Glossitis

What is Glossitis

Glossitis is inflammation of the tongue. This may be a stand-alone condition or it may be a symptom of a different condition that you have.

Generally, glossitis goes away when its cause is identified and treated. Glossitis can be dangerous if it causes difficulty breathing.

What are the causes?

This condition can be caused by many different things. In some cases, the cause may not be known. Certain underlying conditions may cause glossitis, such as:

  • Viral, bacterial, or yeast infections.
  • Allergies.
  • Dysfunction of the skin and mucous membranes. This can happen with certain autoimmune disorders.
  • Abnormal tissue growths (tumors).
  • Lack of healthy red blood cells (anemia).
  • Movement of stomach acid into the tube that connects the mouth and the stomach (gastroesophageal reflux).
  • Lack of proper nutrition or certain vitamins.
  • Certain lifelong (chronic) medical conditions, such as diabetes.

Sometimes, glossitis may not be caused by an underlying condition. In these cases, glossitis may be caused by:

  • Use of tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes.
  • Excessive alcohol use.
  • Tongue injury or irritation.
  • Certain medicines, such as medicines to treat cancer.

What increases the risk?

This condition is more likely to develop in:

  • People who are 50 years or older.
  • Men.
  • People who are taking antibiotics or steroids, such as asthma medicines.
  • People who drink alcohol excessively.
  • People who use tobacco products, including cigarettes, chewing tobacco, or e-cigarettes.
  • People with chronic medical conditions, such as immune diseases or cancer.
  • People who do not brush or floss their teeth regularly.
  • People who lack proper nutrition or are anemic.

What are the symptoms?

Symptoms of this condition vary depending on the cause. Symptoms may include:

  • Swelling of the tongue.
  • Pain and tenderness in the tongue. Sometimes, this condition is painless.
  • Changes in tongue color. The tongue may be pale or bright red.
  • Smooth areas on the tongue’s surface.
  • A small mass of tissue (node) or white patch on the tongue.
  • Difficulty chewing, swallowing, or talking.
  • Difficulty breathing.

How is this diagnosed?

This condition is diagnosed based on a physical exam and medical history. Your health care provider may ask you about your eating and drinking habits. You may have tests, including:

  • Blood tests.
  • Removal of a small amount of cells from the tongue that are examined under a microscope (biopsy).

You may be given the name of a dentist or a health care provider who specializes in ear, nose, and throat (ENT) problems (otolaryngologist).

How is this treated?

Treatment for this condition depends on the underlying cause and may include:

  • Following instructions from your health care provider about keeping your mouth clean and avoiding irritants that may have caused your condition or made it worse.
  • Nutritional therapy. Your health care provider may tell you to change your eating and drinking habits or take a nutritional supplement.
  • Managing underlying conditions that may have caused your glossitis.
  • Medicines, such as:
    • Corticosteroids to reduce inflammation.
    • Antibiotics if your condition was caused by an infection.
    • Local anesthetics that numb your tongue or mouth (local anesthetics).

Follow these instructions at home:

  • Keep your teeth and mouth clean. This includes brushing and flossing frequently and having regular dental checkups.
  • If you wear dentures or dental braces, work with your dentist to make sure they fit correctly.
  • Eat healthy foods. Follow instructions from your health care provider about eating or drinking restrictions.
  • Avoid tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. If you need help quitting, ask your health care provider.
  • Avoid excessive alcohol use.
  • Avoid any irritants that may have caused your condition or made it worse, such as chemicals or certain foods.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have a fever.
  • You develop new symptoms.
  • You have symptoms that do not get better with medicine or get worse.
  • You have symptoms that do not go away after 10 days.
  • You cannot eat or drink because of your pain.

Get help right away if:

  • You have severe pain or swelling.
  • You have difficulty breathing, swallowing, or talking.

