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].

• Candidiasis

  No patient had disseminated candidiasis. [ncbi.nlm.nih.gov]

  […] and diabetes mellitus ( Eur J Dent 2011;5:367 ) Treatment Usually none Antifungal therapy to reduce clinical erythema of candidiasis Clinical images Images hosted on other servers: Median rhomboid glossitis Diabetic patient Microscopic (histologic) description [pathologyoutlines.com]

  Oral candidiasis 2. Poorly fitting dentures 3. Bacterial infection 4. [epomedicine.com]

  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 [symptoma.com]

  […] as loss of papillae) Broad-spectrum antibiotics Topical or inhaled corticosteroids Various other medications (e.g., captopril, clarithromycin, enalapril, lansoprazole, lithium, metronidazole, NSAIDs) Local Infections (e.g., HSV, Epstein-Barr virus, candidiasis [unboundmedicine.com]

• Burning Pain

  • Burning pain on touching. Cantharis: • Sore, burning and smarting vesicles in mouth. • Fiery red tongue with inflammation of sublingual glands. • Burning pain in mouth,throat and stomach. [drthindhomeopathy.com]

  Sensory dysfunction in burning mouth syndrome. Pain. 2002 Sep. 99(1-2):41-7. [Medline]. Grushka M, Sessle BJ, Howley TP. Psychophysical assessment of tactile, pain and thermal sensory functions in burning mouth syndrome. [emedicine.medscape.com]

• Vomiting

  Treatment Principle Herb Formulas Points Clinical Manifestations High fever or Fever Aversion to Heat Irritability Restlessness (neither activity nor resting brings relief) Heat sensation in the chest Thirst Has urge to vomit but cannot May have dark [americandragon.com]

  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]

   Toxic shock syndrome:This is characterized by fever, drop in blood pressure, vomiting, rashes, red mouth and throat. It is caused by toxins released by certain bacteria.This can quickly assume life threatening proportions. 16. [slideshare.net]

• Nausea

  […] tolerate oral iron or does not take it reliably, if there is continuing blood loss, or in malabsorption. [ 12 ] Side-effects to iron supplementation Common side-effects usually reduce with time and include: Constipation Black stools Diarrhoea Heartburn Nausea [patient.info]

• Xerostomia

  BACKGROUND: The purpose of this study was to clarify the species of Candida that are important for the development of atrophic glossitis in xerostomia patients. [ncbi.nlm.nih.gov]

  […] hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody positivity in atrophic glossitis patients. ( 30087017 ) Chiang CP...Sun A 2018 6 The Candida species that are important for the development of atrophic glossitis in xerostomia [malacards.org]

  Xerostomia Xerostomia is a symptom in up to 64% of patients. Patients may not volunteer symptoms of xerostomia but affirm it on direct questioning. [emedicine.medscape.com]

  […] many causes, usually related to iron-deficiency anemia, pernicious anemia, B vitamin complex deficiencies, [8] unrecognized and untreated celiac disease (which often presents without gastrointestinal symptoms), [9] [10] [11] or other factors such as xerostomia [ipfs.io]

  […] many causes, usually related to iron-deficiency anemia, pernicious anemia, B vitamin complex deficiencies, [10] unrecognized and untreated celiac disease (which often presents without gastrointestinal symptoms), [16] [17] [18] or other factors such as xerostomia [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]

• Erythema

  Candidiasis may be a concurrent finding or an alternative cause of erythema, burning, and atrophy. [ipfs.io]

  Clinical features The characteristic presenting features of denture-related stomatitis are chronic erythema and oedema of the mucosa that contacts the fitting surface of the denture ( Fig. 2 ). [nature.com]

  […] dorsal tongue just anterior to V shaped grouping of circumvallate papillae with loss of papillae or taste buds; associated with candidiasis and diabetes mellitus ( Eur J Dent 2011;5:367 ) Treatment Usually none Antifungal therapy to reduce clinical erythema [pathologyoutlines.com]

