Geographic Tongue

Definition/diagnostic criteria Geographic tongue, also known as benign migratory glossitis, is characterised by irregular, smooth, red patches on parts of the tongue, surrounded by slightly raised, white, or yellow borders. These patches can change size, shape, and location over time. The condition is benign and not linked to any infection or cancer. Diagnosis is primarily clinical, based on the appearance of the tongue. It is often identified during an examination for other reasons.

Epidemiology Geographic tongue affects approximately 1-3% of the population and can occur at any age but is less common in children. It appears to have a familial tendency and can be associated with other systemic conditions such as psoriasis and fissured tongue. Both genders are affected, but some studies suggest a slight female predominance.

Diagnosis

Clinical features The clinical presentation of geographic tongue includes smooth, red, irregularly-shaped patches on the dorsal and lateral aspects of the tongue. These areas lose the papillae, leading to the smooth appearance. The lesions can change in size and pattern over days to months and typically recur. Patients may report discomfort, sensitivity, or a burning sensation, particularly when eating spicy or acidic foods.

Investigations Investigations typically aren’t necessary for the diagnosis of geographic tongue, as it is primarily based on clinical appearance. However, if the diagnosis is uncertain, or to rule out other conditions, a biopsy may be performed. Typical histopathological findings include loss of filiform papillae and elongation of rete ridges. It’s important to distinguish it from other conditions such as oral lichen planus, leukoplakia, and candidiasis, which may present similarly.

Treatment There is no definitive cure for geographic tongue, and treatment is usually not necessary due to its benign nature. However, for symptomatic relief, topical corticosteroids, antiseptic mouthwashes, or anaesthetic lozenges might be useful in reducing discomfort. Patients should be advised to avoid irritants such as spicy or acidic foods and to maintain good oral hygiene. Any underlying systemic conditions, such as psoriasis, should be managed appropriately.

Prognosis Geographic tongue is a benign condition with a variable course. Lesions may persist for months to years, often healing in one area only to recur in another. While it can cause discomfort, it does not lead to cancer and doesn’t typically affect the function of the tongue. Reassurance that the condition is benign and education about the symptoms can be helpful for patients experiencing anxiety related to the appearance or symptoms of their tongue.