drg.

Zaiviani Juniani K, Mkes
Disorders of Tongue
1. Glossodynia (burning mouth syndrome)- spontaneous
burning, discomfort, pain, irritation, or rawness of the tongue
2. Glossitis- presents as pain, irritation or burning, hypogeusia, or
dysgeusia
3. Median rhomboid glossitis
4. Geographic tongue- benign inflammatory condition, due to
Loss of filiform papillae
5. Fissured tongue (furrowed tongue, scrotal tongue, grooved
tongue)
6. Herpetic geometric glossitis
7. Hairy tongue (white or black hairy tongue) - hypertrophy of
filiform papillae resembling hair-like projections
8. Macroglosi →hypothyridism



Disorders of Tongue
 Glossodynia (burning mouth syndrome)- spontaneous
burning, discomfort, pain, irritation, or rawness of the
tongue, has no identifiable etiology most of the time
 Etiology-
 Idiopathic, Infection, Allergic/contact hypersensitivity,
Mechanical trauma
 Xerostomia, Geographic tongue/ Fissured tongue
 Vesiculobullous disease, temporomandibular dysfunction
 Referred pain from teeth or tonsils
 Drugs- Antibiotics, psychiatric medications, chemotherapy
Etiology of Glossodynia
 Neurologic
 Peripheral nerve damage
 Diabetic neuropathy
 Trigeminal neuralgia
 Acoustic neuroma

 psychiatric
 Depression
 Anxiety
 Cancerophobia
 Somatoform disorder
 OCD

 Systemic disorders
 Anemia (iron deficiency,
pernicious)
 Nutritional deficiency
 Gastroesophageal reflux
disease
 Sjogren syndrome
 Hypothyroidism
 Acquired immunodeficiency
syndrome
Disorders of Tongue…
 Glossitis- presents as pain, irritation or burning,
hypogeusia, or dysgeusia
 Atrophic glossitis
 Due to filiform de-papillation
 Mild patchy erythema to a completely smooth, atrophic,
beefy-red surface
 Etiology - pernicious anemia, protein and other
nutritional deficiencies, chemical irritants, drug
reactions, amyloidosis, sarcoidosis, vesiculobullous
diseases, oral candidiasis and systemic infections
 Moeller or Hunter glossitis of pernicious anemia
affects the lateral aspects and tip of the tongue
respectively

Disorders of Tongue…
 Median rhomboid
glossitis - atrophic
disorder of the tongue
secondary to chronic
candidiasis
Disorders of Tongue…
 Geographic tongue- benign
inflammatory condition, due to
Loss of filiform papillae
 Erythematous plaques with an
annular or serpiginous well
demarcated white border
 Etiology- psoriasis, Reiter
syndrome, atopic dermatitis,
diabetes mellitus, anemia,
hormonal disturbances, Down
syndrome, lithium therapy


Disorders of Tongue…
 Fissured tongue (furrowed
tongue, scrotal tongue,
grooved tongue)
 normal variant seen in 5-11%
individuals
 Numerous small irregular
fissures oriented laterally on
the dorsal tongue
 Also seen in - Melkersson-
Rosenthal syndrome, psoriasis,
Down syndrome, acromegaly,
Sjogren syndrome
Disorders of Tongue…
 Herpetic geometric
glossitis - rare cause of
fissuring of tongue,
presents with acute onset
of pain and deep
longitudinal grooves with
smaller lateral fissures
Disorders of Tongue…
 Hairy tongue (white or black
hairy tongue) - hypertrophy of
filiform papillae resembling
hair-like projections
 Associated with - heavy tobacco
use, mouth breathing, antibiotic
therapy, poor oral hygiene,
general debilitation, radiation
therapy, chronic use of bismuth
containing antacids, lack of
dietary roughage
 White, yellow green, brown, or
black color is due to
chromogenic bacteria or
staining from exogenous sources


Disorders of Tongue…
 Orai hairy leukoplakia-
caused by Epstein-Barr
virus, presents as
asymptomatic, corrugated,
white plaques with
accentuation of vertical
folds along the lateral
borders of tongue
 Predominantly seen in
HIV infection, organ
transplant recipients and
patients on
chemotherapy
Macroglosi

Lichen Planus




Glossitis
 Is the term used for red, smooth and sore tongue ,
perticularly characteristic of anaemia

 Inflammation of the Tongue
 May be PRIMARY or SECONDARY

Clinical Type of Sore Tongue
• Ulcus (of any type) involving the
tongue
• Glositis (red and sore tongue)
• The sore, physically normal tongue
• Geographical tongue (erythema
migrans)
Important Causes of Glossitis
 Anaemia
 deficiencies Vit B group ( especially B12) may occur as a primary
condition
 • Causes may include:
 – Bacterial / Viral Infections
 – Mechanical Irritation from teeth, dentures etc.
 – Tobacco, Hot Food, Alcohol
 – Allergy ( toothpaste, mouthwash, etc).

 Causes of secondary Glossitis
 Iron Deficiency Anaemia(
 • Pernicious Anaemia
 • Vitamin B Deficiency
 • Oral Lichen Planus
 • Syphilis
 • Apthous Ulcers



Symptoms Glositis

 Tongue Swelling
 Tongue becomes smooth and looses
 papillae (finger-like projections on surface)
 Colour change (Red cells with or not stained
film )
 – Usually dark red, like uncooked beef
 – Pale if pernicous anaemia
 – Fiery red if Vitamin B deficiency

 Sore and tender tongue
 • Difficulty swallowing, chewing & talking


Clinical features :
 Glossitis with →(riboflavin or nicotinic acid
deficiencies)
 Candidosis can cause the tongue to be red, sore or
oedematous ↔angular stomatitis and other feature
of candidosis
 In Sjogren’s syndrome, the tongue becomes red and
acquires a cobblestone texture
 Lichen Planus ↔smooth tongue due atrophy of the
papillae (particulary late in long-standing disease) but
→no soreness and typically no erythema. →bluish-
white surface of the tongue,
DIAGNOSIS
 Diagnosis is usually achieved by
examination of the clinical features
 Blood tests may be required to diagnose
 underlying systemic disease
 Serum levels of iron and ferritin, B12 or Folate (as
the case may be) are depressed. When abnormalies
such as this are found, found spesific treatment
quickly relieves the symptoms
 MCV ( mean corpuscular Volume ) is frequently a
useful guide
Therapy
 Vit B
 The therapy is depend on the type of the cause glositis
 Analgetik to relief the soreness
 Aim of treatment is to reduce inflammation
 • Good oral hygiene is essential
 • Steroids may be used to reduce the inflammation. An oral
suspension of → used in severe cases
 Prednisolone →mild cases t→prevent the side effects
associated with systemic steroids.
 Antibiotics, Antifungal → for treatment of infection
 Treatment of underlying anaemia or nutritional
deficiencies may be required
 • Avoid irritants such as tobacco, hot, spicy ,food and
alcohol

Prognosis and Complications
 Resolution is usually complete and rapid

COMPLICATIONS MAY INCLUDE

 Discomfort
 Airway Obstruction
 Dysphagia
 Dysphonia