Detailed Info of Glossitis

5 Interesting Facts of Glossitis

  1. Glossitis is acute or chronic inflammation of the tongue, which manifests as 1 of 3 main clinical types: atrophic glossitis (Hunter glossitis), benign migratory glossitis (geographic tongue), and median rhomboid glossitis
  2. Clinical presentation ranges from asymptomatic to increased tongue sensitivity, glossalgia, glossodynia, pruritus, and/or taste disturbances
  3. Diagnosis is based on history and clinical examination of the tongue, with diagnostic tests according to suspected underlying cause (eg, nutritional deficiency, Candida infection)
  4. Managed with supportive oral care and specific treatment of any underlying condition
  5. Severe glossitis may lead to dysphagia, speech impairment, or airway obstruction

Pitfalls

  • Median rhomboid glossitis with associated palatal inflammation may indicate immunosuppression; consider HIV infection 
  • Glossitis is acute or chronic inflammation of the tongue, which manifests as 1 of 3 main clinical types: atrophic glossitis (Hunter glossitis), benign migratory glossitis (geographic tongue), and median rhomboid glossitis 
    • May be asymptomatic or cause pain, swelling, change in appearance, impaired speech, and/or dysphagia

Classification

  • Clinical types
    • Atrophic glossitis 
      • Characterized by diffuse papillary atrophy 
        • Incidence ranges from 1.3% to 9% in the general population worldwide 
        • Present in nearly 5% of hospitalized elderly people in the United States 
    • Benign migratory glossitis (geographic tongue)
      • Characterized by well-delineated areas of papillary atrophy that develop, spontaneously resolve, and reappear in different regions of the dorsal surface of the tongue 
        • Affects approximately 2% of the general population worldwide 
    • Median rhomboid glossitis
      • Hallmark is an elliptical or rhomboid area of papillary atrophy localized at the center of the dorsal surface of the tongue 
        • Usually associated with a Candida infection 
        • Affects 0.01% to 1% of the general population worldwide 

Diagnosis

Clinical Presentation

History

  • History of antibiotic or corticosteroid use, poorly fitting dentures, poor nutrition, immunocompromised status, or tobacco or alcohol use
  • Symptoms may affect only the tongue or may involve additional areas that suggest underlying cause
    • Atrophic glossitis
      • Tongue pain (glossalgia) is often present 
      • Additional symptoms may include burning sensation (glossodynia) and pruritus 
      • Symptoms correlated with an underlying condition include the following:
        • Chronic diarrhea, abdominal pain, and weight loss (classic features of celiac disease)  
        • Intermittent xerostomia
          • Typical of some autoimmune conditions (eg, Sjögren syndrome) 
        • Fatigue, dizziness, weakness, and/or dyspnea (typical symptoms of anemia)
        • Paresthesias, anorexia, weight loss, and low-grade fever (symptoms of pernicious anemia)
    • Benign migratory glossitis (geographic tongue)
      • Typically asymptomatic 
      • Some patients experience increased sensitivity and/or glossodynia, generally associated with cigarette smoke or certain foods (eg, spicy or acidic food)
    • Median rhomboid glossitis
      • Typically asymptomatic 
      • Some patients complain of persistent glossalgia, irritation, glossodynia, or pruritus 
      • Typically results from chronic candidiasis; history of oral candidiasis or underlying immunodeficiency may be present
      • Median rhomboid glossitis with associated palatal inflammation may indicate immunosuppression; consider HIV infection 
    • Glossalgia related to lingual paresthesia may cause dysphagia and impaired speech may develop
    • Some patients experience parageusia and/or hypogeusia 

Physical examination

  • Physical examination focuses on the appearance of the tongue 
    • Atrophic glossitis (Hunter glossitis)
      • Characterized by the absence or flattening of the filiform papillae (atrophy) on more than 50% of the tongue surface 
      • Presents with typical smooth, glossy, beefy red tongue 
        • Recurrent ulcers can occur in some patients 
      • Signs of anemia (eg, pallor, tachycardia) may be present in patients with atrophic glossitis caused by nutritional deficiencies
      • Abdominal distention may be present in patients with underlying celiac disease 
    • Benign migratory glossitis (geographic tongue)
      • Characterized by sharply defined demarcations of inflammation developing on multiple sites of the tongue, mostly on the dorsal surface 
        • Presents as annular areas of smooth red atrophic patches surrounded by a raised white hyperkeratotic border, giving the tongue a typical variegated appearance 
        • Patches spontaneously resolve and reappear in new areas (creating a migratory pattern) 
    • Median rhomboid glossitis
      • Lesion consists of an area of papillary atrophy that is elliptical or rhomboid 
      • Characterized by well-demarcated, symmetric, erythematous, plaquelike lesions on the dorsal midline of the tongue 
        • Surface of lesion can be smooth or lobulated 

