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Glossitis

Essentials

  • 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.

Inflammation of the median sulcus

  • Atrophy around the median sulcus of the tongue, which affects the filiform papillae located in front of the circumvallate papillae (picture )
  • 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 ), also known as central papillary atrophy, which requires no treatment Benign Lesions of the Tongue
    • Ulceration due to sarcoidosis or tuberculosis

Thrush (candidiasis)

  • 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 )

Atrophic glossitis (smooth tongue)

  • The rough structure of the filiform papillae is lost (depapillation), and the tongue becomes smooth (picture ).
  • Erythematous patches may occur on the tongue or on the other mucous surfaces (pictures ).
  • Causes
  • Treatment in accordance with the underlying disease where it has been identified.

Oedema of the foliate papillae

  • 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.

Granulomatous glossitis

  • 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)

Geographic and fissured tongue

  • See Benign Lesions of the Tongue and pictures .
  • Unknown aetiology
  • Does not require treatment.
  • Often associated with psoriasis Psoriasis.
  • Differential diagnosis
    • Allergy, asthma
    • Reiter syndrome
    • Candida infection

Strawberry tongue

  • A typical sign of scarlet fever
  • Fungiform papillae on the tongue surface become erythematous and swollen
  • Diagnosis is based on systemic symptoms.

    References

    • 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]