Atrophic glossitis (AG) is a disorder of the tongue mucosa characterized by atrophy of the filiform papillae (and fungiform according to some authors) on the dorsal surface of the tongue [1] [2] [3] [4]. As a result, ulcer-like lesions on the dorsal and lateral tongue appear, and the term "smooth" or "bald" tongue is used to describe the smooth and glossy red-to-pink mucosa [1] [2] [3]. AG is typically seen in adults and elderly individuals, and the most common causes are nutritional deficiencies, (iron, vitamin B12, folic acid, riboflavin, and niacin) and protein malnutrition [1] [2] [5] [6] [7]. In this patient population, pain and a burning sensation of the tongue are frequently reported [4]. In addition to nutritional deficiencies, a number of diseases have been confirmed as possible causes of AG, including amyloidosis, Sjögren syndrome, sarcoidosis, infections (candidiasis, syphilis), bullous dermatoses (pemphigus, bullous pemphigoid), alcohol abuse, exposure to chemical irritants and numerous drugs [1] [2] [3] [5]. Celiac disease, however, a gluten-sensitive enteropathy, is one of the more important causes of AG, in which case chronic diarrhea, vomiting, weight loss, and growth impairment accompany the changes seen on the tongue [2]. Conversely, anemia is a frequent finding in AG due to iron (sideropenic) or vitamin B12 deficiencies (pernicious anemia). Thus symptoms of weakness and fatigue may be present as well [1] [4].

• Anemia

  Of 69 anemia AG+/RAS patients, 30 (43.5%) had normocytic anemia and 23 (33.3%) had iron deficiency anemia. Of 38 anemia AG-/RAS patients, 26 (68.4%) had normocytic anemia and 5 (13.2%) had iron deficiency anemia. [ncbi.nlm.nih.gov]

  This condition occurs during a vitamin B deficiency, such as in pellagra, and certain disorders like pernicious anemia. Causes 1. Anemia Folic Acid deficiency Anemia Vitamin B12 Deficiency Anemia Iron Deficiency Anemia 2. [doctorsgates.blogspot.com]

  Conversely, anemia is a frequent finding in AG due to iron (sideropenic) or vitamin B12 deficiencies (pernicious anemia). Thus symptoms of weakness and fatigue may be present as well. [symptoma.com]

  pernicious anemia, and pellagra, a disorder of skin and mucous membranes due to niacin deficiency. [britannica.com]

  Pallor : paleness of the skin and even the conjunctiva (mucous membrane that lines the eyelids) can be seen in anemia (including in iron deficiency anemia). [stepwards.com]

• Dentist

  Treatment or Self-Care for Geographic Tongue Seeing a dentist or doctor is the best way to rule out a more serious problem. [webmd.com]

  Treatment Options A trip to your dentist is the best place to start if you suspect you have anemia tongue. During an exam, your dentist will look for blisters, a lack of papillae and any signs of inflammation on your tongue. [colgate.com]

  Accuracy of entries is verified by an expert review board including dentists and dental hygienists. Colored thumb bleeds make it easy to locate definitions quickly. [books.google.com]

  General symptoms include: pain or tenderness in the tongue swelling of the tongue change in the color of your tongue an inability to speak, eat, or swallow loss of papillae on the surface of your tongue You may see your dentist or doctor for an assessment [healthline.com]

  Dentists mostly say it’s from fluoride, that the mother took tetracycline, or that there was an illness early on ↑ Giuca MR, Cei G, Gigli F, Gandini P (2010). "Oral signs in the diagnosis of celiac disease: review of the literature". [ipfs.io]

• Sputum

  0.0 % 60+: 100 % Top co-used drugs for these people *: Vitamin B6: 1 person, 100.00% Symbicort: 1 person, 100.00% Erivedge: 1 person, 100.00% Amlodipine: 1 person, 100.00% Acetaminophen: 1 person, 100.00% Top other side effects for these people *: Sputum [ehealthme.com]

• Pleural Disorder

  It is often used in muscle spasms. ( latest outcomes from Baclofen 63,904 users ) Atrophic glossitis Atrophic glossitis (smooth tongue) has been reported by people with basal cell carcinoma, osteoporosis, pleural disorder, vitamin b12 deficiency, asthma [ehealthme.com]