Causes

  • Atrophic glossitis
    • Nutritional deficiencies 
      • Vitamin B₁₂, folic acid, riboflavin, or niacin
        • Pernicious anemia is associated with atrophic glossitis secondary to vitamin B₁₂ deficiency in up to 25% of cases 
      • Iron deficiency anemia 
    • Xerostomia associated with Sjögren syndrome 
  • Benign migratory glossitis (geographic tongue)
    • Etiology is uncertain but numerous associated factors have been proposed 
  • Median rhomboid glossitis
    • Chronic local candidiasis is present in 90% of cases

Risk factors and/or associations

Age
  • Atrophic glossitis 
    • Most common in hospitalized elderly population (incidence reaches approximately 5% in the United States) 
  • Benign migratory glossitis (geographic tongue)
    • Highest incidence in people aged 20 to 29 years (about 39.4%) 
    • Increased prevalence in the pediatric population ranging from 0.37% to 14.3% 
Sex
  • Benign migratory glossitis (geographic tongue)
    • Some studies report higher incidence in women than in men (ratio of 1.5 to 1), whereas others report no significant difference between sexes 
  • Median rhomboid glossitis 
    • Men are affected 3 times more than women
Genetics
  • Benign migratory glossitis (geographic tongue) may have possible genetic predisposition 
Ethnicity/race
  • Benign migratory glossitis (geographic tongue) has higher prevalence among White and Black populations compared to the Hispanic population 
Other risk factors/associations
  • Atrophic glossitis
    • Type 1 diabetes mellitus
      • 26.9% of patients with diabetes develop atrophic glossitis 
        • Approximately 4% of patients with diabetes have concomitant celiac disease and between 2.6% and 4% have pernicious anemia
    • Celiac disease 
      • 29.6% of patients with celiac disease describe glossalgia or glossodynia, whereas 8.6% show erythema or atrophic lesions 
    • Amyloidosis
    • Syphilis infection
  • Benign migratory glossitis (geographic tongue)
    • Psoriasis 
      • Studies indicate that geographic tongue is present in 7.7% to 12% of patients with psoriasis but in only 1% to 3% of healthy people 
    • Diabetes mellitus
      • Patients with diabetes have 4-fold higher prevalence of benign migratory glossitis, with 8% prevalence in type 1 diabetes 
    • Hormonal fluctuations (eg, in postmenopausal women)
    • Exposure to irritants (eg, alcohol, tobacco, hot/spicy/acidic food)
    • Fissured tongue (anomaly of the tongue with prevalence of 5%-11.4% in the general population)
      • Fissures may trap food, debris, and bacteria, causing localized inflammation and potentially developing into benign migratory glossitis 
      • Fissured tongue and benign migratory glossitis are 2 different entities of the same disease 
    • Nutritional deficiency of vitamins B₆, B₁₂, folic acid, iron, and zinc 
      • May be associated with benign migratory glossitis (an established cause for atrophic glossitis)
    • Psychosomatic factors (eg, emotional stress, anxiety)
    • Intolerance or allergic reaction 
      • Food or food ingredients (eg, flavoring agents, food coloring) may lead to geographic tongue in people predisposed to developing this form of glossitis
      • Oral care products (eg, toothpaste, mouthwash, breath fresheners)
    • Use of certain drugs
      • Cardiovascular drugs, such as ACE inhibitors (enalapril) or potassium channel activators (nicorandil) 
      • Lithium, oral contraceptives (responsible for hormonal fluctuations), and bevacizumab 
    • Immunosuppression 
    • Down syndrome 
  • Median rhomboid glossitis
    • Inadequate oral hygiene favoring development of infection (eg, candidiasis)
    • Type 1 diabetes mellitus
      • Associated with increased risk of opportunistic Candida albicans infection 
    • Immunosuppression
      • Median rhomboid glossitis with associated palatal inflammation may indicate immunosuppression; consider HIV infection 
  • Other generic associations
    • Viral infection (eg, HSV infection)
    • Bacterial infection (extremely rare; only 7 cases have been reported, caused by Pseudomonas species, Trichomonas species, Haemophilus influenzae type B, or Streptococcus pneumoniae
    • Head and neck radiation therapy can injure oral mucosa and cause glossitis

