Impact of different tongue cleaning methods on the bacterial load of the tongue dorsum

Objective: To assess the extent and duration of the effect of tongue cleaning procedures on bacterial load on the dorsal surface of the tongue. Methods: 19 subjects participated in this blinded crossover study. Subjects abstained from oral hygiene, eating and drinking from 22:00 h the previous evening. Tongue samples were collected at baseline and within 15 minutes of one of three procedures: teeth brushing alone; teeth brushing plus tongue scraping; teeth brushing plus tongue cleaning using a high speed vacuum ejector and irrigation with 20 ml antibacterial mouthwash. Subjects then brushed twice daily for 3 days apart from the second group who additionally scraped their tongue twice daily On day 4, baseline and post-treatment samples were collected as per day 1. Bacteria (total anaerobes, Gram-negative anaerobes, VSC-producing bacteria and Streptococcus salivarius) were enumerated using appropriate selective media. Results: The tongue dorsum was colonized by all 4 bacterial categories (log(10) 6-8 cfu/sample). For subjects who brushed their teeth only, there was a significant reduction from baseline for S. salivarius only in contrast, tooth brushing plus tongue scraping resulted in statistically significant reductions from baseline for all bacterial categories (range log(10) 0.11-0.40cfu/sample). Highly statistically significant reductions (log(10) 1.11-1.96 cfu/sample) were observed for subjects who underwent thorough tongue cleaning with the saliva ejector/mouthwash. To determine longevity of treatment effects, baseline bacterial loads for days 1 and 4 were compared. Only daily tongue scraping resulted in statistical significant reduction in baseline microbial loads on day 4. Conclusions: While mechanical tongue cleaning with or without chemical intervention can reduce bacterial load on the tongue, this effect is transient, and regular tongue cleaning is required to provide a long lasting (overnight) reduction in bacterial numbers. Nevertheless, tongue cleaning is an oral hygiene procedure that is little practiced due to discomfort and/or lack of awareness on the part of dental professionals and their patients. (C) 2008 Elsevier Ltd. All rights reserved.