Glossitis

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Glossitis

Glossitis in a person with scarlet fever ("red strawberry

tongue").

Classification and external resources

Specialty gastroenterology

ICD-10 K14.0

ICD-9-CM 529.0

DiseasesDB 5252
 MedlinePlus 001053

[edit on Wikidata]

Glossitis can mean soreness of the tongue, or more usually inflammation with depapillation of
the dorsal surface of the tongue (loss of the lingual papillae), leaving a smooth and erythematous
(reddened) surface,[1][2] (sometimes specifically termed atrophic glossitis). In a wider sense,
glossitis can mean inflammation of the tongue generally.[3] Glossitis is often caused by nutritional
deficiencies and may be painless or cause discomfort. Glossitis usually responds well to
treatment if the cause is identified and corrected. Tongue soreness caused by glossitis is
differentiated from burning mouth syndrome, where there is no identifiable change in the
appearance of the tongue, and there are no identifiable causes.[4]

Contents
[hide]

 1 Symptoms
 2 Causes
o 2.1 Anemias
o 2.2 Vitamin B deficiencies
o 2.3 Infections
o 2.4 Other causes
 3 Diagnosis
o 3.1 Classification
 3.1.1 Atrophic glossitis
 3.1.2 Median rhomboid glossitis
 3.1.3 Benign migratory glossitis
 3.1.4 Geometric glossitis
 3.1.5 Strawberry tongue
 4 Prevention
 5 Treatment
 6 Epidemiology
 7 References

Symptoms[edit]
Patchy depapillation of filiform papillae with prominence of the fungiform papillae.

Depending upon what exact meaning of the word glossitis is implied, signs and symptoms might
include:

 Smooth, shiny appearance of the tongue, caused by loss of lingual papillae.

 Tongue color changes, usually to a darker red color than the normal white-pink color of a
healthy tongue.
 Tongue swelling.
 Difficulty with chewing, swallowing, or speaking (either because of tongue soreness of
tongue swelling).
 Burning sensation.[1] Some use the term secondary burning mouth syndrome in cases
where a detectable cause, such as glossitis, for an oral burning sensation.[4]

Depending upon the underlying cause, there may be additional signs and symptoms such as
pallor, oral ulceration and angular cheilitis.[1]

Causes[edit]
Anemias[edit]

Iron-deficiency anemia is mainly caused by blood loss, such as may occur during menses or
gastrointestinal hemorrhage. This often results in a depapilled, atrophic glossitis, giving the
tongue a bald and shiny appearance, along with pallor (paleness) of the lips and other mucous
membranes a tendency towards recurrent oral ulceration,[5] and cheilosis (swelling of the lips).[6]
The appearance of the tongue in iron deficiency anemia has been described as diffuse or patchy
atrophy with tenderness or burning.[7] One cause of iron deficiency anemia is sideropenic
dysphagia (Plummer–Vinson or Paterson–Brown–Kelly syndrome) which is also characterized
by esophageal webbing and dysphagia.[5]

Pernicious anemia is usually caused by autoimmune destruction of gastric parietal cells. Parietal
cells secrete intrinsic factor which is required for the absorption of vitamin B12. Vitamin B12
deficiency results in megaloblastic anemia and may present as glossitis. The appearance of the
tongue in vitamin B12 deficiency is described as "beefy" or "fiery red and sore".[5] There may be
linear or patchy red lesions.[1]
Vitamin B deficiencies[edit]

Vitamin B1 deficiency (thiamin deficiency) can cause glossitis.[6] Vitamin B2 deficiency

(ariboflavinosis) can cause glossitis, along with angular cheilitis, cheilosis, peripheral neuropathy
and other signs and symptoms.[6] The glossitis in vitamin B2 deficiency is described as magenta.[8]
Vitamin B3 deficiency (pellagra) can cause glossitis.[6] Vitamin B6 deficiency (pyridoxine
deficiency) can cause glossitis, along with angular cheilitis, cheilosis, peripheral neuropathy and
seborrheic dermatitis.[6] Folate deficiency (vitamin B9 deficiency) can cause glossitis, along with
macrocytic anemia, thrombocytopenia, leukopenia, diarrhea, fatigue and possibly neurological
signs.[6] Apart from pernicious anemia discussed above, any other cause of vitamin B12
deficiency can cause glossitis, which tends to be painful, smooth and shiny.[6]

