Common signs and symptoms of glossitis are:

• Erythematous, swollen tongue
• Tender tongue
• Pale or patchy white tongue 
• Burning sensation [8]
• Dysphagia
• Odynophagia 
• Difficulty in mastication 
• Abnormally smooth surface of tongue
• Difficulty in speaking 

• Pain

  The patient's tongue pain resolved within 2 days, and all his lingual lesions had healed after 12 days of therapy; a post-treatment viral culture of the tongue was negative. [nejm.org]

  Are you having difficulty eating or talking because of a painful tongue? Glossitis has nothing to do with your lips and everything to do with your tongue. Simply means inflamed tongue, and a painful tongue usually means its sore, red and swollen. [healthblurbs.com]

  When unexpected oral inflammation and pain occur, the potential for drug-induced oral lesions should be considered. [ncbi.nlm.nih.gov]

  The condition causes pain or a burning sensation and sensitivity to hot or spicy foods; it often resists treatment. [medical-dictionary.thefreedictionary.com]

• Dentist

  Prevention A good oral hygiene, maintained by proper brushing and flossing of teeth along with regular visits to your dentist may prevent glossitis. [symptoma.com]

  A: Median rhomboid glossitis is usually readily diagnosed by your dentist based upon its rather characteristic appearance. In some cases, your dentist may recommend further testing to confirm the diagnosis and rule out other conditions. [aaom.com]

  Use a special toothpaste advised by the dentist. Thorough hygiene is not enough. Use special means to avoid complications in future (this refers not only to treatment of the acute form of gingivitis ). [dent-wiki.com]

  Case presentation A 17-year-old Sardinian young woman underwent an initial examination at the dentist’s office during a routine checkup in 2010. [jmedicalcasereports.com]

• Candidiasis

  Candidiasis is a superficial fungal infection which can cause sensitivity. [thebody.com]

  The disappearance of MRG in three subsequent oral antifungus treatments, apart from being concomitant to the presence of esophagic candidiasis, reinforces the participation of candidiasis as a factor, or one of the factors, in the genesis of tongue alteration [scielo.br]

  […] 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]

  Infections Chronic mucocutaneous candidiasis Enterovirus infections Hairy leukoplakia Hand foot and mouth disease Herpangina Herpes simplex (cold sores) Herpes zoster (shingles) Kawasaki disease Measles Oral candidiasis (thrush) Scarlet fever (scarlatina [dermnetnz.org]

  Median Rhomboid Glossitis Median Rhomboid Glossitis ( MRG ), also known as Central Papillary Atrophy, Posterior Lingual Papillary Atrophy or Posterior Midline Atrophic Candidiasis, is a type of erythematous candidiasis unique to the midline posterior [exodontia.info]

• 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]

  REPORT OF A CASE The patient, a young married woman aged 23 years, complained of burning, painful areas on her tongue. [jamanetwork.com]

  Some patients with this condition may experience burning pain or soreness of the tongue. In serious cases of geographic tongue, patients may have trouble breathing, chewing, swallowing or speaking. [healthpedian.com]

• Pallor

  Some use the term secondary burning mouth syndrome in cases where a detectable cause, such as glossitis, for an oral burning sensation.Depending upon the underlying cause, there may be additional signs and symptoms such as pallor, oral ulceration and [en.wikipedia.org]

  Iron: Cheilosis; atrophic glossitis; gingivitis; Candidiasis; intraoral pain or burning; mucosal ulcerations and erosions; pallor Hemagenics - 3 tablets daily with food. Nutritional support for red blood cell formation. [ecopolitan.com]

  Iron deficiency anemia Iron deficiency anemia is the most common hematological disorder. [2] It may manifest in the orofacial region as atrophic glossitis, mucosal pallor and angular cheilitis. [ijdr.in]

• Overeating

  Glossitis Symptoms The symptoms of Glossitis may arise rapidly or gradually over a period of time. [hxbenefit.com]

  The glossitis, treated with viscous lidocaine, resolved over a three-week period. Four weeks after doxepin therapy was firt initiated, the drug was reinstituted; glossitis recurred eight days later. [ncbi.nlm.nih.gov]

