Glossitis Disease

BASICS

DESCRIPTION

Acute or chronic inflammation of the tongue either as a primary disease or symptom of systemic disease

System(s) affected: Gastrointestinal
Genetics: N/A
Incidence/Prevalence in USA: Common
Predominant age: All ages
Predominant sex: Male > Female

SIGNS AND SYMPTOMS

Reddened tip and edges of tongue (with pellagra, anemia, excess smoking)
Fiery red, swollen, ulcerated tongue (pellagra)
Tongue smooth and pale (anemias)
Ulcers (herpetic or aphthous lesions, streptococcal infection, erythema multiforme, pemphigus)
White patches (candidiasis, syphilis, leukoplakia, lichen planus, mouth breathing)
Denuded smooth areas (geographic tongue)
Painful tongue (anemia, pellagra, viral)
Hairy tongue (follows antibiotic therapy, fever or excessive use of mouthwashes with peroxide)
Tenderness, pain, swelling of the tongue (infections or trauma)
Burning, painful tongue (candidiasis, anemia, diabetes, malignancies)
Non-painful solitary ulcerations (malignancy)
Painful combination of ulcers, nodules, linear fissures (herpetic geometric glossitis in HIV)
Malignancy - painless red and/or white lesions
Verrucous plaque, lateral aspect (EBV-oral hairy leukoplakia, in HIV patients)

CAUSES

Systemic:
- Malnutrition with avitaminosis (e.g., B group)
- Anemia (pernicious, iron deficiency)
- Skin diseases (e.g., lichen planus, erythema multiforme, aphthous lesions, Behçet's syndrome, pemphigus vulgaris, syphilis)
- HIV (candidiasis, HSV, loss of papillae)
- Lansoprazole plus clarithromycin, amoxicillin, metronidazole (for treatment of H. Pylori in PUD)
Local:
- Infections (HSV, EBV, candidiasis, tuberculosis, streptococcal)
- Trauma (ill-fitting dentures, burns, convulsive seizures)
- Primary irritants (alcohol, tobacco, hot foods, spices, excessive peppermint, citrus)
- Sensitization (chemical irritants, e.g., dyes, mouth wash, toothpaste, systemic drugs)
- Malignancy

RISK FACTORS

Low socioeconomic status
Poor nutrition
Dentures
Smoking, smokeless tobacco
Alcoholism
Anxiety, stress
Depression
Advancing age
Immunocompromised state

DIAGNOSIS

LABORATORY

CBC
Serologic tests for syphilis
Chemical profile
Tests for vitamin B12 deficiency
Postprandial glucose
Smear and culture lesions when indicated

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Varies according to underlying causes

SPECIAL TESTS

Biopsy solitary lesions that do not respond to treatment in one week
10% KOH scrapings for suspected candidiasis

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Biopsy
KOH scrapings

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Avoid any possible sensitizing irritants or agents
Specific therapy for oral infections (see Medications)
Local treatment (see Medications)
Analgesics when needed
Request dental evaluation
Scrupulous oral hygiene

SURGICAL MEASURES

N/A

ACTIVITY

No restrictions unless there is a systemic infection

DIET

Bland or liquid diet

PATIENT EDUCATION

Griffith: Instructions for Patients; Philadelphia, W.B. Saunders Co. 6th ed., 1998

FOLLOW UP

PREVENTION/AVOIDANCE

Evaluation of nutritional status including B-vitamin deficiencies, anemias
Cessation of tobacco use (including "smokeless")
Assess for irritation from teeth, dentures

POSSIBLE COMPLICATIONS

Lymphadenopathy
Chronicity

EXPECTED COURSE AND PROGNOSIS

Prompt improvement when cause can be identified and treated
Aphthous ulcers, erythema multiforme and hairy tongue often recur

MISCELLANEOUS

ASSOCIATED CONDITIONS

Diabetes mellitus
HIV infection

AGE-RELATED FACTORS

Pediatric: Median rhomboid glossitis is a developmental lesion causing a rhomboid-shaped, smooth, reddish, nodular area on the dorsal surface of the back portion of the middle third of the tongue. This type of glossitis is innocuous and requires no treatment.
Geriatric: Many patients with glossitis are postmenopausal or elderly
Others: N/A

PREGNANCY

N/A

OTHER NOTES

Some symptoms of glossitis have no organic cause. Treat symptoms and reassure regarding malignancy.

ABBREVIATIONS

EBV = Epstein-Barr virus
HSV = herpes simplex virus

Clinical Investigations

ROLE OF HOMOEOPATHY

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