Diagnostic Procedures

Primary diagnostic tools

  • Diagnosis is based on history and clinical findings on inspection and palpation of dorsum, lateral margins, and ventral surface of the tongue 
  • Additional tests for an underlying cause are directed by physical examination findings
    • If atrophic glossitis is diagnosed clinically, obtain CBC panel results and levels of serum vitamin B₁₂ and/or iron 
      • Serologic screening for autoantibodies (eg, anti–tissue transglutaminase) may be indicated if celiac disease is suspected
      • Screening for inflammatory markers, antinuclear antibodies (anti-Ro and anti-La), and anti–alpha fodrin antibody may be indicated if underlying Sjögren syndrome is suspected
    • If appearance is that of median rhomboid glossitis, obtain tongue scraping and culture swab to confirm candidiasis 
    • If appearance is consistent with benign migratory glossitis, additional tests are not usually necessary unless an associated predisposing condition (eg, diabetes) is suspected 

Laboratory

  • CBC panel and peripheral smear findings
    • Results may indicate microcytic or megaloblastic anemia
  • Serum B vitamin levels
    • Results may indicate deficiencies of vitamin B₁₂, folate, or riboflavin
  • Iron studies
    • Results may indicate iron deficiency
  • Candida culture of scraping/smear of tongue lesion
    • Confirms candidiasis in suspected median rhomboid glossitis 

Differential Diagnosis

Most common

  • Burning mouth syndrome
    • Multifactorial condition characterized by burning pain in the mouth with or without signs of inflammation, and without specific lesions (clinically normal mucosa) 
    • As in glossitis, glossalgia and altered sense of taste are common presenting symptoms 
    • Unlike glossitis, burning mouth syndrome is typically more severe and the whole mouth is affected with oral dysesthesia, stomatopyrosis, and/or stomatodynia; sense of taste is altered concurrently with changes to salivation 
    • Differentiated on basis of history and presence of normal clinical and histologic findings 
  • Oral lichen planus
    • Chronic immunologic and inflammatory disease of oral mucosa 
    • Like glossitis, may be either asymptomatic or cause glossalgia if ulcerative lesions are present 
    • Differentiated on basis of clinical and histopathologic findings 
      • Manifests either as a reticular white, lacy pattern on the dorsal tongue or as shallow, scattered erythematous ulcerations 
      • Lesions are bilateral and more or less symmetrical 
  • Herpes simplex infection
    • Infection caused by HSV type 1
      • Herpetic geometric glossitis is a clinically distinctive presentation of oral herpes simplex infection
        • Occurs in immunocompromised patients infected with HSV (eg, patients with HIV, acute myelogenous leukemia)
    • Like other forms of glossitis, may include tender and painful lesions of the tongue 
    • Unlike glossitis, lesions may also involve the lips as typical in herpetic infection 
    • Differentiated on basis of history, clinical findings, and viral culture
      • Lesions may be longitudinal, crossed, or branched, or may be organized in a geometric pattern (albeit not always present) and develop at the center of the tongue 
  • Squamous cell carcinoma 
    • Cancer of squamous epithelial cells; the tongue is 1 of the possible affected sites
    • As with glossitis, tongue discomfort and glossalgia are common symptoms
    • Unlike glossitis, lesions commonly involve the lateral surface of the tongue and may initially appear as a slightly thickened area over a red or white background progressing to nodularity or ulceration
    • Differentiated on basis of clinical and histopathologic findings 

