Abstract

Objectives: The audience member will learn of this not uncommun condition, Pigmented Fungiform and Filliform Papillae of the Tongue, and its serious impact it can have on the emotional well-being of certain patients. Many of these people have been told by their dentists and physicians that there is nothing to do to help but I will present my work showing how effective and easy it is to perform this treatment with the Q-switched ruby laser. Introduction: Approximately 30% of patients of skin of color have pigmented papillae of the tongue (PPT). Some are so self conscious that they are not actively working and rarely leave their house. PPT are most common on the dorsal tip and lateral borders but some patients have extensive involvement of the dorsum anteriorly and laterally covering 66% of the lingual surface. The Q-switched Ruby 695nm. laser has been found to be very effective in reducing the pigmentation after 1-4 or more treatments done at least a month apart. PPT recurs from 3 months to more than a year but usually not as dense. Materials / method: Topical spray anesthetic consisting of Benzocaine 14.0 %, Butamben 2.0 %, and Tetracaine Hydrochloride 2.0 % is sprayed on to a gauze and that is placed on the affected part of the tongue for 1-2 minutes. The extender tip of the laser is wrapped with a protective plastic wrap without obstruting the lens. The tongue is held with the non-dominant hand using dry gauze and the Ruby laser is set using a 4mm. spot size and starting fluence of 4.5 J/cm2. If there is not enough of a clinical response with whitening and minimal acoustic response , the fluence is increased in .5 J/cm2 increments. Results: The majority of patients see significant clearing after one treatment but most do require to have a series of 3-4 and even more in those that have very densely populated pigmented papillae. There can be droplets of blood from the tip of the papillae which quickly coagulate without assistance . A wooden moistened tongue blade can help separate the dense papillae into rows, to facilitate more effective laser coverage. The paient is instructed not to consume acidic food, alcohol or crusty hard bread for the first two days. The first 2 days post, irrigation with 50% hydrogen peroxide is optional. Conclusion: Pigmented papillae of the tongue are not uncommon and can be emotionally devastating for some patients who have sought treatment only to be told nothing can be done to help them and others have had painful waterjet and laser treatments that created weeks of downtime and permanent loss of taste without reducing the pigmentation. Dentists, oral surgeons, and physicians should be aware of this relatively easy treatment that can be done with a Q-swtiched ruby laser and repeated eventually for maintenance to reduce the PPT as it recurs, which is expected.