Gustatory and Tongue Disorder - Ners Unair

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Consideration. • The tongue is mainly composed of muscles. It is covered with a mucous membrane. Small bumps. (papillae) cover the upper surface of the ...

Gustatory and Tongue Disorder By: Retnayu Pradanie

Consideration • The tongue is mainly composed of muscles. It is covered with a mucous membrane. Small bumps (papillae) cover the upper surface of the tongue. Between the papillae are the taste buds, which allow you to taste. The tongue moves food to help you chew and swallow. • The tongue also helps you form words. • There are many different reasons for changes in the tongue's function and appearance

Peranan lidah dan air ludah •

Peran Lidah: – pengunyahan makanan di dalam rongga mulut, – proses menelan, – artikulasi (bicara), dan – pengecapan karena mengandung papil pengecap pada permukaan lidah yang mengandung sel-sel pengecap dan saraf pengecap.



Suatu zat hanya dapat dinikmati rasanya jika larut dalam air ludah. Melalui pori pengecap suatu zat dapat mencapai sel-sel pengecap dan mempengaruhi ujung-ujung sel-sel pengecap dan sesudahnya melalui serabut-serabut saraf akan menghasilkan respons saraf sehingga seseorang dapat merasakan rasa makanan (mengecap).

The Organs of Taste

Taste Buds (Sel Pengecap)

Figure 16.1a, b

TASTE BUDS • TASTE BUDS: are the sense organs that respond to gustatory (taste) stimuli • PAPILLAE: are the small elevated projections on the tongue – Fungiform , circumvallate , and foliate papillae contain taste buds – Filiform papillae do not contain taste buds but allow us to experience food texture and feel • It was once thought that the taste buds of the tongue were locat ed in specific regions (bitter in the posterior portion and sweet a t the anterior portion) HOWEVER, this is NOT TRUE. – There is no known taste “map” all tastes can be detected in all areas of the tongue that contain taste buds.

Taste bud receptors • Taste buds house of the chemoreceptors responsible for taste. • Stimulated by chemicals termed TESTANTS that are dissolved in saliva • Each grapelike taste bud contains 50 -125 chemorecptors termed GUSTATORY CELLS which are surrounded by supportive capsules – Tiny cilia -like structures extend from each gustatory cell and project into an opening called TASTE PORES which are bathed in saliva

Faktor2 yg mempengaruhi kemampuan mengecap: • Banyaknya papil pengecap dan sel pengecap • Gerakan lidah (msal: gg. Gerak lidah pada px stroke) • Banyaknya air ludah

Gangguan Gangguanpada padahal2 hal2tersebut tersebut Sering Seringdialami dialamioleh olehlansia lansia

What can we taste? • All taste cells can respond at least to most taste -producing chemicals • Functionally however, there are five “primary’ taste sensation: – Sour All tastes come from a combination of – Sweet these basic taste sensations. – Bitter – Salty – Umami (from glutamate) • primary sensation + sense of smell = ability to detect many different flavors.

•Areas of sensitivity on the tongue • Tip of the tongue: Sweetness • Back of the tongue: Bitterness • Sides of tongues: Saltiness and sourness •The five taste qualities combine with other oral sensations, such as texture, spiciness, temperature, and aroma to produce what is commonly referred to as flavor. •we recognize flavors largely through our sense of smell •Smell and taste are closely linked senses. •It is common for people who lose their sense of smell to say that food has lost its taste. This is incorrect; the food has lost its aroma, but taste remains.

The Gustatory Pathway

Neuronal pathway for taste • Begins with creation of a receptor potential in the gustatory cells of a taste bud • It is then transmitted via sensory input to the brain • anterior 2/3 of the tongue cells travel over the facial VII nerve. The posterior 1/3 are conducted by the fibers of the glossopharyngeal IX nerve • The III cranial nerve and the vagus X nerve plays minor role in taste except form the taste buds located on the walls of the pharynx and epiglottis • The three cranial nerves carry impulses into the medulla, into the thalamus and then into the taste area of the cerebral cortex in the parietal lobe

Taste Disorder • Dysgeusia (altered sense of taste) – the system may misread and or distort an odor, a taste, or a flavor. Or a person may detect a foul taste from a substance tha t is normally pleasant tasting.

