Glossitis – Causes, Treatment and Prevention

Definition

Glossitis refers to inflammation of the tongue, wherein it displays prominent swelling similar to ulcers on the tongue, apart from unusual colour changes and abnormal texture on its surface. In grave instances, the tongue becomes vastly enlarged, making it difficult to speak clearly and swallow food.

The tongue is a vital muscular organ located inside the mouth, composed of a moist, pink tissue known as the mucosa, that works to help chew and consume food. It also has tiny bumps on the surface termed papillae which contain taste buds that help distinguish between sweet, sour, bitter and other palates. Owing to this function, when glossitis occurs, the papillae may diminish leading to minor instances of ageusia i.e., loss of sense of taste.

Epidemiology

Precise epidemiological statistics are lacking, largely owing to the diverse nature of potential causes of glossitis. Various vitamin deficiencies are endemic in some regions of the world and may fluctuate with the overall nutritional status of the population. It caused by a vitamin deficiency or infection will often resolve with treatment of the underlying condition. Infectious glossitis will likewise resolve with the eradication of the causative organism. Medication-induced glossitis will typically resolve with discontinuation of the offending agent.

Per to the Third National Health and Nutrition Examination Survey III (NHANES III) that performed oral mucosal examinations on 17,235 adults 27.9 % of them had a total of 6,003 clinically oral lesions, 14.2% of the mucosal lesions were on the dorsum of the tongue, while 1.3% only on the lateral border of the tongue. Overall, the prevalence ranges of geographic tongue (benign migratory glossitis) were 1.41 to 2.29%, and 0.46 to 0.30% for median rhomboid glossitis.

Pathophysiology

It is a condition characterized by inflammation of the tongue, and its pathophysiology can vary depending on the underlying cause. Infections, both bacterial and fungal, can infiltrate the tissues of the tongue and trigger an immune response, leading to inflammation. Bacterial species like Streptococcus and Actinomyces, as well as the Candida fungus (particularly Candida albicans), are commonly associated with glossitis. Nutritional deficiencies, such as inadequate intake or impaired absorption of essential vitamins (e.g., vitamin B12, niacin, riboflavin) and minerals (e.g., iron, zinc), can compromise the normal maintenance and integrity of the tongue’s epithelial cells, resulting in inflammation.

Allergic reactions to certain foods, medications, or oral care products can also contribute to glossitis. The immune system recognizes specific allergens as foreign substances, launching an immune response that includes inflammation of the tongue. Autoimmune disorders, such as oral lichen planus and geographic tongue (benign migratory glossitis), involve the immune system mistakenly attacking healthy cells in the oral cavity, including the tongue. This immune-mediated inflammation can cause glossitis.

Mechanical trauma or irritants can also induce glossitis. Tongue injuries caused by accidental biting, burns, or abrasive dental appliances can lead to tissue damage and subsequent inflammation. Irritation from smoking tobacco, consuming excessive amounts of alcohol, or consuming spicy or acidic foods can also irritate the tongue’s surface, initiating an inflammatory response. Additionally, underlying medical conditions like Sjögren’s syndrome, Crohn’s disease, or psoriasis, which involve immune dysregulation, can contribute to the development of glossitis. By understanding the diverse pathophysiological mechanisms at play in glossitis, healthcare professionals can accurately diagnose the condition and implement appropriate management strategies tailored to the underlying cause, thereby alleviating symptoms and promoting healing.

Types of glossitis

There are different types, which include:

Acute glossitis

An inflammation of the tongue known as acute glossitis often has severe symptoms and manifests rapidly. Glossitis of this kind often results from an allergic reaction.

Chronic glossitis

An inflammation of the tongue that recurs frequently is called chronic glossitis. This kind could get started as an indication of another illness.

Atrophic glossitis

Hunter glossitis, also known as atrophic glossitis, develops when a significant number of papillae are lost. The tongue’s colour and texture change as a result. This kind of glossitis frequently causes the tongue to seem glossy.

Other types includes:

Rhomboid glossitis

Another type of glossitis is median rhomboid glossitis. This is caused by a Candida infection, and appears as a red, smooth or thickened patch in the centre of the upper side of the tongue. With this type of glossitis you can get a sore mouth, and there may be red and white spots or patches in your mouth too.

Herpetic geometric glossitis

Other types of include geometric glossitis – also called herpetic geometric glossitis – which is caused by the herpes simplex virus and has been found in people with weakened immune systems (iv). Geometric glossitis causes a deep crack in the middle of the tongue and is often quite painful.

Strawberry tongue

Meanwhile, strawberry tongue (sometimes also called raspberry tongue) is a lot like glossitis. It makes your tongue swollen, red and bumpy but it’s not an actual condition itself, rather a symptom of a condition such as scarlet fever, kawasaki disease (which causes inflammation in your arteries), toxic shock syndrome or it can be caused by food or medicine allergies. Strawberry tongue can be a sign of vitamin B12 deficiency. A sore or painful tongue can also be caused by oral thrush (Candida) or mouth ulcers, which can affect the underside of the tongue.

Geographic tongue

Sometimes called benign migratory glossitis, geographic tongue causes patches of missing papillae and smooth, “map-like” red lesions. Though the condition is inflammatory, it’s completely harmless.

What causes glossitis?

Allergic reactions

Allergic reactions to medications, food, and other potential irritants may aggravate the papillae and the muscle tissues of the tongue. Irritants include toothpaste and certain types of medications that treat high blood pressure.