• Diarrhea

  To the Editor: Diagnosing celiac disease is relatively easy in typical cases, characterized by the classic features of chronic diarrhea, abdominal pain and distention, and weight loss. [nejm.org]

  Celiac disease, however, a gluten-sensitive enteropathy, is one of the more important causes of AG, in which case chronic diarrhea, vomiting, weight loss, and growth impairment accompany the changes seen on the tongue. [symptoma.com]

  […] deficiency) can cause glossitis, along with angular cheilitis, cheilosis, peripheral neuropathy and seborrheic dermatitis. [25] Folate deficiency (vitamin B9 deficiency) can cause glossitis, along with macrocytic anemia, thrombocytopenia, leukopenia, diarrhea [ipfs.io]

  […] deficiency) can cause glossitis, along with angular cheilitis, cheilosis, peripheral neuropathy and seborrheic dermatitis. [7] Folate deficiency (vitamin B9 deficiency) can cause glossitis, along with macrocytic anemia, thrombocytopenia, leukopenia, diarrhea [en.wikipedia.org]

• Lesion of the Tongue

  Glossitis Symptoms Symptoms and signs of glossitis can include: Mouth pain or burning that affects entire mouth Oral lesions Mouth ulcer Tongue pain or tingling sensation Redness of the tongue Swelling of the tongue Hairy tongue – caused by taste buds [healthool.com]

  The lesions often heal in one area and then migrate to a different part of the tongue. This tongue ailment often arises due to a yeast infection. Contact of the tongue with certain kinds of food can also lead to this condition. [naijafoodtherapy.com]

  Further histological findings and the parallel improvement of psoriatic skin lesion and tongue lesion with systemic retinoid treatment supports this hypothesis. [ispub.com]

  Unlike glossitis due to nutritional deficiencies and anemia, the lesions of geographic tongue move around the tongue over time. [12] This is because in geographic tongue, new areas of the tongue become involved with the condition whilst previously affected [ipfs.io]

  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 [en.wikipedia.org]

• Sore Mouth

  Sore tongue and sore mouth: systemic diseases that may cause sore tongue and sore mouth. In: MacBryde CM, Blacklow RS, eds. Signs and symptoms, applied pathologic physiology and clinical interpretation, 5th ed. Philadelphia: J. B. [link.springer.com]

• Tongue Atrophy

  […] finding), bald tongue, hunter's glossitis, smooth tongue, atrophy of the tongue papillae, tongue atrophy papillae, atrophy of the tongue papillae (diagnosis), Tongue papillary atrophy NOS (disorder), Atrophic glossitis (disorder), Moeller's glossitis [fpnotebook.com]

  Cleansing the tongue at least twice a day. Diamond Glossite The chronic inflammatory process, in which the nipples of the tongue atrophy, is called rhomboid glossitis. [en.medicine-worlds.com]

• Dysgeusia

  […] speaking Difficulty swallowing Pain and/or burning of the tongue Loss of taste sensation (partial or complete) – inflammation may also disrupt the taste sensation leading to the perception of a bad taste in the mouth (cacogeusia) and other taste disorders (dysgeusia [healthhype.com]

  Dysgeusia Dysgeusia is present in up to 70% of cases and may take the form either of a persistent taste in the mouth or altered perception of tastes. Dysgeusic tastes may be bitter, metallic, or mixed. [emedicine.medscape.com]

• Toothache

  Manifestations Burning Heat and pain in the epigastrium Irritating thirst: drinks copious fluids and prefers cold drinks Excessive appetite: hungry again quickly after eating (as if food vanishes) Swelling, pain, ulceration and bleeding of gums Foul breath Toothache [americandragon.com]

• Muscle Spasm

  It is often used in muscle spasms. ( latest outcomes from Baclofen 63,904 users ) Atrophic glossitis Atrophic glossitis (smooth tongue) has been reported by people with basal cell carcinoma, osteoporosis, pleural disorder, vitamin b12 deficiency, asthma [ehealthme.com]

• Facial Pain

  J Oral Facial Pain Headache. 2017 Summer. 31 (3):257-63. [Medline]. Petruzzi M, Lauritano D, De Benedittis M, et al. Systemic capsaicin for burning mouth syndrome: short-term results of a pilot study. J Oral Pathol Med. 2004 Feb. 33(2):111-4. [emedicine.medscape.com]

