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Glossitis

Glossitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • An acute or chronic inflammation of the tongue, either as primary disease or a symptom of systemic disease
  • Common forms:
    • Atrophic glossitis (AG) or Hunter glossitis or smooth tongue
    • Benign migratory glossitis (BMG) or geographic tongue (GT) or erythema migrans
    • Median rhomboid glossitis (MRG)
    • Herpetic geometric glossitis (HGG)
  • System(s) affected: gastrointestinal (GI)

Epidemiology

  • Predominant age: all ages; BMG more frequent in children and often diminishes with age
  • Predominant gender:
    • Male > female (3:1, MRG)
    • Female > male (BMG)

Geriatric Considerations
Many patients with glossitis caused by nutritional deficiencies are postmenopausal or elderly.

Prevalence
Varies; usual reported range: 1–14%; higher with nutritional deficiencies

Etiology and Pathophysiology

  • Systemic
    • Nutritional deficiencies (e.g., vitamin B12, folic acid, ascorbic acid)
    • Anemia (pernicious, iron deficiency)
    • HIV (opportunistic infections such as candidiasis [MRG], herpes simplex virus [HSV]; or HIV-associated changes such 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)
    • Trauma (ill-fitting dentures, piercings, burns, convulsive seizures)
    • Primary irritants (alcohol, tobacco, hot foods, spices, excessive peppermint, citrus)
    • Sensitization with chemical irritants (e.g., dyes, mouthwash, toothpaste, systemic drugs)
    • Malignancy (95% are squamous cell)
  • Tongue
    • AG: atrophy of filiform papillae
    • BMG: erythematous, yellow-white lesions (dorsum)
    • MRG: atrophic filiform, plaque-like lesions (midline)
    • HGG: linear fissures (dorsum)

Genetics
  • Familial history may be present with BMG.
  • GT and psoriasis share a common genetic marker.
  • One recent small study has suggested that some GT cases may be true oral psoriasis, whereas others are only GT.

Risk Factors

  • Poor nutrition
  • Dentures
  • Piercings
  • Allergic background (e.g., asthma, eczema, hay fever)
  • Smoking, smokeless tobacco
  • Alcoholism
  • Anxiety, stress
  • Depression
  • Hormonal disturbances
  • Oral contraceptives
  • Advancing age
  • Immunocompromised state

General Prevention

  • Evaluation of nutritional status, including vitamin B deficiencies, anemias
  • Cessation of tobacco use (including smokeless)
  • Assess for irritation from teeth, dentures, or piercings.

Commonly Associated Conditions

  • Fissured tongue (BMG)
  • HIV infection (rare)
  • Reiter syndrome (rare)
  • Down syndrome (rare)
  • Crohn disease (rare)
  • Celiac disease (possible correlation)
  • Psoriasis (possible correlation)

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Citation

Stephens, Mark B., et al., editors. "Glossitis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116247/all/Glossitis.
Glossitis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116247/all/Glossitis. Accessed April 25, 2019.
Glossitis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116247/all/Glossitis
Glossitis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 25]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116247/all/Glossitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Glossitis ID - 116247 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116247/all/Glossitis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -