Glossitis can mean soreness of the tongue, or more usually inflammation with depapillation of the dorsal surface of the tongue (loss of the lingual papillae), leaving a smooth and erythematous (reddened) surface, (sometimes specifically termed atrophic glossitis). In a wider sense, glossitis can mean inflammation of the tongue generally. Glossitis is often caused by nutritional deficiencies and may be painless or cause discomfort. Glossitis usually responds well to treatment if the cause is identified and corrected. Tongue soreness caused by glossitis is differentiated from burning mouth syndrome, where there is no identifiable change in the appearance of the tongue, and there are no identifiable causes.
Symptoms
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.
Causes
Anemias
Iron-deficiency anemia is mainly caused by blood loss, such as may occur during menses or gastrointestinal hemorrhage. This often results in a depapilled, atrophic glossitis, giving the tongue a bald and shiny appearance, along with pallor (paleness) of the lips and other mucous membranes a tendency towards recurrent oral ulceration, and angular cheilitis (crockings and inflammation at the corners of the lips). The appearance of the tongue in iron-deficiency anemia has been described as diffuse or patchy atrophy with tenderness or burning. One cause of iron-deficiency anemia is sideropenic dysphagia (Plummer–Vinson syndrome, also called Paterson–Brown–Kelly syndrome) which is also characterized by esophageal webbing and dysphagia. Pernicious anemia is usually caused by autoimmune destruction of gastric parietal cells. Parietal cells secrete intrinsic factor which is required for the absorption of vitamin B12. Vitamin B12 deficiency results in megaloblastic anemia and may present as atrophic glossitis (Hunter's atrophic glossitis). The appearance of the tongue in vitamin B12 deficiency is described as "beefy" or "fiery red and sore". There may be linear or patchy red lesions.
Vitamin B deficiencies Vitamin B1 deficiency (thiamine deficiency) can cause glossitis. Vitamin B2 deficiency (ariboflavinosis) can cause glossitis, along with angular cheilitis, cheilosis, peripheral neuropathy and other signs and symptoms. The glossitis in vitamin B2 deficiency is described as magenta. Vitamin B3 deficiency (pellagra) can cause glossitis. Vitamin B6 deficiency (pyridoxine deficiency) can cause glossitis, along with angular cheilitis, cheilosis, peripheral neuropathy and seborrheic dermatitis. Folate deficiency (vitamin B9 deficiency) can cause glossitis, along with macrocytic anemia, thrombocytopenia, leukopenia, diarrhea, fatigue and possibly neurological signs. Apart from pernicious anemia discussed above, any other cause of vitamin B12 deficiency can cause atrophic glossitis (Hunter's atrophic glossitis), which tends to be painful, smooth and shiny.
Infections Bacterial, viral or fungal infections can cause glossitis. Chronic Candida infections of the tongue can cause an atrophic glossitis known as median rhomboid glossitis. Syphilis is now relatively rare, but the tertiary stage can cause diffuse glossitis and atrophy of lingual papillae, termed "syphilitic glossitis", "luetic glossitis" or "atrophic glossitis of tertiary syphilis". It is caused by Treponema pallidum and is a sexually transmitted infection.
Other causes Many conditions can cause glossitis via malnutrition or malabsorption, which creates the nutritional deficiencies described above, although other mechanisms may be involved in some of those conditions listed.
Alcoholism Sprue (celiac disease, or tropical sprue), secondary to nutritional deficiencies Crohn's disease Whipple disease Glucagonoma syndrome Cowden disease Acquired immunodeficiency syndrome (AIDS) Carcinoid syndrome Kwashiorkor amyloidosis Veganism and other specialized diets, without B12 supplementation. Poor hydration and low saliva in the mouth, which allows bacteria to grow more readily Mechanical irritation or injury from burns, rough edges of teeth or dental appliances, or other trauma Tongue piercing Glossitis can be caused by the constant irritation by the ornament and by colonization of Candida albicans in site and on the ornament Exposure to irritants such as tobacco, alcohol, hot foods, or spices Allergic reaction to toothpaste, mouthwash, breath fresheners, dyes in confectionery, plastic in dentures or retainers, or certain blood-pressure medications (ACE inhibitors) Administration of ganglion blockers (e.g., Tubocurarine, Mecamylamine). Oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris Heredity Albuterol (bronchodilator medicine) A painful tongue may be an indication of an underlying serious medical condition and nearly always merits assessment by a physician or dental surgeon.
Diagnosis
Classification
Glossitis could be classified as a group of tongue diseases or gastrointestinal diseases. It may be primary, where there is no underlying cause, or secondary where it is a sign or symptom of another condition. It can be acute or chronic. Generally speaking, there are several clinical patterns of glossitis, some more common than others.
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