The diagnosis of atrophic glossitis mandates a thorough clinical and laboratory workup in order to identify the underlying cause, as the list of diseases that can induce atrophic changes is quite long [1]. The distinct red-to-pink and smooth appearance of the tongue and the presence of erythematous and sharply defined ulcer-like lesions should be easily recognized during the physical examination, suggesting that the role of a proper exam is perhaps crucial in making the initial diagnosis. In addition, a comprehensive history taking is equally important, as it may identify additional complaints, assess if preexisting disorders might cause tongue-related symptoms, determine whether proper dietary intake of nutrients is normal (as malnutrition is a common etiology, especially among the elderly), and exclude alcohol abuse [6]. Once the clinical diagnosis of AG is made, the physician should order a full laboratory workup comprising of a complete blood count (CBC) that often reveals anemia, serum levels of iron, ferritin and total iron binding capacity (TIBC), folic acid, several B group vitamins, gastric parietal cell antibodies, and also homocysteine levels, which could also contribute to atrophy of the tongue [3] [7]. If there is a suspicion of celiac disease then, IgA-endomysial, tissue transglutaminase, and antigliadin antibodies should be tested [3].

Systemic Implications and Complications None Treatment Options Median rhomboid glossitis is a benign condition so no treatment is necessary. [dermatologyadvisor.com]

Full-color photomicrographs help you identify pathologic elements and provide correct diagnoses and treatment plans. Boxes and tables offer clear, at-a-glance information on the clinical features, diagnosis, and treatment for many conditions. [books.google.com]

The blood homocysteine and hematinic levels at baseline and after treatment till all oral symptoms had disappeared were measured and compared by paired t-test. [ncbi.nlm.nih.gov]

Treatment  No treatment is required  Gentle tongue scrapping and removal of etiology  Surgical removal of papillae- laser, electrodesication Filiform papillae attains 15 mm length 9. [slideshare.net]

Prognosis of Glossitis The condition responds well to medicines. Complications of Glossitis • Severe inflammation of tongue causes breathing troubles by blocking airways. • Difficulties with speaking, chewing or swallowing. [drthindhomeopathy.com]

Prognosis Erythroplasia has areas of dysplasia, carcinoma in situ, or invasive carcinoma in most cases. [nature.com]

The ambiguous definition of burning mouth syndrome (BMS) makes evaluation of prognosis and treatment difficult. Anatomy and Physiology The oral cavity is comprised of mucosa, glands, muscle, teeth and sensory receptors. [emedicine.medscape.com]

The term "smooth tongue" is used to illustrate its appearance, and pain, as well as several other features, may be present depending on the etiology. [symptoma.com]

Etiology The etiology of median rhomboid glossitis is unknown. It is most often hypothesized to be a congenital anomaly or a chronic, localized candida infection. [dermatologyadvisor.com]

Glossodynia, or painful sensation of the tongue, can have a spectrum of etiologies, such as local infection, trauma, nerve damage, glossitis, or the enigmatic neuropathic pain syndrome, burning mouth disorder (BMD; also known as burning mouth syndrome [ncbi.nlm.nih.gov]

Expanded sections on etiology, treatment, and diagnosis of oral cancer (HPV) describe how subtypes can play an important role in the development and natural history of some head and neck cancers, most notably those arising in the oropharynx. [books.google.com]

Review Benign migratory glossitis or geographic tongue is common benign disorder of unknown etiology. [ispub.com]

[…] general Inflammation or beefy red tongue associated with deficiency states Due to atrophy of tongue papillae, thinning of mucosa and exposure of underlying vasculature Terminology Also called central papillary atrophy, posterior lingual papillary atrophy Epidemiology [pathologyoutlines.com]

D. (2002) Taxonomy and epidemiology of spinal cord injury pain. In: Yezierski, R.P. and Burchiel, K. (eds.) [shiga-med.ac.jp]

(AG) or Hunter glossitis or smooth tongue Benign migratory glossitis (BMG) or geographic tongue (GT) or erythema migrans or annulus migrans Median rhomboid glossitis (MRG) Herpetic geometric glossitis (HGG) System(s) affected: gastrointestinal (GI) Epidemiology [unboundmedicine.com]

