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 Fungal Infections of the Mouth
• 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
  • Iron deficiency anaemia Iron Deficiency Anaemia
  • Megaloblastic anaemia Megaloblastic Anaemia
  • Deficiency of vitamin B₁₂
  • Sjögren's syndrome Primary Sjögren's Syndrome, dry mouth Dryness of the Mouth
  • Eating disorders
• 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.

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.

Pictures