Glossitis

Glossitis is an inflammation of the tongue. In this condition, the tongue swells and alters color. The finger like projections on the tongue of the surface is lost as the tongue appears smooth.

Types of glossitis
Benign migratory glossitis has annular areas of desquamation of the filiform papillae on the dorsal part of the tongue. There are pinkish-red central lesions having thin, yellowish lines or bands. Patterns and locations are changed after every few days. This is also called erythema migrans, glossitis migrans, glossitis areata exfoliativa or pityriasis linguae.

Hunter's glossitis is characterized by pain and burning sensation, but can also extend to other parts of the oral mucosa. Finally, the tongue is transformed to atrophic and has a beefy red color and a smooth shiny appearance. There are sometimes small ulcers spread over its surface. This is also called atrophic glossitis.

Median Rhomboid glossitis is a congenital disorder of noninflammatory origin having a somewhat rhomboid reddish, smooth and shiny lesion along with some opalescent spots. These occur in the central third of the dorsal surface of the tongue.

Idiopathic glossitis is an inflammation of the substance of the tongue and its mucous membrane.

Herpetic geometric glossitis is a painful, longitudinal, crossed or branched fissure on the dorsum of the tongue.

Causes

• irritants like alcohol, hot foods, tobacco or spices
• bacterial and viral infections (including oral herpes simplex)
• mechanical irritation, rough edges of teeth, injury from burns, dental appliances
• allergic reaction to toothpaste, dyes in candy, breath fresheners, mouthwash, plastic in dentures, some blood pressure medications
• disorders like pernicious anemia, iron deficiency anemia and other B-vitamin deficiency
• conditions like oral lichen planus, aphthous ulcers, syphilis and erythema multiform
• alcohol consumption can cause many birth defects like fetal alcohol syndrome
• Plummer-Vinson syndrome which includes iron deficiency anemia, dysphagia and nail abnormalities
• Psoriasis is a chronic skin disease that has scaling and inflammation
• Pemphigus vulgaris is a rare autoimmune disorder having blisters and on mucous membranes like the mouth
• Deficiency of Niacin, Iron, B12, Vitamin E, Folate and Riboflavin
• Sometimes glossitis can also be inherited.

Symptoms

• Smooth appearance to the tongue
• Swelling of the tongue
• Sore and tender tongue
• Color of the tongue becomes pale if by pernicious anemia and fiery red if by deficiency of B vitamins
• difficulty when swallowing, speaking or chewing
• White patches may be noted in patients

Tests
An examination proves the presence of a swollen tongue or patches of swelling. It is seen that the nodules on the surface of the tongue called papillae are not present. Blood tests have to be done to detect systemic causes of the disorder.

Treatments
The aim of treatment is reduction of inflammation. There is need of hospitalization only if tongue swelling is severe. Good oral hygiene is essential. Tooth brushing has to be done minimum two times in a day and flossing has to be done daily. Corticosteroids like prednisone reduces the inflammation of glossitis. For mild cases, topical applications may be prescribed to overcome the side effects of swallowed or injected corticosteroids. Antibiotics, antifungal medications or some other microbials are useful if infection is the reason. Anemia or other deficiencies have to be treated by dietary changes or other supplements. Irritants like alcohol, tobacco and hot/spicy foods have to be avoided to minimize discomfort.

Prognosis
The condition can be painless or it may lead to tongue and mouth discomfort. Sometimes there may be severe tongue swelling due to which the airway is blocked.

Complications
There may be conditions like airway blockage, discomfort and difficulty while speaking, swallowing or chewing.

Prevention
Proper oral hygiene using tooth brushing and flossing and regular professional cleaning and examination are useful to prevent the disorders. The irritants or injury in the mouth have to be minimized whenever possible. The eating of any food or substance that irritates the mouth or tongue has to be avoided.