  Surgical removal of a small tumor is preferred over the possible alternatives. Notice that your neck’s lymph nodes are very close for a spreading possibility. [healthblurbs.com]

  Benign migratory glossitis, also known as geographic tongue, presents with map-like, irregular smooth reddish patches over the surface of the tongue. [phaa.com]

• Dysphagia

  AN iron-deficiency anemia associated with chronic dysphagia and glossitis in women between forty and fifty years of age is now known as side-ropenic dysphagia. [nejm.org]

  Prognosis and Complications Resolution is usually complete and rapid COMPLICATIONS MAY INCLUDE Discomfort Airway Obstruction Dysphagia Dysphonia [de.slideshare.net]

  Common signs and symptoms of glossitis are: Erythematous, swollen tongue Tender tongue Pale or patchy white tongue Burning sensation Dysphagia Odynophagia Difficulty in mastication Abnormally smooth surface of tongue Difficulty in speaking Workup consists [symptoma.com]

  Disorders Other associated disorders such as pernicious anaemia, erythema multiform, pemphigus vulgaris, oral lichen planus, aphthous ulcers, Plummer-Vinson syndrome, dysphagia, psoriasis may also lead to glossitis. [primehealthchannel.com]

• Odynophagia

  Common signs and symptoms of glossitis are: Erythematous, swollen tongue Tender tongue Pale or patchy white tongue Burning sensation Dysphagia Odynophagia Difficulty in mastication Abnormally smooth surface of tongue Difficulty in speaking Workup consists [symptoma.com]

• Fissured Tongue

  Geographic tongue has also been seen more frequently in people with psoriasis and in those with fissured tongue. In fissured tongue, cracks and grooves appear on the tops and sides of the tongue. [webmd.com]

  Geographic tongue has been reported with increased frequency in patients with psoriasis [3, 4, 5, 6, 7] and in patients with fissured tongue. [8, 9] Geographic tongue and fissured tongue have been reported in association with chronic granulomatous disease [emedicine.medscape.com]

  TONGUE With fissured tongue ( Figure 2 ), deep grooves can develop due to physiologic deepening of normal tongue fissures. [aafp.org]

• Lesion of the Tongue

  Painful, tender, papular lesions on the tongue were observed in a 48-year-old woman seven days after initiation of doxepin and ampicillin therapy. [ncbi.nlm.nih.gov]

  DURING the meeting of the American Dermatological Association in Chicago in 1944, I presented at the clinical session a patient of mine with lesions on the tongue which were so unusual in character that a precise classification could not be made. [jamanetwork.com]

  1991/37/4/238/744 Median rhomboid glossitis is a diamond shaped, elevated, inflammatory lesion of the tongue, covered by smooth red mucosa. [jpgmonline.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]

  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]

• Tongue Ulcer

  […] disease (cachectic aphthae) 529.0 Riga-Fede disease (cachectic aphthae) 529.0 Ulcer, ulcerated, ulcerating, ulceration, ulcerative 707.9 tongue (traumatic) 529.0 [icd9data.com]

  […] that appears to be due to trauma; and an exophytic, dark red, superficially ulcerated nodule on the dorsum of the tongue 3-7. [nejm.org]

  (-Fede) Ulcer, ulcerated, ulcerating, ulceration, ulcerative frenum K14.0 (tongue) tongue K14.0 (traumatic) ICD-10-CM Codes Adjacent To K14.0 K13.24 Leukokeratosis nicotina palati K13.29 Other disturbances of oral epithelium, including tongue K13.3 Hairy [icd10data.com]

• Dysgeusia

  […] bright red plaques; it may then evolve into the atrophic form, noted as atrophy of the lingual papillae, affecting more than 50% of the tongue’s surface. 3 Reported oral symptoms include a burning sensation, pruritus, lingual paresthesia, glossodynia and dysgeusia [cmaj.ca]

  […] 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]

• Macroglossia

  Macroglossia is an abnormal enlargement of the tongue compared with the mouth and jaws. [aafp.org]