Treatment Goals

  • Reduce pain and inflammation
  • Treat underlying cause (if known)

Disposition

Recommendations for specialist referral

  • Refer to specialist depending on underlying cause of glossitis (eg, gastroenterologist for diagnosis or management of celiac disease or pernicious anemia)
  • Refer patients with tongue lesions of uncertain cause to oral surgeon, head and neck surgeon, or dentist experienced in oral pathology

Treatment Options

Atrophic glossitis

  • Treat underlying cause
    • Correct nutritional deficiency with supplements (eg, iron, cyanocobalamin, folic acid, riboflavin, niacin)
    • Treat any associated disease
      • Amyloidosis
      • Celiac disease
      • Sjogren syndrome
  • Supportive care including avoidance of irritants (eg, harsh oral hygiene products, hot/spicy foods, alcohol, cigarette smoke), as well as use of soothing saline mouth rinse and gentle oral hygiene

Benign migratory glossitis (geographic tongue)

  • Typically asymptomatic, hence treatment is usually unnecessary; offer reassurance that the condition is benign and not a sign of systemic illness 
  • If symptomatic (ie, increased tongue sensitivity and/or glossodynia), options include the following:
    • Supportive care with avoidance of irritants (eg, harsh oral hygiene products, hot/spicy foods, alcohol, smoke) as well as use of soothing saline mouth rinse and gentle oral hygiene 
    • Topical corticosteroid gels and antihistamine mouth rinses after meals and at bedtime(first line medical therapy) 
    • Topical tacrolimus (second line medical therapy) or systemic cyclosporine (third line medical therapy) have been successfully used to treat persistent inflammation refractory to other treatments 

Median rhomboid glossitis

  • Treat Candida infection with antimycotic agents
    • Topical therapy with clotrimazole or nystatin is recommended for mild disease 
    • Systemic therapy with fluconazole is recommended for moderate to severe disease 
  • Supportive care including avoidance of irritants (eg, harsh oral hygiene products, hot/spicy foods, alcohol, smoke) as well as use of soothing saline mouth rinse and gentle oral hygiene

