Geographic Tongue

Geographic tongue (migratory glossitis) is a condition characterized by the temporary loss of tongue papillae. Although it can be permanent, it is a harmless condition. It is a chronic and inflammatory lesion of the tongue, mostly of immunological origin.

Geographic tongue is not a disease. It is not a type of infection that transmits from person to person. Although heritability is still unproven, we can see it between members of the same family. So it could be genetic. It is roughly a structural change and difference on the tongue. Geographic tongue affects % 0.5 to % 5 of the world’s population.

We call the structures on the upper and lateral sides of the tongue that give our tongue a rough appearance as papillae. Papillae contain taste buds. In the case of the geographic tongue, lines, and shapes form on the tongue, with the disappearance of the papillae in some parts. Because these shapes on the tongue resemble a map, we also call it a mapped tongue.

Geographic tongue generally does not cause a complaint, except for appearance. Many patients are not even aware that they have mapped tongues. Some parts of the lesions may be slightly sunken and some parts may be slightly protruding. Similar-looking lesions on the floor of the mouth, palate, cheek, lips, and gingiva (geographic stomatitis) may accompany these lesions.

Geographic Tongue Symptoms

Geographic tongue presents with erythematous (reddened) spots on the tongue. The loss of tongue papillae forms this reddened (erythematous) area. Sometimes the lesions begin as small, white plaques. It then turns into increasingly red spots, moving away from the center. The lesions usually appear suddenly and mainly affect the dorsal region and lateral edges of the tongue. In some cases, they reach the lower part of the tongue.

One of the main features of a mapped tongue is that the lesions disappear in one place and then occur in another. These lesions have the appearance of having a map on the tongue (geographic tongue or mapped tongue). Because the lesions appear to move, we call them migratory glossitis in medicine.

Formation and Appearance

The most typical appearance of the mapped tongue is lesions located in the middle and anterior region of the tongue, with a reddish center and a yellowish-white border around it. We can briefly describe the formation and appearance of the patchy tongue as follows;
– red patches formed as a result of the disappearance of papillae on the tongue surface,
– a raised yellowish-white line surrounding these patches,
– the presence of a thin and reddened area slightly outside this line.

The location and size of lesions on the mapped tongue tend to change over time (weeks or months), which is why we name it ‘migratory’. This trend of change occurs with periods of exacerbation and regression. The change occurs as a result of the erosion of the surface in one region and the renewal of the surface in the other.

In general, lesions on the mapped tongue are often asymptomatic. However, some patients may have complaints such as pain and burning in the tongue, especially when consuming spicy, acidic foods because the surface of these red spots is thin and sensitive. In this respect, acidic foods such as citrus fruits and spicy foods such as chili peppers can cause tongue burns. However, these do not worsen the person’s condition, they may make the person slightly uncomfortable.

Causes of Geographic Tongue and Risk Factors

The exact cause of geographic tongue is unknown. It is estimated that this may be due to stress, psychological factors, habits, allergies, diabetes, and hormonal disorders. However, it is not clear that any of these factors are unequivocally related to the mapped tongue.

Concerning age, geographic tongue is more common in individuals before the age of 30. It is most common in the late 20s. We can also see the mapped tongue in children. However, this does not cause any symptoms, such as restlessness or pain, except for the appearance of the child’s tongue. Geographic tongue is less common in older people. In women, the mapped tongue is almost twice as common as in men.

Factors such as consuming spicy or acidic foods, eating hot food, some toothpaste and mouthwashes, smoking, and chewing tobacco can trigger the formation of a geographic tongue. Interestingly, however, the incidence of the mapped tongue is relatively low in smokers. One study has shown that mapped tongue is less common in individuals who smoke an average of one pack a day.

Geographic Tongue and Fissured Tongue

Another tongue abnormality known as the fissured tongue (fissured geographic tongue) may also accompany the geographic tongue. The geographic tongue presents itself as smooth and usually red spots with slightly raised edges. In this case, the tongue looks like a map. A normal tongue has small, pinkish-white projections called papillae on its surface. However, a person with a mapped tongue has a reduced number of papillae on the tongue.

Geographic Tongue and Psoriasis

Geographic tongue can be associated with stress, atopy, psoriasis, lichen planus, anemia, diabetes, and Down syndrome. These are reported to increase sensitivity in the tongue. Psoriasis is the disease in which the relationship with the mapped tongue is seen the most. Because the patchy tongue is very common in psoriasis patients. In addition, the occurrence and course of mapped tongue and psoriasis are similar.

Some studies suggest that geographic tongue may be an oral manifestation of psoriasis. Because treatments for psoriasis can be effective in partially passing or healing the mapped tongue. However, although there is a very strong relationship between mapped tongue and psoriasis, there is no conclusive evidence that it is an oral manifestation of psoriasis. Because individuals who do not have psoriasis can also have a mapped tongue.

Other Reasons

In some studies, it has been emphasized that there is a relationship between the use of antihypertensive drugs and mapped tongue. One study reported the emergence of mapped tongue in Celiac disease. In addition, emotional factors, vitamin deficiencies, and bacterial and fungal factors may also play a role in the formation of a patchy tongue.

Diagnosis

The patient does not need to have a special test for the diagnosis of the mapped tongue. Diagnosis is generally based on observation. The dentist or doctor can diagnose the problem just by looking at the tongue. In these cases, dentists usually refer the patient to a dermatologist. However, in rare cases, a doctor or dentist can take a biopsy from the person’s tongue so that the patches on the tongue are not confused with another disease.

Geographic Tongue Treatment

There is no definite cure for the geographic tongue, the cause of which is unknown. The condition resolves on its own, even without medical intervention. However, in cases where a mapped tongue gives symptoms such as pain and burning, treatment starts, albeit symptomatic. At this time, the patient may be offered topical prednisolone as a drug or corticosteroid rinses for the geographic tongue.

If a person with a geographic tongue also has oral thrush, it is recommended to use topical or systemic antifungal drugs. Some people may have partial improvement with systemic drugs used during the treatment of psoriasis or with vitamin A and zinc supplements.

Concomitant use of cyclosporine and antihistamine drugs for the treatment of mapped tongue is relatively successful. However, the place of this method in the definitive treatment of mapped tongue is still controversial.

In general, we can summarize the frequently recommended remedies for the mapped tongue as follows; zinc-containing mouthwash (eg, TheraBreath Plus Fresh Breath or Tom’s of Maine Natural Wicked Fresh), pain relievers (eg, ADA approved; Kank-A Mouth Pain Liquid, or Benzodent Maximum Strength Pain Relieving Cream, etc.), Vit A, Vit B, zinc supplements, etc. But even after treatment, the symptoms of the geographic tongue may return after a while.

Geographic Tongue Prevention

Doctors usually advise the patient to avoid foods that can cause tongue irritation and discomfort. In this respect, patients with complaints should avoid very hot, spicy, acidic, dry, crusty, and salty foods and beverages that increase symptoms. Already, the person realizes over time which foods cause burning or pain and should be avoided.

In children, experts recommend maintaining oral hygiene by brushing their teeth regularly. Mothers can also use sterile gauze to clean babies’ mouths. Another precaution is to keep track of what the child eats. Some foods such as kiwi, bananas, melons, walnuts, vinegar, and tomatoes increase the risk of the mapped tongue.

Conclusion

Because of its appearance, geographic tongue can cause people to experience anxiety or other psychological problems. However, there are no serious complications associated with the mapped tongue. There are also no diseases or cancers known to originate from it. In short, the person will have to learn to live with this disorder.