  Code K14 Diseases of tongue 2016 2017 2018 2019 Non-Billable/Non-Specific Code Type 2 Excludes erythroplakia ( K13.29 ) focal epithelial hyperplasia ( K13.29 ) leukedema of tongue ( K13.29 ) leukoplakia of tongue ( K13.21 ) hairy leukoplakia ( K13.3 ) macroglossia [icd10data.com]

• Blister

  Herpes simplex, a virus that causes cold sores and blisters around the mouth, may contribute to swelling and pain in the tongue. Low iron levels Not enough iron in the blood can trigger glossitis. [healthline.com]

  In oral herpes simplex, the tongue has pain, blisters and swelling. Trauma to the mouth from injuries can also affect the health of the tongue, its muscles and tissues. [epainassist.com]

  It is often associated with other features like mouth sores (blisters, ulcers), pain and sometimes fever. Among the possible infectious causes, a herpes simplex infection of the mouth commonly results in glossitis. [healthhype.com]

• Hyperkeratosis

  Vitamin C: Sore and bleeding gums; gums deep blue color; loose teeth; follicular hyperkeratosis. 500-C Methoxyflavone - 6-8 tablets daily with food. Certified active hesperidin/methoxyflavone complex. [ecopolitan.com]

  Flat leukoplakia, characterized by foci of hyperkeratosis against a healthy mucosa. The whitish coating with leukoplakia is not removed, but when glossitis drifts off by itself, exposing the deep layers of tissues. [en.medicine-worlds.com]

• Foreign Body Sensation

  During exacerbation the lesions may be accompanied by oral discomfort, burning, foreign body sensation or paroxysmal pain in the ears or ipsilateral submandibular lymph nodes. 4,12,51 Clinical examination The characteristic lesions of geographic tongue [ispub.com]

Workup consists of a detailed history and physical examination.

Laboratory Tests

• Laboratory tests are generally not required as a physical examination is sufficient to form a diagnosis. 
• A swab and culture may be performed, if needed.
• Complete blood count  
• Hemoglobin levels 

Imaging 

• Imagined studies are not required.

Test results

• Tongue lesions of unclear etiology may require biopsy or referral to an oral and maxillofacial surgeon, head and neck surgeon, or a dentist experienced in oral pathology [1]. In most cases however, a physical exam provides enough data to start appropriate treatment.

Frequently no medical intervention is required because the lesion is benign and most often asymptomatic [1]. However, Sigal and Mock reported treatment with topical and systemic antihistamines for geographic tongue [10]. Depending on the etiology and type treatment may also include corticosteroids, antibiotics, antifungal medication. An underlying condition must be identified and treated accordingly.   

The prognosis of glossitis is excellent. In most cases, it heals on its own and no treatment is required. In other cases, topical agents or oral antibiotics may be used, giving excellent results.

Complications

Glossitis is often a symptom of other conditions [9] such as:

• Irritants like tobacco, spicy food, etc.
• Allergic reactions to medicine or certain food items
• Allergic reaction to oral health products
• Injury to ill-fitting dental dentures or braces
• Hormonal disorders
• Vitamin deficiencies 
• Sjogren syndrome
• Bacterial, viral or fungal infections, etc.

These conditions may go undiagnosed or untreated and may cause complications. Glossitis, on its own however, is not known to cause any complications.

Atrophic tongue associated with pain with eating, even though it is mild atrophic change, has a high probability of being a candida-induced lesion [3].

Common etiologies of glossitis include bacterial, viral or fungal infection, vitamin deficiency, anemia, scarlet fever, kawasaki disease and Sjögren syndrome.

Glossitis characterized by ulcerative lesions (sometimes along the lateral borders of the tongue), may also be seen with jagged various teeth, ill fitting dentures, and, rarely with syphilis, inhalation burns, or ingestion of corrosive chemicals [4].

Incidence

One review reported overall prevalence ranges of 0.1 to 14.3% for geographic tongue, 1.3 to 9.0% for atrophic tongue, and 0.0 to 3.35% for median rhomboid glossitis [2].

Sex

Glossitis shows a predilection to the female gender.

Age

Glossitis can occur at any age, but it usually affects adult more often.