• Hypogeusia: a reduced ability to taste sweet, sour, bitter, salty, and umami • Ageusia: Can detect no taste (can't detect taste at all) True taste loss is rare; perceived loss usually reflects a smell loss, which is often confused with a taste loss.

Causes

Problems with taste are caused by anything that interrupts the transfer of taste sensations to the brain, or by conditions that affect the way the brain interprets the sensation of taste.

Causes The most common causes of taste disorders are – Certain medications (anti -thyroid, zinc preparations, antibiotics, neurologic drugs and others) – Chemotherapy or radiation treatment – Aging (decreased ability to taste and smell) – Medical conditions (Bell’s Palsy, Parkinson’s Disease, diabetes, GERD and others) – Injuries to the mouth, nose or head – Poor oral hygiene – Fungal infections on the tongue or in the mouth area – Head and neck cancers

Symptoms • People who have taste disorders usually lose their ability to taste or can no longer perceive taste in the same way • The most common taste complaint is "phantom taste perception" -- tasting something when nothing is in the mouth. • a specific ageusia of one or more of the five taste categories: sweet, sour, bitter, salty, and umami, or savory.

How to diagnose? •

Ask about the medical history: – How long has the taste problem been going on? – What kind of taste change has occurred? – What medications is she/he currently, or was recently, taking? – Does she/he smoke, use recreational drugs or drink alcohol? – When was her/his last dental visit? – How is her/his appetite? – Are there any foods that taste normal? – Has there been any recent change in smell? – Any recent injury or illness? – Did she/he recently change her/his brand of mouthwash or toothpaste?

• Tests can be used to evaluate your senses of taste and smell. Certain chemicals made to produce the four major tastes — sour, sweet, bitter, salty — can be applied to areas of your tongue. Or you may be asked to take a taste test. In this test, you will sip certain liquids and try to identify their tastes. The chemicals or liquids used to test taste have no odor. • A "scratch and sniff" test can be used to check out your sense of smell. The test uses special cards. Each one contains an odor that is released when scratched. You will be asked to identify the odor on each card. • Other tests that may be performed include imaging (MRI, CT scans), blood tests or saliva flow rate.

Prognosis • How long dysgeusia lasts depends on the cause. Sometimes the problem disappears once the cause is removed. This can occur if the cause is gum disease, plaque, a medicine you are taking for a short time or a short -term condition such as a cold. • If the cause is a yeast infection, the dysgeusia should disappear after the yeast infection is properly treated. In some cases — for example, if nerves have been damaged — the dysgeusia may be permanent.

Prevention • Practice good oral hygiene, • keep up to date with your dental appointments, • tell your doctor if you notice any problems with your sense of taste. • Avoid contact with insecticides and solvents • Quit smoking

Treatment • dysgeusia is treated by treating the cause. • If no cause can be found, this is called "idiopathic dysgeusia." It's hard to say what the outlook for this condition will be. In some cases, idiopathic dysgeusia may go away on its own. In others, it will not. It is important to be evaluated so that the known causes of dysgeusia can be ruled out.

• A distorted sense of taste can be a serious risk factor for heart disease, diabetes, stroke, and other illnesses that require sticking to a specific diet. When taste is impaired, a person may change his or her eating habits. Some people may eat too little and lose weight, while others may eat too much and gain weight. • This can be a problem for people with certain medical conditions, such as diabetes or high blood pressure. In severe cases, loss of taste can lead to depression.

Tongue Disorder

Injury • Traumatic injury is the most common cause of tongue discomfort. • The tongue has many nerve endings for pain and touch and is more sensitive to pain than most other parts of the body. • The tongue is frequently bitten accidentally but heals quickly. A sharp, broken filling or tooth can do considerable damage to this delicate tissue.

Hairiness • An overgrowth of the normal projections on the top of the tongue (villi) can give it a hairy appearance. • The tongue may also appear hairy after a fever, after antibiotic treatment, or when peroxide mouthwash is used too often. • These "hairs" on the top of the tongue should not be confused with hairy leukoplakia. Hairy leukoplakia forms on the side of the tongue and is characteristic of AIDS.

