By Stacey Butterfield
The hospital medicine content at Internal Medicine Meeting 2026 began on Wednesday morning at a logical starting place: the letter A.
Jamie S. Newman, MD, MHA, MACP, gave attendees of the pre-meeting course “Hospital Medicine: Success in a Complex Environment” a primer, or A to Z review, of conditions that can be seen in inpatients' mouths, if hospitalists think to investigate.
“Almost every single patient I've ever admitted to the hospital has had a mouth,” joked Dr. Newman, a hospitalist at Mayo Clinic in Rochester, Minn., and physician editorial advisor for ACP Hospitalist. “The problem is that people never look at it. … I guarantee, any time you're on a hospital service, if you start really looking in your patients' mouths, you're going to find some important clues.”
Thus began his alphabetic recital. A was for amyloidosis, which is identified by an enlarged tongue, although that finding is not specific. “There's a lot of reasons you can get a big tongue,” noted Dr. Newman, listing hypothyroidism, Beckwith-Wiedemann syndrome, hamartomas, neoplasm, and angioedema as other potential causes.
B is for black, hairy tongue. “I see this all the time. All you have to do is look for it," he said. "It's often a patient from a nursing home, especially if they smoke and have no teeth.” It results from overproduction of pigmented bacteria and is common in patients on a low-fiber diet, Dr. Newman explained. Treat with gentle debridement and hydrogen peroxide, along with addressing candidemia, if present.
On to C. “Chlamydia can show up in all kinds of interesting places, and [the mouth] is one of them,” said Dr. Newman. His tip on this finding was to be cautious about the risk of a false-positive test result if you use nucleic acid amplification testing for gonorrhea.
Next up, D for dentures, which hospitalists should keep an eye on. “What a disaster for patients when they lose their dentures in the hospital,” said Dr. Newman. “It affects nutrition, finances.” It's particularly important to know if perioperative patients have dentures, he noted, showing an X-ray of a denture that escaped into a patient's body.
E is for endocarditis because hospitalists should look to poor dentition as a source of infection.
Moving on to F, fissured tongues “are very common, but people get upset if they see them,” said Dr. Newman. Reassure patients that the finding is benign, he advised. It can be present together with a double G, geographic tongue, more formally known as glossitis areata migrans. “Dermatologists don't like to call things easy stuff,” he joked.
Geographic tongue is transient, affecting approximately 2% of the population. It can be seen in patients with asthma, hay fever, or psoriasis. As a bonus, he offered a much rarer G finding, glucagonoma, a neuroendocrine tumor.
Sliding along the alphabet, Dr. Newman showed gingival hyperplasia, which can be a side effect of medications, including calcium-channel blockers. I is for iron deficiency, which presents with a smooth tongue. “In the hospital, we see this condition all the time,” he said.
Next up was a pediatric condition, Peutz-Jeghers syndrome, followed by a condition that was much more common before HIV became treatable, Kaposi’s sarcoma. “There was quite a bit of Kaposi’s sarcoma in this city about 30 years ago,” said Dr. Newman to his San Francisco audience.
L is for lichen planus. “That is an idiopathic inflammatory disorder, T-cell mediated,” he explained. M is for multiple endocrine neoplasia type 2B, which can entail mucosal neuromas, typically involving the lips and tongue, eyelid margins, conjunctivae, palate, and nasal and laryngeal mucosa.
It's a rare occurrence, as opposed to neoplasms, a finding that hospitalists should expect to see, especially in patients who smoke, drink, and have poor oral hygiene, Dr. Newman advised. “They have such a high rate of mouth cancer, and it gets missed. I personally don't want to discharge a patient from a hospital service with a lot of tongue cancer that I didn't catch,” he said.
O is for oral hairy leukoplakia, which can be seen in HIV or Epstein-Barr virus and entails raised hairy patches on the lateral tongue. Pemphigus, on the other hand, presents with blisters, which are more painful before they pop, Dr. Newman noted.
The disease for the letter Q is relatively rare, but Dr. Newman saw three patients with this last month: Quincke's syndrome. “It's a hereditary C1 esterase inhibitor deficiency, and they get hereditary angioedema, and it can be brought on by trauma like dental work,” he said. Stay alert and catch this, because the swelling can compromise the patient's airway, he stressed.
R is for median rhomboid glossitis, where an embryonic tongue is formed by two lateral lingual tubercles meeting in the midline and fusing above a central structure. Next up was sarcoidosis, which can first present cutaneously, Dr. Newman reported.
“We had a patient once that his entire head was full of sarcoid,” he said. “You have to look for the skin signs for that disease.” Bonus S's were scrotal tongue and syphilis.
Next up was hereditary hemorrhagic telangiectasia, an autosomal dominant condition also known as Osler-Weber-Rendu disease. A more common T is torus mandibularis, a bony growth of the palate that is benign and may occur with biphosphonate use.
U is for ulcers from herpes simplex virus. “Everyone who's had an aphthous ulcer knows what they are, knows that feeling,” said Dr. Newman.
V was a historical disease that doesn't seem to be going away: scurvy or vitamin C deficiency. “There's a lot of patients who get these weird nutritional diseases now, especially with the GLP-1 drugs. People eat weird now,” said Dr. Newman.
For the letter W, he reviewed the disease formerly known as Wegener’s, now granulomatosis polyangiitis, which presents with granulomatous ulcerations in the palate.
X is for xerostomia, a particularly good reason for looking in an inpatient's mouth. “A month ago, we got a consult for a patient with persistent nausea,” said Dr. Newman. “I look in the patient's mouth. It's so dry that, on the back of the tongue, there was a pill stuck.” Many drugs and conditions can give inpatients dry mouth, so think about the problem, look for it, and then address it, Dr. Newman urged.
Next to last was another ever-present issue, yeast. “This is the most common oral finding in the hospital,” he said. “I guarantee you, if you spend a week on a hospital service and you don't see this, you didn't look. So many patients are on antibiotics.” Confirm the diagnosis of thrush with scraping or culture and treat topically or orally, he advised.
The alphabetic recital wrapped up with zinc deficiency. “So many of our patients are malnourished,” said Dr. Newman. He noted that zinc is particularly important for wound healing. “Any patient I admit with wounds, I get a zinc level because I want them to get better and discharge as soon as possible.”
Twenty-six findings (plus bonuses) should be enough reason for hospitalists to do quick oral exams, Dr. Newman concluded. “There are many clues to systemic disease to be found, and oral findings can impact nutrition and length of stay,” he said. “If you don't look in the mouth, you're not going to find them.” ■