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Glossitis

Glossitis can mean soreness of the tongue, or more usually


Glossitis
inflammation with depapillation of the dorsal surface of the tongue
(loss of the lingual papillae), leaving a smooth and erythematous
(reddened) surface,[1][2] (sometimes specifically termed atrophic
glossitis). In a wider sense, glossitis can mean inflammation of the
tongue generally.[3] Glossitis is often caused bynutritional deficiencies
and may be painless or cause discomfort. Glossitis usually responds
well to treatment if the cause is identified and corrected. Tongue
soreness caused by glossitis is differentiated from burning mouth
syndrome, where there is no identifiable change in the appearance of
the tongue, and there are no identifiable causes.[4]

Contents
Symptoms
Causes
Anemias
Vitamin B deficiencies
Infections Glossitis in a person with scarlet fever ("red
Other causes strawberry tongue").
Diagnosis
Specialty Gastroenterology
Classification
Atrophic glossitis
Median rhomboid glossitis
Benign migratory glossitis
Geometric glossitis
Strawberry tongue

Prevention
Treatment
Epidemiology
References
External links

Symptoms
Depending upon what exact meaning of the word glossitis is implied, signs and symptoms might include:

Smooth, shiny appearance of the tongue, caused by loss of lingual papillae.


Tongue color changes, usually to a darker red color than the normal white-pink color of a healthy tongue.
Tongue swelling.
Difficulty with chewing, swallowing, or speaking (either because of tongue soreness of tongue swelling).
Burning sensation.[1] Some use the term secondary burning mouth syndrome in cases where a detectable cause,
[4]
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 angular cheilitis.[1]

Causes

Anemias
Iron-deficiency anemia is mainly caused by blood loss, such as may occur during
menses or gastrointestinal hemorrhage. This often results in a depapilled, atrophic
glossitis, giving the tongue a bald and shiny appearance, along with pallor (paleness) Patchy depapillation of filiform
of the lips and other mucous membranes a tendency towards recurrent oral papillae with prominence of the
ulceration,[5] and cheilosis (swelling of the lips).[6] The appearance of the tongue in fungiform papillae.
iron deficiency anemia has been described as diffuse or patchy atrophy with
tenderness or burning.[7] One cause of iron deficiency anemia is sideropenic
dysphagia (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. Parietal cells secrete intrinsic factor which is
required for the absorption of vitamin B12. Vitamin B12 deficiency results in megaloblastic anemia and may present as glossitis. The
appearance of the tongue in vitamin B12 deficiency is described as "beefy" or "fiery red and sore".[5] There may be linear or patchy
red lesions.[1]

Vitamin B deficiencies
Vitamin B1 deficiency (thiamin deficiency) can cause glossitis.[6] Vitamin B2 deficiency (ariboflavinosis) can cause glossitis, along
with angular cheilitis, cheilosis, peripheral neuropathy and other signs and symptoms.[6] The glossitis in vitamin B2 deficiency is
described as magenta.[8] Vitamin B3 deficiency (pellagra) can cause glossitis.[6] Vitamin B6 deficiency (pyridoxine deficiency) can
cause glossitis, along with angular cheilitis, cheilosis, peripheral neuropathy and seborrheic dermatitis.[6] Folate deficiency (vitamin
B9 deficiency) can cause glossitis, along with macrocytic anemia, thrombocytopenia, leukopenia, diarrhea, fatigue and possibly
neurological signs.[6] Apart from pernicious anemia discussed above, any other cause of vitamin B12 deficiency can cause glossitis,
.[6]
which tends to be painful, smooth and shiny

Infections
Bacterial, viral or fungal infections can cause glossitis. Candida species are involved in median rhomboid glossitis. Candida species
,[9]
also may be involved in creating a more generalized glossitis with erythema, burning, and atrophy

[1]
e.g. erythematous candidiasis (e.g. as may occur inHIV/AIDS) may involve the tongue giving glossitis with depapillation.

Syphilis is now relatively rare, but the tertiary stage can cause diffuse glossitis and atrophy of lingual papillae, termed "syphilitic
glossitis",[1] "luetic glossitis" or "atrophic glossitis of tertiary syphilis".[7] It is caused by Treponema pallidum and is a sexually
transmitted infection.

Other causes
Many conditions can cause glossitis via malnutrition or malabsorption,[6] which creates the nutritional deficiencies described above,
although other mechanisms may be involved in some of those conditions listed.

