Inspect the dorsum of the tongue (while it is at rest) for any swelling, ulcers, coating, or variation in size, color, and texture. Observe the margins of the tongue and note the distribution of filiform and fungiform papillae, crenations and fasciculations, depapillated areas, fissures, ulcers, and keratotic areas. Note the frenal attachment and any deviations as the patient pushes out the tongue and attempts to move it to the right and left.
Wrap a piece of gauze (4 cm × 4 cm) around the tip of the protruding tongue to steady it, and lightly press a warm mirror against the uvula to observe the base of the tongue and vallate papillae; note any ulcers or significant swellings. Holding the tongue with the gauze, gently guide the tongue to the right and retract the left cheek to observe the foliate papillae and the entire lateral border of the tongue for ulcers, keratotic areas, and red patches. Repeat for the opposite side, and then have the patient touch the tip of the tongue to the palate to display the ventral surface of the tongue and floor of the mouth; note any varicosities, tight frenal attachments, stones in Wharton’s ducts, ulcers, swellings, and red or white patches. Gently palpate the muscles of the tongue for nodules and tumors, extending the finger onto the base of the tongue and pressing forward if this has been poorly visualized or if any ulcers or masses are suspected. Note tongue thrust on swallowing.