"[Incidence of tongue diseases based on epidemiologic studies (review of the literature)].". Fogorvosi szemle. 85 (11): 335–41. PMID 1291323. [ipfs.io]

"[Incidence of tongue diseases based on epidemiologic studies (review of the literature)]". Fogorv Sz (in Hungarian). 85 (11): 335–41. PMID 1291323. [en.wikipedia.org]

Pathophysiology The filiform papillae anterior to the cicumvate papillae are almost exclusively involved. Systemic Implications and Complications None Treatment Options Median rhomboid glossitis is a benign condition so no treatment is necessary. [dermatologyadvisor.com]

Prevalence Varies; usual reported range: 1–14%; higher with nutritional deficiencies Etiology and Pathophysiology Systemic Nutritional deficiencies (e.g., vitamin B 12, folic acid, ascorbic acid ) Anemia (pernicious, iron deficiency) HIV (opportunistic [unboundmedicine.com]

Pathophysiology The pathophysiology of burning mouth syndrome (BMS) is not understood. It was originally considered a psychogenic illness; however, a neuropathic mechanism for burning mouth syndrome (BMS) is currently favored. [emedicine.medscape.com]

Psoriasis: pathophysiology and oral manifestations. Oral Dis 1996; 2:135-44. 23. Zargari O. The prevalence and significance of fissured tongue and geographical tongue in psoriatic patients. Clin Dermatol 2006; 31:192-5. 24. [ispub.com]

Psoriasis: pathophysiology and oral manifestations. Oral Dis 1996; 2(2): 135-44. [ http://dx.doi.org/10.1111/j.1601-0825.1996.tb00214.x ] [PMID: 8957926 ] [107] Fortuna G, Lozada-Nur F, Pollio A, et al. [benthamopen.com]

WAS THERE A WAY TO PREVENT IT? Eating a well balanced diet that has plenty of iron in it (meat!) or supplementing a vegetarian/vegan diet with oral iron therapy can help prevent dietary causes of iron deficiency anemia. [stepwards.com]

It can also be prevented by drinking lots of water so as to produce sufficient amounts of saliva which shall prevent the growth of bacteria in the mouth. [primehealthchannel.com]

Practicing proper oral hygiene may also help reduce or prevent problems. Speak with your doctor if your symptoms don’t improve with treatment or continue to occur. [healthline.com]

Prevention Tips Proper diet and nutrition Avoid irritants such as cigarette smoking and acidic or spicy foods Maintain good oral hygiene Watch Out Severe tongue swelling that blocks the airway and interferes with breathing. [mtatva.com]

Expanded section on bisphosphonate-related osteonecrosis of the jaws helps you effectively manage patients taking bisphosphonates to prevent bone loss, including information on oral complications, risk factors, and benefits. [books.google.com]

1. Reamy BV, Derby R, Bunt CW. Common tongue conditions in primary care. Am Fam Physician. 2010;81(5):627-634.
2. Erriu M, Canargiu F, Orrù G, Garau V, Montaldo C. Idiopathic atrophic glossitis as the only clinical sign for celiac disease diagnosis: a case report. J Med Case Rep. 2012;6:185.
3. Erriu M, Pili FMG, Cadoni S, Garau V. Diagnosis of Lingual Atrophic Conditions: Associations with Local and Systemic Factors. A Descriptive Review. Open Dent J. 2016;10:619-635.
4. Ristow Montes G, Duarte Vilella K, Veiga Bonotto D, Compagnoni Martins M, Soares de Lima AA. Atrophic glossitis as a clinical signs of severe anemia – Report of two cases. Polski Przegląd Otorynolaryngologiczny. 2014;3(4):201-204.
5. Gómez-Moyano E, Martínez-Pilar L, Pérez-Belmonte LM, Godoy-Díaz DJ. Erythema and atrophy on the tongue. Cleve Clin J Med. 2014;81(9):523-524.
6. Daley TD, Armstrong JE. Oral manifestations of gastrointestinal diseases. Can J Gastroenterol. 2007;21(4):241-244.
7. Sun A, Lin HP, Wang YP, Chiang CP. Significant association of deficiency of hemoglobin, iron and vitamin B12, high homocysteine level, and gastric parietal cell antibody positivity with atrophic glossitis. J Oral Pathol Med. 2012;41(6):500-504.