Infections[edit]

Bacterial, viral or fungal infections can cause glossitis. Candida species are involved in median
rhomboid glossitis. Candida species also may be involved in creating a more generalized
glossitis with erythema, burning, and atrophy,[9] [clarify]

e.g. erythematous candidiasis (e.g. as may occur in HIV/AIDS) may involve the tongue giving
glossitis with depapillation.[1] [clarify]

Syphilis is now relatively rare, but the tertiary stage can cause diffuse glossitis and atrophy of
lingual papillae, termed "syphilitic glossitis",[1] "luetic glossitis" or "atrophic glossitis of tertiary
syphilis".[7] It is caused by Treponema pallidum and is a sexually transmitted infection.

Other causes[edit]

Many conditions can cause glossitis via malnutrition or malabsorption,[6] which creates the
nutritional deficiencies described above, although other mechanisms may be involved in some of
those conditions listed.

 Alcoholism[6]
 Sprue (celiac disease,[10] or tropical sprue), secondary to nutritional deficiencies[6]
 Crohn’s disease[6]
 Whipple disease[6]
 Glucagonoma syndrome[6]
 Cowden disease[6]
 Acquired immunodeficiency syndrome (AIDS)[6]
 Carcinoid syndrome[6]
 Kwashiorkor amyloidosis[6]
 Veganism and other specialized diets,[1]
 Poor hydration and low saliva in the mouth, which allows bacteria to grow more readily
 Mechanical irritation or injury from burns, rough edges of teeth or dental appliances, or
other trauma
 Tongue piercing[11] Glossitis can be caused by the constant irritation by the ornament and
by colonization of Candida albicans in site and on the ornament[12]
  Exposure to irritants such as tobacco, alcohol, hot foods, or spices
 Allergic reaction to toothpaste, mouthwash, breath fresheners, dyes in confectionery,
plastic in dentures or retainers, or certain blood-pressure medications (ACE inhibitors)
 Administration of ganglion blockers (e.g., Tubocurarine, Mecamylamine).
 Oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris
 Heredity
 Albuterol (bronchodilator medicine)

A painful tongue may be an indication of an underlying serious medical condition and nearly
always merits assessment by a physician or dental surgeon.

Diagnosis[edit]
Classification[edit]

Median rhomboid glossitis

Geographic tongue (benign migratory glossitis)

Glossitis could be classified as a group of tongue diseases or gastrointestinal diseases.[3] It may be
primary, where there is no underlying cause, or secondary where it is a sign or symptom of
another condition.[2] It can be acute or chronic.[3] Generally speaking, there are several clinical
patterns of glossitis, some more common than others.

Atrophic glossitis[edit]

Atrophic glossitis, also known as bald tongue,[2] smooth tongue, Hunter glossitis, Moeller
glossitis, or Möller-Hunter glossitis,[13] is a condition characterized by a smooth glossy tongue
that is often tender/painful,[14] caused by complete atrophy of the lingual papillae
(depapillation).[2] The dorsal tongue surface may be affected totally, or in patches, and may be
associated with a burning sensation, pain and/or erythema.[9] Atrophic glossitis is a non-specific
finding,[9] and has a great many causes, usually related to iron-deficiency anemia, pernicious
anemia, B vitamin complex deficiencies,[15] unrecognized and untreated celiac disease (which
often presents without gastrointestinal symptoms),[16][17][18] or other factors such as xerostomia (dry
mouth). Although the terms Möller and Hunter glossitis were originally used to refer to
specifically the glossitis that occurs in vitamin B12 deficiency secondary to pernicious anemia,
they are now used as synonyms for atrophic glossitis generally.[13] In this article, the term
glossitis, unless otherwise specified, refers to atrophic glossitis.

Candidiasis may be a concurrent finding or an alternative cause of erythema, burning, and

atrophy.

Median rhomboid glossitis[edit]

Main article: Median rhomboid glossitis

This condition is characterized by a persistent erythematous, rhomboidal depapillated lesion in

the central area of the dorsum of the tongue, just in front of the circumvallate papillae.[1][14]
Median rhomboid glossitis is a type of oral candidiasis, and rarely causes any symptoms. It is
treated with antifungal medication. Predisposing factors include use of corticosteroid sprays or
inhalers or immunosuppression.