Alcoholism[6]
Sprue (celiac disease,[10] or tropical sprue), secondary to nutritional deficiencies[6]
Crohn’s disease[6]
Whipple disease[6]
Glucagonoma syndrome[6]
Cowden disease[6]
Acquired immunodeficiency syndrome(AIDS)[6]
Carcinoid syndrome[6]
Kwashiorkor amyloidosis[6]
Veganism and other specialized diets,[1]
Poor hydration and lowsaliva in the mouth, which allows bacteria to grow more readily
Mechanical irritation or injury from burns, rough edges of teeth or dental appliances, or other trauma
Tongue piercing[11] Glossitis can be caused by the constant irritation by the ornament and by colonization of
Candida albicans in site and on the ornament[12]
Exposure to irritants such astobacco, alcohol, hot foods, or spices
Allergic reaction to toothpaste, mouthwash, breath fresheners, dyes in confectionery
, plastic in dentures or retainers,
or certain blood-pressure medications A ( CE inhibitors)
Administration of ganglion blockers (e.g., Tubocurarine, Mecamylamine).
Oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris
Heredity
Albuterol (bronchodilator medicine)
A painful tongue may be an indication of an underlying serious medical condition and nearly always merits assessment by a
physician or dental surgeon.

Diagnosis

Classification
Glossitis could be classified as a group of tongue diseases or gastrointestinal
diseases.[3] It may be primary, where there is no underlying cause, or secondary
where it is a sign or symptom of another condition.[2] It can be acute or chronic.[3]
Generally speaking, there are several clinical patterns of glossitis, some more
common than others.

Atrophic glossitis
Atrophic glossitis, also known as bald tongue,[2] smooth tongue, Hunter glossitis,
Moeller glossitis, or Möller-Hunter glossitis,[13] is a condition characterized by a
smooth glossy tongue that is often tender/painful,[14] caused by complete atrophy of
the lingual papillae (depapillation).[2] The dorsal tongue surface may be affected
totally, or in patches, and may be associated with a burning sensation, pain and/or Median rhomboid glossitis
erythema.[9] Atrophic glossitis is a non-specific finding,[9] and has a great many
causes, usually related to iron-deficiency anemia, pernicious anemia, B vitamin
complex deficiencies,[15] unrecognized and untreated celiac disease (which often presents without gastrointestinal
symptoms),[16][17][18] or other factors such as xerostomia (dry mouth). Although the terms Möller and Hunter glossitis were
originally used to refer to specifically the glossitis that occurs in vitamin B12 deficiency secondary to pernicious anemia, they are
now used as synonyms for atrophic glossitis generally.[13] In this article, the term glossitis, unless otherwise specified, refers to
atrophic glossitis.

Candidiasis may be a concurrent finding or an alternative cause of erythema, burning, and atrophy
.

Median rhomboid glossitis


This condition is characterized by a persistent erythematous, rhomboidal
depapillated lesion in the central area of the dorsum of the tongue, just in front of the
circumvallate papillae.[1][14] Median rhomboid glossitis is a type of oral candidiasis,
and rarely causes any symptoms. It is treated with antifungal medication.
Predisposing factors include use of corticosteroid sprays or inhalers or
immunosuppression.

Benign migratory glossitis


Geographic tongue, also termed benign migratory glossitis, is a common condition
which usually affects the dorsal surface of the tongue. It is characterized by patches
of depapillation and erythema bordered by a whitish peripheral zone. These patches
give the tongue the appearance of a map, hence the name. Unlike glossitis due to
nutritional deficiencies and anemia, the lesions of geographic tongue move around
the tongue over time.[19] This is because in geographic tongue, new areas of the Geographic tongue (benign migratory
glossitis)
tongue become involved with the condition whilst previously affected areas heal,
giving the appearance of a moving lesion.[2] The cause is unknown,[20] and there is
no curative treatment. Rarely are there any symptoms associated with the lesions, but occasionally a burning sensation may be
present, which is exacerbated by eating hot, spicy or acidic foodstuffs. Some consider geographic tongue to be an early stage of
[21]
fissured tongue, since the two conditions often occur in combination.