Drug therapy

  • Corticosteroids
    • Triamcinolone
      • Triamcinolone Acetonide Dental paste; Adults: Apply on lesion(s) once daily at bedtime. May apply up to 2 or 3 times a day, preferably after meals. Reassess if repair/regeneration has not occurred in 7 days.
  • Antihistamines
    • Diphenhydramine mouth rinse
      • Extemporaneous compounding required
      • Diphenhydramine mouth rinse (12.5 mg/5 mL of diphenhydramine elixir diluted in a 1:4 ratio with water); Adults: Rinse mouth with 5 mL PO after meals and at bedtime. 
  • Immunosuppressants
    • Cyclosporine
      • Cyclosporine Oral capsule; Adults: 3 mg/kg/day PO for 2 months, followed by 1.5 mg/kg/day PO as maintenance therapy. 
    • Tacrolimus
      • Tacrolimus Topical ointment; Adults: Apply 0.1% tacrolimus ointment to the lesion twice daily for 2 weeks. 
  • Antimycotic drugs
    • Nystatin
      • Nystatin Oral suspension; Adults, Adolescents, and Children: 400,000 to 600,000 units (4 to 6 mL) PO swished in the mouth 4 times per day; administer one-half of each dose into each side of the mouth; guidelines recommend to treat for 7 to 14 days.
    • Fluconazole 
      • Fluconazole Oral suspension; Infants, Children, and Adolescents: 12 mg/kg/dose PO once daily recommended by guidelines as alternative to echinocandin therapy in patients who are not critically ill and are unlikely to have a fluconazole-resistant isolate, specifically no prior azole exposure for neutropenic patients. FDA-approved dosage is 6 to 12 mg/kg/dose PO once daily. Usual Max: 600 mg/dose. Treat for 2 weeks after documented clearance from the bloodstream and resolution of signs and symptoms for invasive candidiasis without metastatic complications. Ophthalmological examination is recommended for all patients. Consider intravascular catheter removal.
      • Fluconazole Oral tablet; Adults: 800 mg (12 mg/kg) PO once, then 400 mg (6 mg/kg) PO once daily recommended by guidelines as alternative to echinocandin therapy in patients who are not critically ill and are unlikely to have a fluconazole-resistant isolate, specifically no prior azole exposure for neutropenic patients. FDA-approved dosage is 400 mg PO once daily. Treat for 2 weeks after documented clearance from the bloodstream and resolution of signs and symptoms for invasive candidiasis without metastatic complications. Ophthalmological examination is recommended for all patients. Consider intravascular catheter removal.
    • Clotrimazole
      • Clotrimazole Oral troche; Children and Adolescents 3 to 17 years: 10 mg PO 5 times daily for 7 to 14 days.
      • Clotrimazole Oral troche; Adults: 10 mg PO 5 times daily for 7 to 14 days.
  • Vitamin supplements
    • Iron
      • Correction of deficiency
        • Iron Oral solution; Term Neonates, Infants, and Children: 3 to 6 mg elemental iron/kg/day PO (divided into 1 to 3 doses/day) for 4 weeks; 60 mg/day PO has been recommended for school aged children. Repeat anemia screening; an increase in hemoglobin of 1 g/dL or more or an increase in hematocrit of 3% or more confirms the diagnosis. If diagnosis is confirmed, continue treatment for 2 to 3 more months then repeat anemia screening. Smaller dosages may be used but correction will occur at a slower rate.
        • Iron Oral tablet; Adults and Adolescents: 60 mg elemental iron PO 1 to 3 times daily for 4 weeks. Repeat anemia screening; an increase in hemoglobin of 1 g/dL or more or an increase in hematocrit of 3% or more confirms the diagnosis. If diagnosis is confirmed, continue treatment for 2 to 3 more months then repeat anemia screening. Smaller dosages may be used, but correction will occur at a slower rate.
      • Supplementation (some chronic conditions associated with glossitis require long-term therapy supplementation to prevent recurrence)
        • Iron Oral solution; Children 1 to 3 years: 7 mg PO once daily.
        • Iron Oral solution; Children 4 to 8 years: 10 mg PO once daily.
        • Iron Oral solution; Children 9 to 13 years: 8 mg PO once daily.
        • Iron Oral tablet; Adolescent females 14 years and older: 15 mg PO once daily.
        • Iron Oral tablet; Adolescent males 14 years and older: 11 mg PO once daily.
        • Iron Oral tablet; Adult males: 8 mg PO once daily.
        • Iron Oral tablet; Adult females 19 to 50 years: 18 mg PO once daily.
        • Iron Oral tablet; Adult females older than 50 years: 8 mg PO once daily.
    • Cyanocobalamin 
