood, Body Fluids, Spleen and Stomach. KampoMedicine, 45, 841-847. https://doi.org/10.3937/kampomed.45.841
[6]
Kakinoki, Y. and Nishihara, T. (2001) Introduction to Tongue Diagnosis for Dentists and Dental Hygienists—Development of New Dental Practice. Hyoron Publishers, 10-38.
[7]
Ueda, T., Shimizu, T., Tasaka, A. and Sakurai, K. (2012) New Method for Evaluation of Tongue-Coating Status. Journal of the Tokyo Dental College Society, 112, 620-623. http://hdl.handle.net/10130/2944
[8]
Arjun, T.N., Dwivedi, V. and Tyagi, S. (2019) Effectiveness of Various Tongue Cleaning Aids in the Reduction of Tongue Coating and Bacterial Load: A Comparative Clinical Study. TheJournalofContemporaryDentalPractice, 20, 444-448. https://doi.org/10.5005/jp-journals-10024-2536
[9]
Shimoyama, K. and Watanabe, Y. (2003) Oral Hygiene for the Dependent Elderly. Japanese Journal of Gerontology, 18, 149-153.
[10]
Shirakawa, S., Nagano, T., Matsushima, Y., Yashima, A. and Gomi, K. (2024) Safety and Clinical Evaluation of a Sonic Tongue Brush. InternationalDentalJournal, 74, 321-327. https://doi.org/10.1016/j.identj.2023.10.002
[11]
Izumi, M. and Akifusa, S. (2021) Tongue Cleaning in the Elderly and Its Role in the Respiratory and Swallowing Functions: Benefits and Medical Perspectives. JournalofOralRehabilitation, 48, 1395-1403. https://doi.org/10.1111/joor.13266
[12]
Danser, M.M., Gómez, S.M. and Van der Weijden, G.A. (2003) Tongue Coating and Tongue Brushing: A Literature Review. InternationalJournalofDentalHygiene, 1, 151-158. https://doi.org/10.1034/j.1601-5037.2003.00034.x
[13]
Kadowaki, R., Kikuchi, C., Fujiwara, K. and Inoue, K. (2005) Effects of Tongue Care Using a Sponge with Water-Supply Function. ProceedingsoftheJapaneseNursingAssociation: NursingGeneral, 36, 396-398.
[14]
Masato, H., Kouhei, N., Shoichi, I., Akira, S. and Kohji, Y. (2007) The Safe Use of Tongue Brush-Stained Tongue Brushing Force in Subjects. The Japanese Journal of Conservative Dentistry, 50, 332-337.
[15]
Onodera, N., Kuniyasu, N., Namioka, T., Kishi, M., Yonemitsu, M. and Sekine, M. (2009) Evaluation of the Effectiveness of Professional Tongue Cleaning Using Mechanical Devices. The Journal of Japan Society of Dental Hygiene, 4, 11-17.
[16]
Yaegaki, K., Coil, J.M., Kamemizu, T. and Miyazaki, H. (2002) Tongue Brushing and Mouth Rinsing as Basic Treatment Measures for Halitosis. InternationalDentalJournal, 52, 192-196. https://doi.org/10.1002/j.1875-595x.2002.tb00923.x
[17]
Matsui, M. and Kishi, M. (2014) Contribution of Gingival Conditions and Bacterial Levels in Dental Plaque and Tongue Coating on Oral Malodor of Young Subjects without Periodontitis. Dental Journal of Iwate Medical University, 38, 93-106.
[18]
Yonezawa, T. (2019) Systematic Review about the Current State and Problems in Relation to the Implementation, Tools and Evaluation Methods for the Cleaning of Tongue Coating. Journal of Japan Health Medicine Association, 28, 2-9.
[19]
Ito, K., Fukuhara, T., Kouchi, I. and Inoue, M. (2009) Relation between Tongue Cleaning Effect and Type of Brush. The Japanese Journal of Dysphagia Rehabilitation, 13, 77-87.
[20]
Ito, K., Kurokawa, A. and Takei, N. (2000) Efficacy of Tongue Brushing on Oral Malodor. Journal of the Japan Dental Hygienists’Association, 29, 82-83.
[21]
Galvan, J. and Andrade, C. (2025) Salivary pH Recovery: Analyzing the Buffering Capacity of Saliva after Consuming Basic, Neutral, and Acidic Drinks. Acta Scientific Dental Sciences, 9, 26-32.
[22]
Pedrazzi, V., Sato, S., de Mattos, M.d.G.C., Lara, E.H.G. and Panzeri, H. (2004) Tongue-Cleaning Methods: A Comparative Clinical Trial Employing a Toothbrush and a Tongue Scraper. JournalofPeriodontology, 75, 1009-1012. https://doi.org/10.1902/jop.2004.75.7.1009
[23]
Chérel, F., Mobilia, A., Lundgren, T., Stephens, J., Kiger, R., Riggs, M., et al. (2008) Rate of Reformation of Tongue Coatings in Young Adults. InternationalJournalofDentalHygiene, 6, 371-375. https://doi.org/10.1111/j.1601-5037.2008.00306.x
[24]
Bouillanne, O., Morineau, G., Dupont, C., Coulombel, I., Vincent, J., Nicolis, I., et al. (2005) Geriatric Nutritional Risk Index: A New Index for Evaluating At-Risk Elderly Medical Patients. TheAmericanJournalofClinicalNutrition, 82, 777-783. https://doi.org/10.1093/ajcn/82.4.777
[25]
Kakinoki, Y. (2015) Disease Condition and Treatment of Dry Mouth. AnnalsofJapanProsthodonticSociety, 7, 136-141. https://doi.org/10.2186/ajps.7.136
[26]
Fukushima, Y., Yoda, T., Araki, R., Sakai, T., Toya, S., Ito, K., et al. (2017) Evaluation of Oral Wetness Using an Improved Moisture-Checking Device for the Diagnosis of Dry Mouth. OralScienceInternational, 14, 33-36. https://doi.org/10.1016/s1348-8643(17)30017-4
[27]
Shimizu, T., Ueda, T. and Sakurai, K. (2007) New Method for Evaluation of Tongue-Coating Status. JournalofOralRehabilitation, 34, 442-447. https://doi.org/10.1111/j.1365-2842.2007.01733.x
[28]
Cheruvathoor, D., Thomas, V., Kumar, N. and Jose, M. (2020) High Prevalence of Oral Mucosal Lesions in Elderly: Call for Revolutionizing Geriatric Dental Care Strategies. JournalofFamilyMedicineandPrimaryCare, 9, 4375-4380. https://doi.org/10.4103/jfmpc.jfmpc_51_20
[29]
Chen, G., Tang, Z. and Bao, Z. (2022) Vitamin B12 Deficiency May Play an Etiological Role in Atrophic Glossitis and Its Grading: A Clinical Case-Control Study. BMCOralHealth, 22, Article No. 456. https://doi.org/10.1186/s12903-022-02464-z
[30]
Uemori, N., Kakinoki, Y., Karaki, J. and Kakigawa, H. (2011) New Method for Determining Surface Roughness of Tongue. Gerodontology, 29, 90-95. https://doi.org/10.1111/j.1741-2358.2011.00509.x
[31]
Yoshiyuki, O., Fumihiko, F., Masato, E., Naoto, I., Nobuyuki, Y. and Tadashi, Y. (1998) The Relationship between Clinical Tongue Inspection and Microscopic Structure of Tongue Surface. Bulletin of the Meiji University of Oriental Medicine, 22, 39-49.