Discoloration •



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The tongue's villi may become discolored if a person smokes or chews tobacco, eats certain foods, or has colored bacteria growi ng on the tongue. The top of the tongue may look black if a person takes bismuth preparations for an upset stomach. Brushing the tongue with a toothbrush or scraping it with a tongue scraper can remove such discoloration. Iron deficiency (anemia) & Pernicious anemia (deficiency of vita min B12) may make the tongue look pale and smooth. A strawberry-red tongue maybe the sign of scarlet fever, Kawasaki disease, pellagra (a type of malnutrition caused by a deficiency of niacin/vitamin B3 in the diet) accompanied with painful mouth, inflamed (glossitis)—the tongue is red, painful, and swollen.

Sores and Bumps •







Sores on the tongue can be caused by allergic reactions, oral herpes simplex virus infection, canker sores, tuberculosis, bacterial infections, or early-stage syphilis. Although small bumps on both sides of the tongue are usually harmless, a bump on only one side may be cancerous. Unexplained red or white areas, sores, or lumps (particularly when hard) on the tongue —especially if painless—may be signs of cancer and should be examined by a doctor or dentist Most oral cancers grow on the sides of the tongue or on the floor of the mouth. Cancer almost never appears on the top of the tongue, except when the cancer occurs after untreated syphilis.

Discomfort •





Tongue discomfort can result from irritation by certain foods, especially acidic ones (for example, pineapple), or by certain ingredients in toothpaste, mouthwash, candy, or gum. Some drugs can cause tongue discomfort, as can injury and infection. A common infection causing tongue discomfort is thrush (candidiasis) in which an overgrowth of fungi forms a white film that covers the tongue. Intense pain of the entire mouth can be caused by burning mouth syndrome.

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Usually, it is a process of elimination to find out just what is causing the discomfort. Tongue discomfort not caused by an infection is usually treated by eliminating the cause. For example, the person may try changing brands of toothpaste, discontinue irritating foods, or have a sharp or broken tooth repaired by a dentist. Warm salt-water rinses may help. Thrush can be treated with an antifungal drug, such as nystatin or fluconazole.

DIFFICULTY MOVING THE TONGUE

• Tongue movement problems are most often caused by nerve damage. • Problems moving the tongue may also be caused by ankyloglossia, a disorder where the band of tissue that attaches the tongue to the floor of the mouth is too short. • Tongue movement disorders may result in speech difficulties or difficulty moving food during chewing and swallowing.

ENLARGEMENT OF THE TONGUE

• Tongue swelling occurs with Down syndrome, acromegaly, myxedema, amyloidosis, rhabdomyoma, and other disorders. • The tongue may get wider in persons who have no teeth and do not wear dentures.

Asuhan Keperawatan

Anamnesa • • • • • • •

Data demografi umum Keluhan utama Riwayat penyakit saat ini Riwayat penyakit terdahulu Riwayat alergi Pola makan Personal higiene

Pemeriksaan Fisik • Pemeriksaan fisik pada lidah – Warna: merah, putih, kuning, hitam, pucat – Bentuk: pembengkakan, luka, benjolan, simetris atau tidak, tekstur, – Pergerakan lidah – Produksi air ludah – Kelembaban mukosa

Diagnosa Keperawatan • Perubahan sensori-persepsi: pengecapan b.d gangguan resepsi/transmisi/integrasi sensori sekunder terhadap proses penuaan/ penyakit pada sistem persyarafan/ efek medikasi • Resiko nutrisi kurang dari kebutuhan tubuh b.d penurunan nafsu makan sekunder terhadap disgeusia/ageusia/hipogeusia • Resiko penatalaksanaan regimen terapeutik inefektif b.d gangguan stimulus sensori rasa • Cemas b.d kurang pengetahuan

Tujuan & Kriteria Hasil • Mengetahui faktor penyebab perubahan sensori-persepsi • Mengetahui tingkat gangguan sensoripersepsi • Mengusahakan keadaan normal untuk merespon stimulus • Meningkatkan pengetahuan dan kesejahteraan • Mencehag terjadinya komplikasi

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