-IBIS-1.5.0-
tx
eyes/ears/nose/throat
glossitis
diagnoses
definition and etiology
definition: An acute or chronic inflammation of the tongue.
etiology: Glossitis may be either a primary or secondary manifestation of disease.
Systemic disorders that may cause the problem include: vitamin deficiency (esp. B vitamins), anemia (pernicious or iron deficiency), and a multitude of skin diseases (aphthous lesions, pemphigus, erythema multiforme, lichen planus, etc.).
Local problems that may give rise to glossitis include: mechanical trauma
(poorly fitting dentures, jagged teeth); sensitization (toothpastes, candy/gum additives, mouthwashes); or direct oral irritants (alcohol, tobacco, spicy foods).
As the tongue is often a valuable mirror for disease in the body (particularly in Chinese Medicine), a patient presenting with glossitis should be studied closely on a systemic level.
signs and symptoms
The manifestations of glossitis vary immensely depending on the cause and the patient's own response to the initiating factor. Often, the severity of the lesions does not correlate with the patient's reporting on symptoms severity.
tongue appearance
Pellagra, pernicious anemia, smoking, mechanical irritation: Reddened edges and tips of the tongue. Also heart disease (Chinese Medicine). In later stages of pellagra the entire tongue is fiery red, ulcerated and swollen.
Iron and B12 deficiency: The tongue is pale and smooth.
Painful ulcers: Aphthous ulcers, strep infection, pemphigus, etc.
White patches: Leukoplakia, candidiasis, lichen planus, syphilitic mucus patch.
Geographic/wandering tongue: Asymptomatic presentation of denuded red patches "wandering" across the surface of the tongue. Caused by rapid growth and loss of
filiform papillae.
Hairy tongue: Elongation of filiform papillae in the median dorsal area that may stain brown to black because of tobacco smoke, food or chromogenic bacterial overgrowth. Often seen with antibiotic use, fevers, decreased salivation, and use of oxygen-freeing mouthwashes.
Median rhomboid glossitis: Congenital abnormality of the tongue consisting of a reddened, denuded, oval region in the area of the median posterior part of the tongue.
Moeller's glossitis: Slick, shiny/glazed tongue.
Severe, acute glossitis: usually is a result of trauma, burns or infection. It can develop rapidly with swelling and pain; it may present a significant danger by blocking the airway. Chewing, speaking and swallowing can be so painful as to be impossible to perform.
Glossodynia/glossopyrosis: painful, burning tongue, often without lesions visible to explain the pain. This is mostly seen in post-menopausal women.
Signs associated with various specific nutrient deficiencies:
Biotin: geographic tongue; lingual papillae atrophy.
Riboflavin: Soreness and intraoral burning; cheilosis; angular stomatitis; glossitis with magenta tongue.
Niacin: intraoral burning; glossitis; tongue swollen, with red tip and sides; swollen, red fungiform papillae; inflamed and atrophied filiform papillae.
Pyroxidine: intraoral burning; glossitis; mucosal ulcerations and erosions; cheilosis.
Folic acid: Gingivitis; glossitis with atrophy or hypertrophy or filiform papillae; cheilosis.
Cobalamin: Intraoral burning; mucosal erosions and ulcerations; painful glossitis with beefy or fiery red, atrophied tongue.
Vitamin C: Sore and bleeding gums; gums deep blue color; loose teeth; follicular hyperkeratosis.
Iron: Cheilosis; atrophic glossitis; gingivitis; candidiasis; intraoral pain or burning; mucosal ulcerations and erosions; pallor.
Zinc: Marked halitosis; cheilosis; stomatitis; discrete red, scaly plaques from short-lived vesicles; white coating on tongue and mucosa.
lab findings:
bloodwork to discern if a nutrient deficiency truly exists; CBC, iron, B12, folate assays
Heidelberg pH Capsule Gastric Analysis: to check for hypochlorhydria causing B12 or iron deficiency
course and prognosis
Depends on the reasons for the glossitis. When the main reason is uncovered, the condition may usually be quickly reversed. If the lesion is harmless (e.g. median rhomboid glossitis), but permanent, the patient should be reassured the condition is totally benign. All ulcerated lesions that fail to heal after 1-2 weeks should be biopsied.
differential diagnosis
determine the cause
footnotes