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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 bynutritional deficiencies

and may be painless or cause discomfort. Glossitis usually responds

well to treatment if the cause is identified and corrected. Tongue

the tongue, and there are no identifiable causes. [4]



Causes Anemias Vitamin B deficiencies Infections Other causes

Diagnosis Classification Atrophic glossitis Median rhomboid glossitis Benign migratory glossitis Geometric glossitis Strawberry tongue





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Glossitis Glossitis in a person with scarlet fever ("red strawberry tongue"). Specialty Gastroenterology
Glossitis in a person with scarlet fever ("red
strawberry tongue").

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.word glossitis is implied, signs and symptoms might include: Tongue color changes, usually to a darker

Tongue color changes, usually to a darker red color than the normal white-pink color of a healthy tongue.of the tongue, caused by loss of lingual papillae. Tongue swelling. Difficulty with chewing, swallowing ,

Tongue swelling.color than the normal white-pink color of a healthy tongue. Difficulty with chewing, swallowing , or

Difficulty with chewing,swallowing , or speaking (either because of tongue soreness of tongue swelling). 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 [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]


Patchy depapillation of filiform papillae with prominence of the fungiform papillae.
Patchy depapillation of filiform
papillae with prominence of the
fungiform papillae.


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)

iron deficiency anemia has been described as diffuse or patchy atrophy with

dysphagia. [5]

Pernicious anemiais 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 anemiaand 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

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]


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]

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

Syphilis is now relatively rare, but the tertiary stage can cause diffuse glossitis and atrophy of lingual papillae, termed "syphilitic

Other causes

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.

Sprue (celiac disease , [ 1 0 ] or tropical sprue) , secondary to nutritional Sprue (celiac disease, [10] or tropical sprue), secondary to nutritional deficiencies [6]

Glucagonoma syndrome [ 6 ] Glucagonoma syndrome [6]

Kwashiorkor amyloidosis [ 6 ] [6]

Poor hydration and lowsaliva in the mouth, which allows bacteria to grow more readily 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 traumain the mouth, which allows bacteria to grow more readily Tongue piercing [ 1 1 ]

Tongue piercing [ 1 1 ] Glossitis can be caused by the constant irritation by Tongue piercing [11] Glossitis can be caused by the constant irritation by the ornament and by colonization of Candida albicansin site and on the ornament [12]

Exposure to irritants such as tobacco , alcohol , hot foods, or spices stobacco, alcohol, hot foods, or spices

Allergic reaction totoothpaste , mouthwash , breath fresheners, dyes in confectionery, plastic in dentures or retainers, toothpaste, mouthwash, breath fresheners, dyes in confectionery, plastic in dentures or retainers,

or certain blood-pressure medications ACE(

Administration ofganglion blockers (e.g., Tubocurarine , Mecamylamine) . ganglion blockers(e.g., Tubocurarine, Mecamylamine).

Hereditymultiforme , aphthous ulcer , pemphigus vulgaris Albuterol (bronchodilator medicine) A painful tongue may

Albuterol (bronchodilator medicine) Albuterol (bronchodilator medicine)

A painful tongue may be an indication of an underlying serious medical condition and nearly always merits assessment by a



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.

Median rhomboid glossitis
Median rhomboid glossitis





Atrophic glossitis

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

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

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,




Geographic tongue (benign migratory glossitis)
Geographic tongue (benign migratory





symptoms. It










Benign migratory glossitis

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

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 systemicaciclovir. [22]

Strawberry tongue

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 ofgroup A β- hemolytic streptococci), [25] and red strawberry tongue occurs later, after 4–5 days. [7]


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.voidingA excessive use of any food or

substance that irritates the mouth or tongue may also help.


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.


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]



Scully, Crispian (2008).Oral and maxillofacial medicine : the basis of diagnosis and treatment(2nd ed.). Edinburgh:

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Rogers, K (editor) (2010).The digestive system(1st ed.). New York, NY: Britannica Educational Pub., in association with Rosen Educational Services. p. 146.ISBN 978-1615301317.