Diseases

Certain diseases that affect your immune system may attack the tongue’s muscles and papillae. Herpes simplex, a virus that causes cold sores and blisters around the mouth, may contribute to swelling and pain in the tongue.

Low iron levels

Not enough iron in the blood can trigger glossitis. Iron regulates cell growth by helping your body make red blood cells, which carry oxygen to your organs, tissues, and muscles. Low levels of iron in the blood may result in low levels of myoglobin. Myoglobin is a protein in red blood cells that’s important for muscle health, including the tongue’s muscle tissue.

Mouth trauma

Trauma caused by injuries to the mouth can affect the condition of your tongue. Inflammation may occur because of cuts and burns on the tongue or dental appliances like braces placed on your teeth.

Symptoms of Glossitis

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 or tongue swelling).
• Burning sensation. Some use the term secondary burning mouth syndrome in cases where a detectable cause, 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.

Complications of Glossitis

Complications associated with glossitis can be progressive and vary depending on the underlying cause. Because glossitis can be due to serious diseases, failure to seek treatment can result in complications and permanent damage. It is important to contact your healthcare provider when you experience any kind of tongue swelling or other symptoms of the mouth or tongue. Once the underlying cause is diagnosed, following the treatment plan you and your healthcare provider develop specifically for you will minimize the risk of complications including:

• Difficulty breathing, ineffective breathing, and respiratory arrest due to blockage of the airway
• Difficulty chewing or swallowing
• Discomfort
• Speech problems
• Spread of infection
• Surgery to remove the tongue due to a serious infection or malignant condition

Risk factors

You may be at risk for tongue inflammation if you:

• Have mouth trauma
• Consume spicy food
• Having low amounts of iron
• Wear tongue-irritating braces or dentures
• Have dietary sensitivities
• Already have herpes
• Have a disease of the immunological system

Diagnosis

Diagnostic Procedures for Glossitis:

• Visual Inspection: The tongue will be visually inspected to identify any atrophy, swelling, or discoloration. The healthcare provider may use a tongue depressor and a light source to get a better view of the tongue’s surface.
• Physical Exam: Examining the tongue, mouth, and lips for signs of atrophy and discoloration.
• Visual Inspection: The tongue will be visually inspected to identify any atrophy, swelling, or discoloration. The healthcare provider may use a tongue depressor and a light source to get a better view of the tongue’s surface.
• Blood Tests: Checking for deficiencies in vitamins and minerals that may contribute to glossitis.
• Imaging Tests: X-rays or CT scans to assess any underlying structural problems in the tongue or mouth.
• Biopsy: Removing a tiny piece of tissue from the afflicted region so that it may be examined under a microscope for any indications of infection or other abnormalities.
• Allergy Testing: If an allergic reaction is suspected as the cause of glossitis, allergy testing may be conducted to identify specific allergens triggering the immune response.

Treatment for Glossitis

The treatment approach for glossitis focuses on addressing the underlying cause of the condition, relieving symptoms, and promoting healing of the inflamed tongue. The specific treatment options may vary depending on the cause and severity of glossitis. Here are some common approaches:

Medications

• Antibiotics: If it is caused by a bacterial infection, oral antibiotics may be prescribed to eliminate the infection.
• Antifungal medications: In cases where glossitis is caused by a fungal infection, antifungal medications, such as antifungal mouth rinses or oral antifungal medications, may be prescribed.
• Corticosteroids: In certain cases, corticosteroid mouth rinses or topical ointments may be prescribed to reduce inflammation and alleviate symptoms.

Nutritional Supplements

Deficiencies in vitamins or minerals may contribute to glossitis. In such cases, nutritional supplements, particularly those containing vitamin B complex, iron, or zinc, may be recommended to address the deficiencies and promote healing of the tongue.

Dental Treatments

• Dental hygiene measures: Good oral hygiene practices, including regular tooth brushing and flossing, are crucial in managing glossitis. Gentle brushing of the tongue using a soft-bristled toothbrush or tongue scraper can help remove debris and reduce irritation.
• Mouth rinses: Prescription or over-the-counter mouth rinses, such as antimicrobial or anti-inflammatory rinses, may be recommended to alleviate symptoms and reduce bacterial growth.
• Dental treatment: If glossitis is caused by dental issues, such as sharp or broken teeth, orthodontic problems, or ill-fitting dental appliances, appropriate dental treatments may be necessary to address the underlying problems.

Lifestyle Modifications

• Avoiding irritants: Minimizing exposure to substances that may irritate the mouth, such as spicy or acidic foods, tobacco, alcohol, or certain oral care products, can help reduce inflammation and promote healing.
• Hydration: Drinking plenty of water and maintaining adequate saliva production can aid in reducing bacterial growth and keeping the mouth moist.

Management of Underlying Conditions:

If glossitis is a symptom of an underlying medical condition, such as an autoimmune disorder or allergies, treating and managing the underlying condition is essential for effectively managing glossitis.

It is important to consult with a healthcare professional, such as a dentist or primary care physician, for an accurate diagnosis and appropriate treatment plan tailored to individual needs. Following the prescribed treatment, practicing good oral hygiene, and making necessary lifestyle modifications can help alleviate symptoms and promote the healing of glossitis.

Prevention of Glossitis

Oral Hygiene and Prevention Measures:

• 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.
• Avoiding excessive use of any food or substance that irritates the mouth or tongue may also help.