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Glossitis

Glossitides


Presentation

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 
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]
  • (Plummer–Vinson or Paterson–Brown–Kelly syndrome) which is also characterized by esophageal webbing and dysphagia. [5] Pernicious anemia is usually caused by autoimmune destruction of gastric parietal cells .[en.wikipedia.org]
  • 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]
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]
  • […] of the tongue is lacking.[nejm.org]
  • Available from: Median rhomboid glossitis is a diamond shaped, elevated, inflammatory lesion of the tongue, covered by smooth red mucosa.[jpgmonline.com]
Macroglossia
  • 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]
  • […] wart Tongue Ankyloglossia Black hairy tongue Caviar tongue Crenated tongue Cunnilingus tongue Fissured tongue Foliate papillitis Glossitis Geographic tongue Median rhomboid glossitis Transient lingual papillitis Glossoptosis Hypoglossia Lingual thyroid Macroglossia[en.wikipedia.org]
  • Macroglossia is an abnormal enlargement of the tongue compared with the mouth and jaws.[aafp.org]
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]
Tongue Ulcer
  • Convert to ICD-10-CM : 529.0 converts directly to: 2015/16 ICD-10-CM K14.0 Glossitis Approximate Synonyms Abscess of tongue Glossitis (tongue inflammation) Tongue abscess 529.0 Excludes Applies To Abscess of tongue Ulceration (traumatic) of tongue ICD[icd9data.com]
  • Applicable To Abscess of tongue Ulceration (traumatic) of tongue Type 1 Excludes Type 1 Excludes Help A type 1 excludes note is a pure excludes. It means "not coded here".[icd10data.com]

Workup

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.

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.   

Prognosis

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.

Etiology

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].

Epidemiology

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.

Sex distribution
Age distribution

Pathophysiology

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].

Prevention

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.

Summary

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].

Patient Information

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.

References

Article

  1. Reamy BV, Derby R, Bunt CW. Common tongue conditions in primary care. Am Fam Physician. 2010 Mar 1;81(5):627-34. 
  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 

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Last updated: 2017-08-09 17:59