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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 1)
  • 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 2 3), 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 4 5 6)

Atrophic glossitis (smooth tongue)

  • The rough structure of the filiform papillae is lost (depapillation), and the tongue becomes smooth (picture 7).
  • Erythematous patches may occur on the tongue or on the other mucous surfaces (pictures 8 9).
  • 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.

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 4 5 10.
  • 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.