Glossitis 1

Glossitis
Glossitis
Classification and external resources

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

ICD-10 K14.0

ICD-9 [1]
529.0

DiseasesDB [2]
5252

MedlinePlus [3]
001053

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, (sometimes
specifically termed atrophic glossitis). In a wider sense, glossitis can mean inflammation of the tongue generally.
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.
Glossitis 2

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

Atrophic glossitis
Atrophic glossitis, also known as bald tongue, smooth tongue, Hunter
glossitis, Moeller glossitis, or Möller-Hunter glossitis, is a condition
characterized by a smooth glossy tongue that is often tender/painful,
caused by complete atrophy of the lingual papillae (depapillation). The Median rhomboid glossitis
dorsal tongue surface may be affected totally, or in patches, and may
be associated with a burning sensation, pain and/or erythema. Atrophic
glossitis is a non-specific finding, and has a great many causes, usually
related to various nutritional deficiencies or other factors such as
xerostomia (dry mouth) or anemia. 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. 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, Geographic tongue (benign migratory glossitis)
rhomboidal depapillated lesion in the central area of the dorsum of the
tongue, just in front of the circumvallate papillae. 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

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. 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. The cause is unknown, 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 2 conditions often occur in combination.
Glossitis 3

Geometric glossitis
Geometric glossitis, also termed herpetic geometric glossitis, is a term used by some to refer to a chronic lesion
associated with herpes simplex virus (HSV) type I infection, in which there is a deep fissure in the midline of the
tongue and gives off multiple branches. 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. The name comes from the geometric pattern of the fissures which are longitudinal, crossed
or branched. 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. Treatment is with systemic aciclovir.

Strawberry tongue
Strawberry tongue (also called raspberry tongue), 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),
and red strawberry tongue occurs later, after 4–5 days. Strawberry tongue is also seen in Kawasaki disease (a
common vasculitic disorder often occurring in children under 5), and toxic shock syndrome. It may mimic other
types of glossitis or Vitamin B12 deficiency.

Symptoms
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. Some use the term secondary burning mouth
Patchy depapillation of filiform papillae with
syndrome in cases where a detectable cause, such as glossitis, for an prominence of the fungiform papillae.
oral burning sensation.
Depending upon the underlying cause, there may be additional signs and symptoms such as pallor, oral ulceration
and angular cheilitis.

Causes

Anemias
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,
and cheilosis (swelling of the lips). The appearance of the tongue in iron deficiency anemia has been described as
diffuse or patchy atrophy with tenderness or burning. One cause of iron deficiency anemia is sideropenic dysphagia
Glossitis 4

(Plummer-Vinson or Paterson–Brown–Kelly syndrome) which is also characterized by esophageal webbing and

dysphagia.
Pernicious anemia is usually caused by autoimune 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". There may be linear or patchy red lesions.

Vitamin B deficiencies
Vitamin B1 deficiency (thiamin deficiency) can cause glossitis. Vitamin B2 deficiency (ariboflavinosis) can cause
glossitis, along with angular cheilitis, cheilosis, peripheral neuropathy and other signs and symptoms. The glossitis in
vitamin B2 deficiency is described as magenta. Vitamin B3 deficiency (pellagra) can cause glossitis. Vitamin B6
deficiency (pyridoxine deficiency) can cause glossitis, along with angular cheilitis, cheilosis, peripheral neuropathy
and seborrheic dermatitis. Folate deficiency (vitamin B9 deficiency) can cause glossitis, along with macrocytic
anemia, thrombocytopenia, leukopenia, diarrhea, fatigue and possibly neurological signs. Apart from pernicious
anemia discussed above, any other cause of vitamin B12 deficiency can cause glossitis, which tends to be painful,
smooth and shiny.

Infections
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,
e.g.
erythematous candidiasis (e.g. as may occur in HIV/AIDS) may involve the tongue giving glossitis with
depapillation.
Syphilis is now relatively rare, but the tertiary stage can cause diffuse glossitis and atrophy of lingual papillae,
termed "syphlitic glossitis", "leutic glossitis" or "atrophic glossitis of tertiary syphilis". It is caused by Treponema
pallidum and is a sexually transmitted infection.

Other causes
Many conditions can cause glossitis via malnutrition or malabsorption, which creates the nutritional deficiencies
described above, although other mechanisms may be involved in some of those conditions listed.
• Alcoholism
• Sprue (celiac disease, or tropical sprue), secondary to nutritional deficiencies
• Crohn’s disease
• Whipple disease
• Glucagonoma syndrome
• Cowden disease
• Acquired immunodeficiency syndrome (AIDS)
• Carcinoid syndrome
• Kwashiorkor amyloidosis
• Veganism and other specialized diets,
• 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 Glossitis can be caused by the constant irritation by the ornament and by colonization of Candida
albicans in site and on the ornament
• Exposure to irritants such as tobacco, alcohol, hot foods, or spices
Glossitis 5

• 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)
• Schizophrenia
• A painful tongue may be an indication of several underlying serious medical conditions and nearly always merits
assessment by a physician or dental surgeon

Treatment
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.

Prevention
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.

Epidemiology
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.

References
[1] http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=529. 0
[2] http:/ / www. diseasesdatabase. com/ ddb5252. htm
[3] http:/ / www. nlm. nih. gov/ medlineplus/ ency/ article/ 001053. htm
Article Sources and Contributors 6

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