TITLE:
Evaluation of Safe Tongue Cleaning Methods in Elderly Individuals Using Microbleeding as an Indicator
AUTHORS:
Yoko Tada, Wataru Fujii, Junichi Karaki, Jumpei Kubota, Yasuaki Kakinoki
KEYWORDS:
Tongue Cleaning, Microbleeding, Tongue Coating Index (TCI)
JOURNAL NAME:
Open Journal of Stomatology,
Vol.16 No.4,
March
30,
2026
ABSTRACT: 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.