McMillan, Roddy; Forssell, Heli; Buchanan, John Ag; Glenny, Anne-Marie; Weldon, Jo C.; Zakrzewska, Joanna M. (2016). "Interventions for treating burning mouth syndrome".The Cochrane Database of Systematic Reviews. 11:



Tadataka Yamada, David H. Alpers, et al., eds. (2009).Textbook of gastroenterology(5th ed.). Chichester, West Sussex: Blackwell Pub. pp. 1717–1744.ISBN 978-1-4051-6911-0.


Neville BW, Damm DD, Allen CA, Bouquot JE(2002). Oral & maxillofacial pathology(2nd ed.). Philadelphia: W.B. Saunders. pp. 169, 170.ISBN 0721690033.



Chi, AC; Neville, BW; Krayer, JW; Gonsalves, WC (Dec 1, 2010). "Oral manifestations of systemic disease". American Family Physician. 82 (11): 1381–88. PMID 21121523 (https://www.ncbi.nlm.nih.gov/pubmed/21121523).



Levin Liran, Zadik Yehuda; Zadik (October 2007). "Oral Piercing: Complications and Side Effects". Am J Dent. 20 (5):


Zadik Yehuda, Burnstein Saar, Derazne Estella, Sandler Vadim, Ianculovici Clariel, Halperin Tamar; Burnstein; Derazne; Sandler; Ianculovici; Halperin (March 2010). "Colonization of Candida: prevalence among tongue-pierced and non-pierced immunocompetent adults".Oral Dis. 16 (2): 172–5. doi:10.1111/j.1601-0825.2009.01618.x(https://d oi.org/10.1111%2Fj.1601-0825.2009.01618.x). PMID 19732353 (https://www.ncbi.nlm.nih.gov/pubmed/19732353).


O. Braun-Falco (2000).Dermatology (2nd ed.). Berlin [u.a.]: Springer. p. 1173. ISBN 3540594523.

14. James, William D.; Berger, Timothy G.; et al. (2006).Andrews' Diseases of the Skin: Clinical Dermatology(14th ed.). Saunders Elsevier. p. 803. ISBN 0721629210.

17. "Dental Enamel Defects and Celiac Disease"(http://celiac.nih.gov/PDF/Dental_Enamel_Defects_508.pdf)(PDF). National Institute of Health (NIH). Retrieved Mar 7, 2016. "Tooth defects that result from celiac diseasemay resemble those caused by too much fluoride or a maternal or early childhood illness. Dentists mostly saysit’from fluoride, that the mother took tetracycline, or that there was an illness early on"

18. Giuca MR, Cei G, Gigli F, Gandini P (2010). "Oral signs in the diagnosis of celiac disease: review of the literature". Minerva Stomatol(Review). 59 (1-2): 33–43. PMID 20212408 (https://www.ncbi.nlm.nih.gov/pubmed/20212408). "There are enough evidence making the correlation between CD and oral defects scientifically sustainable. This recognition should lead dentists to play more significant roles in screening for CD, as otherwise, if not properly diagnosed and not treated with a gluten-free diet, may eventually cause some malignancies."

24. [editor, Scott Stocking, associate editor, Jyothimai Gubili] (2004).Mosby's dental dictionary. St. Louis, Mo.: Mosby. ISBN 978-0323025102.

26. Singh, S; Kansra, S (Jan–Feb 2005). "Kawasaki disease".The National Medical Journal of India. 18 (1): 20–24. PMID 15835487 (https://www.ncbi.nlm.nih.gov/pubmed/15835487).

28. Baehler EA, Dillon WP, Cumbo TJ, Lee RV; Dillon; Cumbo; Lee (August 1982). "Prolonged use of a diaphragm and toxic shock syndrome".Fertil. Steril. 38 (2): 248–50. PMID 7106318

30. Dombi, C; Czeglédy, A (November 1992). "[Incidence of tongue diseases based on epidemiologic studies (review of the literature)]". Fogorvosi szemle. 85 (11): 335–41. PMID 1291323

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This page was last edited on 22 May 2018, at 18:44(UTC).