Can you help explain why the front top surface of my tongue has developed several deep fissures over the past couple of years? My dentist says it is caused by a dry mouth (something I don’t have), and my doctor has given no explanation.
E. Simpson, by email
The deep cracks on the top surface of the tongue you describe are what are known medically as fissured tongue. The cause is often genetic as cases can run in families, and it is more common among older people — around 30 per cent of the population develop it later in life.
However, it may be the fissures have always been there and have become more prominent with age. I am not aware of the connection with a dry mouth. However, a fissured tongue can be associated with other conditions: it can occur alongside geographic tongue — a harmless condition which leads to the development of patches of tissue of differing colours and shapes on the tongue.
A reader asked Dr Martin Scurr to help explain why the front and top of their tongue was cracked (file photo)
This is caused by the skin of the tongue being shed at varying rates, and is more common among those with the skin condition psoriasis. But whereas geographic tongue can come and go, a tongue with fissures remains fissured for good, but does not normally cause symptoms.
All I would suggest is that you brush your tongue maybe once a day to prevent food getting stuck in the grooves, which could otherwise lead to bad breath or inflammation.
But be reassured: while the fissures may look different, they will not cause any long-term problems.
My 35-year-old daughter has osteoporosis as a result of having anorexia about 12 years ago. She was told that she has the bones of an 80-year-old. Her two children were delivered by caesarean due to the risk of bone fracture.
When she had a check a month ago, I asked if any supplements apart from daily vitamin D would help and we were told no.
Mrs T Harris, Hertfordshire
You must have suffered great anxiety at the time of your daughter’s illness, and although she has recovered since that time, sufficiently well to give birth to two children, I’m sorry to hear she has severe osteoporosis.
Anorexia nervosa is characterised by severe restriction of food intake in order to reach a low body weight — and this is associated with a number of medical complications. Chronic starvation leads to hormonal abnormalities. This can lead to a change in the levels of sex hormones such as oestrogen — which leads to absent or irregular periods and has a knock-on effect on bone strength.
Normally, during adolescence, there’s increased bone turnover — old bone cells being reabsorbed and new ones created — so that the bones can grow to peak bone mass.
But research shows that anorexia nervosa at this time reduces both bone reabsorption and formation.
The consequence is that the affected patient reaches adult life without ever attaining peak bone mass, and whatever subsequent treatment is applied, it’s never possible to catch up. This leads to a reported two to sevenfold increase in fractures. Weight gain and the restoration of normal menstrual cycles does improve bone mineral density.
I would say that as well as taking vitamin D (800 international units daily) it is necessary for your daughter to also take calcium (1200 mg daily) as both are vital for bone strength.
It is also established that daily weight-bearing exercise — such as running — is of benefit to bone structure and strength.
I know of no other supplements that are proven to be helpful.
There are drug treatments for osteoporosis in premenopausal women. These include oestrogens, bisphosphonates and a chemical version of the parathyroid hormone (a hormone that plays a key role in bone formation) — but this is an area for expert advice as it is a highly specialised field, so a consultant would make a decision on the use of these.
I wish your daughter well.
In my view… what doctors can learn from hairdressers
A training course was held recently in Norwich for 200 hairdressers who were learning how to identify and advise their clients on domestic abuse.
Given that people tend to find and stick to a single hairdresser, with whom they often develop a close relationship, hairdressers are, I believe, well placed to assist.
The benefit of a trusted, discreet professional relationship cannot be over emphasised. There was a time when the relationship with a family doctor held the same value, but sadly this closeness of contact has been eroded due to the increasingly complex demands of medical care and an ageing population.
This, coupled with a reduction in GP numbers, has resulted in unmanageable workloads, high levels of disillusionment and burnout.
But rather than working to improve the doctor/patient relationship, the powers that be seem determined to do the reverse. The Care Quality Commission — the social care and health watchdog — has started a campaign to encourage people to be more willing to complain about their experiences of GP care, stating that this will result in improvements.
To me, it seems only likely to further erode the morale of GPs, leading yet more to choose to leave, when already 40 per cent of doctors plan to go in the next five years.
Concerns about delays, cancelled appointments, lack of information, or disappointments about treatment, can be addressed and resolved by giving simple feedback (in our compulsory annual appraisals we all have to confirm that we provide opportunities for that).
The best way to get good care from your practice is to develop a warm and confident relationship with your doctor — just as one might with a hairdresser.