  This was first described by Cooke (1955) under the mane of erythema migrans. 12 In the literature several other names are also in use for this condition namely: geographic stomatitis 13,14, stomatitis areata migrans 15, erythema migrans 16 and migratory [ispub.com]

• Flushing

  PC-6, PC-8, ST-6, ST-34, ST-36, ST-43, ST-44, ST-45, UB-21 Clinical Manifestations Ulceration, erosion, and pain of mouth and tongue Thirst with a desire for cold drinks Irritability Irascibility Feeling of Heat and disturbance in the Heart Insomnia Flushed [americandragon.com]

  Nutritional support for healthy lipid levels with a unique, natural non-flush form of niacin. Pyridoxine: Intraoral burning glossitis; mucosal ulcerations and erosions; cheilosis. Pyridoyal-5' Phosphate - 2 tablets daily with food. [ecopolitan.com]

• Burning Sensation

  The latter group was subdivided according to anatomic site of burning sensation: subgroup A (54 patients) with complaints limited to tongue and subgroup B (90 patients) with burning sensations in other parts of oral mucosa. [ncbi.nlm.nih.gov]

  Arunram - • 08 Jul 2016 Verified response Atrophic glossitis or bald tongue from atrophy of filiform papillae symptoms Tongue dryness, Burning sensation or Paresthesias of taste severe tongue pain in advanced cases causes Diabetes Mellitus Folic Acid [dailyrounds.org]

  Clinical features: (1) The tongue is smooth, red and glossy without the usual rough dorsal surface. (2) The tongue is often painful or it may have a burning sensation. (3) Biopsy of the tongue shows atrophy of the papillae. (4) Treatment of the underlying [meducator3.net]

  In this patient population, pain and a burning sensation of the tongue are frequently reported. [symptoma.com]

  The pain and burning sensation are usually confined to the tongue, but may also extend to other parts of the oral mucosa. [whonamedit.com]

• Tingling

  Any B vitamin deficiency, but especially B12, may also lead to burning and tingling of your tongue, according to American Family Physician. [livestrong.com]

  • Piercing and tingling pain in tongue with burning and swelling with inability to swallow. • Face is swollen, red and hot. [drthindhomeopathy.com]

  Patients may not have complaints about the general condition of the body, but some note light tingling on the tip and lateral surfaces of the tongue when they eat spicy or hot foods. [en.medicine-worlds.com]

  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]

  PERNICIOUS ANEMIA  Chronic haematologic disease  Caused by Lack of intrinsic factor used for gastric secretions  Traid of symptoms  1. generalized weakness  2. sore painful tongue  3. tingling of extremities 19. [slideshare.net]

• Paresthesia

  Arunram - • 08 Jul 2016 Verified response Atrophic glossitis or bald tongue from atrophy of filiform papillae symptoms Tongue dryness, Burning sensation or Paresthesias of taste severe tongue pain in advanced cases causes Diabetes Mellitus Folic Acid [dailyrounds.org]

  Paresthesia of the mental nerve stem from periapical infection of mandibular canine tooth: a case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics. May/2008. 105:e28-31. [Medline]. Fischoff DK, Spivakovsky S. [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].

• Polyps

  Amniotic Band Syndrome (35 %) ( Adam Complex, Amniotic Band Sequence, Congenital Constriction Bands, Pseudoainhum,) Dyskeratosis Congenita (35 %) ( Zinsser cole engman Syndrome,) Acrochordon (35 %) ( Cutaneous Papilloma, Cutaneous Tag, Fibroepithelial Polyp [gulfdoctor.net]

  Wisdom tooth impaction Macrodontia Meth mouth Microdontia Odontogenic tumors Keratocystic odontogenic tumour Odontoma Dens in dente Open contact Premature eruption Neonatal teeth Pulp calcification Pulp stone Pulp canal obliteration Pulp necrosis Pulp polyp [ipfs.io]

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.