Benign migratory glossitis[edit]

Main article: Geographic tongue

Geographic tongue, also termed benign migratory glossitis, is a common condition which usually
affects the dorsal surface of the tongue. It is characterized by patches of depapillation and
erythema bordered by a whitish peripheral zone. These patches give the tongue the appearance of
a map, hence the name. Unlike glossitis due to nutritional deficiencies and anemia, the lesions of
geographic tongue move around the tongue over time.[19] This is because in geographic tongue,
new areas of the tongue become involved with the condition whilst previously affected areas
heal, giving the appearance of a moving lesion.[2] The cause is unknown,[20] and there is no
curative treatment. Rarely are there any symptoms associated with the lesions, but occasionally a
burning sensation may be present, which is exacerbated by eating hot, spicy or acidic foodstuffs.
Some consider geographic tongue to be an early stage of fissured tongue, since the two
conditions often occur in combination.[21]

Geometric glossitis[edit]

Geometric glossitis, also termed herpetic geometric glossitis,[3] is a term used by some to refer to
a chronic lesion associated with herpes simplex virus (HSV) type I infection,[22] in which there is
a deep fissure in the midline of the tongue, which gives off multiple branches.[7] The lesion is
usually very painful, and there may be erosions present in the depths of the fissures. Similar
fissured lesions which are not associated with HSV, as may occur in fissured tongue, do not tend
to be painful.[22] The name comes from the geometric pattern of the fissures which are
longitudinal, crossed or branched.[23] It is described as occurring in immunocompromized
persons, e.g. who have leukemia. However, the association between herpes simplex and
geometric glossitis is disputed by some due to a lack of gold standard techniques for diagnosis of
intraoral herpetic lesions, and the high prevalence of asymptomatic viral shedding in
immunocompromized individuals.[7] Treatment is with systemic aciclovir.[22]

Strawberry tongue[edit]

Strawberry tongue (also called raspberry tongue),[24] refers to glossitis which manifests with
hyperplastic (enlarged) fungiform papillae, giving the appearance of a strawberry. White
strawberry tongue is where there is a white coating on the tongue through which the hyperplastic
fungiform papillae protrude. Red strawberry tongue is where the white coating is lost and a dark
red, erythematous surface is revealed, interspaced with the hyperplastic fungiform papillae.
White strawberry tongue is seen in early scarlet fever (a systemic infection of group A β-
hemolytic streptococci),[25] and red strawberry tongue occurs later, after 4–5 days.[7] Strawberry
tongue is also seen in Kawasaki disease (a vasculitic disorder primarily occurring in children
under 5),[26][27] and toxic shock syndrome.[28] It may mimic other types of glossitis or Vitamin B12
deficiency.[29]

Prevention[edit]
Good oral hygiene (thorough tooth brushing and flossing and regular professional cleaning and
examination) may be helpful to prevent these disorders. Drinking plenty of water and the
production of enough saliva, aid in the reduction of bacterial growth. Minimizing irritants or
injury in the mouth when possible can aid in the prevention of glossitis. Avoiding excessive use
of any food or substance that irritates the mouth or tongue may also help.

Treatment[edit]
The goal of treatment is to reduce inflammation. Treatment usually does not require
hospitalization unless tongue swelling is severe. Good oral hygiene is necessary, including
thorough tooth brushing at least twice a day, and flossing at least daily. Corticosteroids such as
prednisone may be given to reduce the inflammation of glossitis. For mild cases, topical
applications (such as a prednisone mouth rinse that is not swallowed) may be recommended to
avoid the side effects of swallowed or injected corticosteroids. Antibiotics, antifungal
medications, or other antimicrobials may be prescribed if the cause of glossitis is an infection.
Anemia and nutritional deficiencies (such as a deficiency in niacin, riboflavin, iron, or Vitamin
E) must be treated, often by dietary changes or other supplements. Avoid irritants (such as hot or
spicy foods, alcohol, and tobacco) to minimize the discomfort. In some cases, tongue swelling
may threaten the airway, a medical emergency that needs immediate attention.

Epidemiology[edit]
One review reported overall prevalence ranges of 0.1–14.3% for geographic tongue, 1.3–9.0%
for "atrophy tongue" (atrophic glossitis), and 0.0–3.35% for median rhomboid glossitis.[30]

References[edit]
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