      • Vitamin B12 (Cyanocobalamin) Solution for injection; Adolescents†: 1,000 mcg IM given daily or every other day for 1 week, then weekly for 4 to 8 weeks, then monthly until recovery is the usual dosage.
      • Vitamin B12 (Cyanocobalamin) Solution for injection; Adults: 1,000 mcg IM given daily or every other day for 1 week, then weekly for 4 to 8 weeks, then monthly until recovery is usual dosage; FDA-approved dosage is 100 mcg IM/subcutaneously once daily for 6 or 7 days; after clinical improvement and if reticulocyte response seen, give 100 mcg IM/subcutaneously on alternate days for 7 doses, then every 3 to 4 days for another 2 to 3 weeks, then 100 mcg IM/subcutaneously monthly. Administer with folic acid, if needed.
    • Folic acid 
      • Supplementation
        • Folic Acid Oral tablet; Infants 0-6 months: 65 mcg/day PO daily is the Adequate Intake; RDA is not established.
        • Folic Acid Oral tablet; Infants 7—12 months: 80 mcg/day PO is the Adequate Intake; RDA is not established.
        • Folic Acid Oral tablet; Children 1—3 years: 0.15 mg PO once daily.
        • Folic Acid Oral tablet; Children 4—8 years: 0.2 mg PO once daily.
        • Folic Acid Oral tablet; Children 9—13 years:  0.3 mg PO once daily.
        • Folic Acid Oral tablet; Adults and Adolescents >= 14 years: 0.4 mg PO once daily.
    • Riboflavin
      • Correction of deficiency
        • Vitamin B2 (Riboflavin) Oral tablet; Children >= 12 years: 3—10 mg/day PO for several days, followed by 0.6mg/1000 calories ingested PO.
        • Vitamin B2 (Riboflavin) Oral tablet; Adults: 5—30 mg/day PO in divided doses for several days, followed by 1—4 mg/day PO.
      • Supplementation
        • Vitamin B2 (Riboflavin) Oral tablet; Infants 0—6 months: 0.3 mg/day PO is the Adequate Intake (AI); an RDA has not been established.
        • Vitamin B2 (Riboflavin) Oral tablet; Infants 7—12 months: 0.4 mg/day PO is the Adequate Intake (AI); an RDA has not been established.
        • Vitamin B2 (Riboflavin) Oral tablet; Children 1—3 years: 0.5 mg/day PO.
        • Vitamin B2 (Riboflavin) Oral tablet; Children 4—8 years: 0.6 mg/day PO.
        • Vitamin B2 (Riboflavin) Oral tablet; Children 9—13 years:  0.9 mg/day PO.
        • Vitamin B2 (Riboflavin) Oral tablet; Adolescent females >= 14 years: 1 mg/day PO.
        • Vitamin B2 (Riboflavin) Oral tablet; Adult and Adolescent males >= 14 years: 1.3 mg/day PO.
        • Vitamin B2 (Riboflavin) Oral tablet; Adult females >= 19 years: 1.1 mg/day PO.
    • Niacin 
      • Supplementation
        • Niacin Oral tablet; Infants younger than 6 months: 2 mg/day PO is the Adequate Intake; no RDA is established.
        • Niacin Oral tablet; Infants 7 to 12 months: 4 mg/day PO is the Adequate Intake; no RDA is established.
        • Niacin Oral tablet; Children 1 to 3 years: 6 mg PO per day.
        • Niacin Oral tablet; Children 4 to 8 years: 8 mg PO per day.
        • Niacin Oral tablet; Children 9 to 13 years: 12 mg PO per day.
        • Niacin Oral tablet; Adolescent females 14 years and older: 14 mg PO per day.
        • Niacin Oral tablet; Adolescent males 14 years and older: 16 mg PO per day.
        • Niacin Oral tablet; Adult females: 14 mg PO per day.
        • Niacin Oral tablet; Adult males: 16 mg PO per day.

Nondrug and supportive care 

Avoiding harsh antibacterial mouthwash, breath mints, and chewing gum

Avoiding hot, spicy, or acidic food, alcohol, and smoke

Gentle brushing of the tongue to remove debris

Soothing mouth rinse with saline solution

Correcting ill-fitting dentures

Monitoring

  • Follow up to monitor response to treatment; biopsy may be indicated for refractory lesions

Complications

  • Severe glossitis may lead to dysphagia, speech impairment, or airway obstruction

Prognosis

  • Atrophic glossitis
    • Prognosis is favorable if underlying condition is treated
  • Benign migratory glossitis (geographic tongue) often remits spontaneously 
    • Certain cases can persist for years and effective therapy may be challenging 
  • Median rhomboid glossitis
    • Favorable prognosis with complete resolution of symptoms after anti-Candida treatment (up to 2 weeks may be necessary)

Prevention

  • Good oral hygiene can prevent food, debris, and bacteria from causing localized inflammation 
  • Maintaining adequate nutrition as well as iron/vitamin supplementation prevents recurrence of glossitis secondary to nutritional deficiencies 

References

1: Reamy BV et al: Common tongue conditions in primary care. Am Fam Physician. 81(5):627-34, 2010 Reference

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