Geometric glossitis
Geometric glossitis, also termed herpetic geometric glossitis,[3] is a term used by some to refer to a chronic lesion associated with
herpes simplex virus (HSV) type I infection,[22] in which there is a deep fissure in the midline of the tongue, which gives off multiple
branches.[7] The lesion is usually very painful, and there may be erosions present in the depths of the fissures. Similar fissured lesions
which are not associated with HSV, as may occur in fissured tongue, do not tend to be painful.[22] The name comes from the
geometric pattern of the fissures which are longitudinal, crossed or branched.[23] It is described as occurring in immunocompromized
persons, e.g. who have leukemia. However, the association between herpes simplex and geometric glossitis is disputed by some due
to a lack of gold standard techniques for diagnosis of intraoral herpetic lesions, and the high prevalence of asymptomatic viral
shedding in immunocompromized individuals.[7] Treatment is with systemicaciclovir.[22]

Strawberry tongue
Strawberry tongue (also called raspberry tongue),[24] refers to glossitis which manifests with hyperplastic (enlarged) fungiform
papillae, giving the appearance of a strawberry. White strawberry tongue is where there is a white coating on the tongue through
which the hyperplastic fungiform papillae protrude. Red strawberry tongue is where the white coating is lost and a dark red,
erythematous surface is revealed, interspaced with the hyperplastic fungiform papillae. White strawberry tongue is seen in early
scarlet fever (a systemic infection ofgroup A β- hemolytic streptococci),[25] and red strawberry tongue occurs later, after 4–5 days.[7]
Strawberry tongue is also seen in Kawasaki disease (a vasculitic disorder primarily occurring in children under 5),[26][27] and toxic
shock syndrome.[28] It may mimic other types of glossitis orVitamin B12 deficiency.[29]

Prevention
Good oral hygiene (thorough tooth brushing and flossing and regular professional cleaning and examination) may be helpful to
prevent these disorders. Drinking plenty of water and the production of enough saliva, aid in the reduction of bacterial growth.
Minimizing irritants or injury in the mouth when possible can aid in the prevention of glossitis.voiding
A excessive use of any food or
substance that irritates the mouth or tongue may also help.

Treatment
The goal of treatment is to reduce inflammation. Treatment usually does not require hospitalization unless tongue swelling is severe.
Good oral hygiene is necessary, including thorough tooth brushing at least twice a day, and flossing at least daily. Corticosteroids
such as prednisone may be given to reduce the inflammation of glossitis. For mild cases, topical applications (such as a prednisone
mouth rinse that is not swallowed) may be recommended to avoid the side effects of swallowed or injected corticosteroids.
Antibiotics, antifungal medications, or other antimicrobials may be prescribed if the cause of glossitis is an infection. Anemia and
nutritional deficiencies (such as a deficiency in niacin, riboflavin, iron, or Vitamin E) must be treated, often by dietary changes or
other supplements. Avoid irritants (such as hot or spicy foods, alcohol, and tobacco) to minimize the discomfort. In some cases,
tongue swelling may threaten the airway, a medical emergency that needs immediate attention.

Epidemiology
One review reported overall prevalence ranges of 0.1–14.3% for geographic tongue, 1.3–9.0% for "atrophy tongue" (atrophic
[30]
glossitis), and 0.0–3.35% for median rhomboid glossitis.

References
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with Rosen Educational Services. p. 146.ISBN 978-1615301317.
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8. Park, KK; Brodell RT; Helms SE. (July 2011)."Angular cheilitis, part 2: nutritional, systemic, and drug-related causes
and treatment" (https://web.archive.org/web/20140419015237/http://www .skinandallergynews.com/fileadmin/qhi_arc
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Derazne; Sandler; Ianculovici; Halperin (March 2010). "Colonization of Candida: prevalence among tongue-pierced
and non-pierced immunocompetent adults".Oral Dis. 16 (2): 172–5. doi:10.1111/j.1601-0825.2009.01618.x(https://d
oi.org/10.1111%2Fj.1601-0825.2009.01618.x) . PMID 19732353 (https://www.ncbi.nlm.nih.gov/pubmed/19732353).
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National Institute of Health (NIH). Retrieved Mar 7, 2016. "Tooth defects that result from celiac diseasemay
resemble those caused by too much fluoride or a maternal or early childhood illness. Dentists mostly saysit’from
fluoride, that the mother took tetracycline, or that there was an illness early on
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18. Giuca MR, Cei G, Gigli F, Gandini P (2010). "Oral signs in the diagnosis of celiac disease: review of the literature".
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1;volume=22;issue=3;spage=454;epage=461;aulast=Adeyemo) . Indian Journal of Dental Research. 22 (3): 454–61.
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Decker. ISBN 1550093452.
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m.org/doi/full/10.1056/NEJM199312163292506)
. The New England Journal of Medicine. 329 (25): 1859–60.
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External links
Classification ICD-10: K14.0 · D
ICD-9-CM: 529.0 ·
DiseasesDB: 5252
External MedlinePlus:
resources 001053

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