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Glossitis

Glossitis may be related to local conditions (infections, irritation) or be a sign of a systemic disease.
Inflammation of the dorsal aspect of the tongue usually results in the loss of filiform papillae, i.e. atrophy (smooth tongue).
The tongue may also have sores Oral Mucosal Ulcers or be affected by various diseases of the oral mucosa Viral Infections of the Oral Mucosa Assessment of Oral Mucosal Changes.
Cancer of the tongue is hardly ever encountered on the dorsal surface of the tongue. Ulcers, leukoplakia and erythroplakia Assessment of Oral Mucosal Changes are an indication for a biopsy if they do not disappear within 2-3 weeks after the removal of potentially irritating factors. The patient should be referred to a dentist for a check-up of the mouth and for biopsy.

Atrophy around the median sulcus of the tongue, which affects the filiform papillae located in front of the circumvallate papillae (picture F1)
A candidal infection, which may also present with other symptoms, including angular cheilitis Cheilitis and erythema of the roof of the mouth.
The condition is more common in those wearing dentures and in smokers.
Treatment consists of the removal of predisposing factors and topical antifungal therapy Oral Yeast Infections
Differential diagnosis
- Median rhomboid glossitis (pictures F2 F3), also known as central papillary atrophy, which requires no treatment Benign Lesions of the Tongue
- Ulceration due to sarcoidosis or tuberculosis

The surface of the tongue is covered with a white coating, which can be scraped off to expose the underlying erythematous mucous membrane.
Often encountered in infants and elderly individuals in poor general health.
Differential diagnosis: geographic tongue (pictures F4 F5 F6)

The rough structure of the filiform papillae is lost (depapillation), and the tongue becomes smooth (picture F7).
Erythematous patches may occur on the tongue or on the other mucous surfaces (pictures F8 F9).
Causes
- Iron deficiency anaemia Iron Deficiency Anaemia
- Megaloblastic anaemia Megaloblastic Anaemia
- Deficiency of vitamin B₁₂
- Sj�gren's syndrome Primary Sj�gren's Syndrome, dry mouth Dryness of the Mouth
- Eating disorders
Treatment in accordance with the underlying disease where it has been identified.

Foliate papillae are ridged masses of mucous membrane that cover the sides of the posterior region of the tongue (lingual tonsils).
The swelling may be caused by
- mechanical or chemical irritation, e.g. rubbing dentures, inflamed wisdom tooth
- upper respiratory tract infections
Treatment consists of the removal of irritating factors
Differential diagnosis
- Fibroma
- Ulceration
- Light-coloured lesions on the lateral margin of the tongue should be biopsied.
- The foliate papillae (lingual tonsils) at the back and on both sides of the tongue are normal ridged masses of mucous membrane. No treatment is needed, only possible irritating factors should be removed.

Chronic inflammation that may lead to permanent macroglossia
Intermittent swelling of the tongue, which lasts for a few days
The median sulcus is markedly deep
A manifestation of the Melkersson-Rosenthal syndrome (see OMIM http://omim.org/entry/155900)

González-Álvarez L, García-Pola MJ. Risk factors associated with tongue lesions: a propensity score-matched case-control study. Med Oral Patol Oral Cir Bucal 2022;27(1):e25-e34. [PubMed]
Hellstein JW, Marek CL. Candidiasis: Red and White Manifestations in the Oral Cavity. Head Neck Pathol 2019;13(1):25-32. [PubMed]
Pinna R, Cocco F, Campus G, et al. Genetic and developmental disorders of the oral mucosa: Epidemiology; molecular mechanisms; diagnostic criteria; management. Periodontol 2000 2019;80(1):12-27. [PubMed]
Park KK, Brodell RT, Helms SE. Angular cheilitis, part 2: nutritional, systemic, and drug-related causes and treatment. Cutis 2011;88(1):27-32. [PubMed]