Atrophic glossitis

Atrophic glossitis is the consequence co-affected by host circumstances of oral cavity and bacteria [5]. In this condition, there is total atrophy of the lingual papillae resulting in a smooth, glossy tongue. It is most often due to vitamin deficiency anemia (pernicious anemia).

Median rhomboid glossitis (MRG)

MRG is an uncommon lesion and when improperly diagnosed may become confused with carcinoma [6]. It is due to infection by the fungus Candida albicans and occurs in the middle of tongue, in front of the circumvallate papillae.

Strawberry tongue

In this type, there is hyperplasia of the fungiform papillae resulting in a swollen, beefy tongue. It may be subdivided into white strawberry tongue, where there is a layer of white on the dorsum of tongue from which the hyperplastic papillae protrude upwards. The other subtype is the red strawberry tongue, where the white layer disappears and only the dark red papillae are apparent. This condition is associated with scarlet fever, Kawasaki disease, pernicious anemia and other diseases.

Benign migratory glossitis or Geographic tongue

Classic appearance of a geographic tongue includes a patch of an erythematous lesion having atrophic filliform papillae, which is surrounded by a white hyperkeratotic boundary. Associations with human leukocyte antigen HLA DR5, HLA DRW6 and HLA Cw6 have been reported [7].

Maintaining a good oral hygiene may prevent glossitis. Regular visits to a dentist and keeping a healthy life style to prevent any vitamin deficiencies may also help in preventing this condition.

Glossitis refers to inflammation of the tongue which may or may not be associated with systemic disease. Although easily examined, abnormalities of the tongue can present a diagnostic and therapeutic dilemma for physicians [1].

Definition

Glossitis is an inflammation of the tongue which is associated with a number of conditions and diseases. It is also known as glossodynia, burning tongue syndrome and smooth tongue.

Cause

Glossitis may be due to infection, irritation of the tongue by ill fitting dentures, tobacco, spicy food, etc or it may be a symptoms of underlying disease such as vitamin B12 deficiency, Sjögren's syndrome, etc.

Symptoms

Symptoms include a pale or beefy red tongue which is painful and makes it difficult to chew, swallow and/or speak.

Treatment

Treatment is not required as it heals on its own. Topical drugs and antibiotics may help if it is due to an infection.

Prevention

A good oral hygiene, maintained by proper brushing and flossing of teeth along with regular visits to your dentist may prevent glossitis.

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2. Dombi C, Czegledy A. (Nov 1992). Incidence of tongue diseases based on epidemiologic studies (Review of the literature). Fogorvosi szemle 85(11):335-41. 
3. Terai H, Shimahara M. Atrophic tongue associated with Candida. J Oral Pathol Med. 2005 Aug;34(7):397-400. 
4. Robbins and Cotran. Pathologic Basis of Disease. 8th ed. Kumar, Abbas, Fausto, Aster, et al eds. Philadelphia. Pa: Saunders Elsevier. Chap 16 p742. ISBN 978-1-4160-3121-5.
5. Nie Y, Liu J, Peng L, Xiao L. Research on flora of tongue dorsum of patients with Atrophic Glossitis and correlated factors. Hua Xi Kou Qiang Yi Xue Za Zhi (Chinese). 2012 Oct;30(5):539-43. PMID 23173324. PubMed
6. Carter LC. Median Rhomboid Glossitis: review of a puzzling entity. Compendium. 1990 Jul;11(7):446,448-51. PMID 2097050. PubMed
7. Fenerli A, Papanicoulaou S, Papanicoulaou M, Laskaris G. Histocompatibility antigens and geographic tongue. Oral Surg Oral Med Oral Pathol. Oct 1993;76(4):476-9 
8. Scully, Crispian. (2008). Oral and maxillofacial medicine: the basis of diagnosis and treatment. 2nd ed. Edinburgh: Churchill Livingstone. p356. ISBN 9780443068188.
9. Mirowski GW, Mark LA. Oral disease and oral cutaneous manifestations of gastrointestinal and liver disease. In: Feldman F, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia. Pa: Saunders Elsevier;2012:chap 22.
10. Sigal MJ, Mock D. Symptomatic benign migratory glossitis: report of two cases and literature review. Paediatr Dent. Nov-Dec 1992;14(6):392-6