Geographic tongue, an inflammatory condition in which red, smooth patches without papillae appear on the surface of the tongue, is generally harmless. However, the pattern of these red patches (often called “islands”) may appear dramatically “geographic” in some patients and cause cosmetic concern. Often, these smooth, red patches will also migrate across the tongue, hence geographic tongue’s other name—benign migratory glossitis.
While geographic tongue is obscure enough to be included in the rare disease database of the National Organization for Rare Disorders, it is still estimated to be present in 1% to 3% of the population, meaning that you’ll likely encounter geographic tongue in your own practice.
That said, let’s dive into how you might diagnose geographic tongue, some symptoms to be aware of, and the available treatment options.
In most cases, geographic tongue is asymptomatic, but the inflammation can become uncomfortable for some patients. Aside from the appearance of physical symptoms, patients with geographic tongue may also experience increased sensitivity or tongue tenderness.
Sensations of pain or burning are sometimes reported when those with geographic tongue consume foods and beverages which are spicy or highly acidic.
Due to its dramatic, characteristic appearance, diagnosing geographic tongue is typically rather straightforward and can be confirmed with only an outward examination of the tongue—it's the management of this diagnosis which makes your awareness of the condition so important.
If geographic tongue is harmless and infrequent, you may be wondering why it’s essential to understand its signs and symptoms in order to make an appropriate diagnosis.
As a dental professional, the role you play in the overall well-being of your patients is crucial—by having awareness of geographic tongue and its implications in an individual's overall state of health, you become a valuable contributor to their quality of life.
And, while geographic tongue is generally considered idiopathic, ongoing research suggests that it may actually be a manifestation of systemic disease.
For example, scientific literature has suggested a relationship between geographic tongue and psoriasis, indicating that geographic tongue could be an oral manifestation of this skin condition. As a result, it’s recommended that general practitioners and dental professionals work together prudently to check for oral symptoms in psoriatic patients and to check for skin lesions in otherwise healthy individuals diagnosed with geographic tongue.
Others have posited that geographic tongue might be caused by vitamin B deficiency or irritation from alcohol or particular foods. For reasons we don’t yet understand, geographic tongue appears less frequently in people who smoke and more commonly in those with allergies.
In other cases, however, geographic tongue manifests in otherwise healthy individuals, complicating the search for a direct cause or consistent association with other diagnoses.
It’s critical that you partner with a patient’s other healthcare providers in order to suggest appropriate management, especially when the patient experiences physical discomfort or anxiety surrounding geographic tongue.
For example, you might recommend rinsing with lukewarm saltwater, alkaline rinses, or anesthetic rinses to provide relief for mild cases of geographic tongue, or you may suggest that a patient follow up with their dermatologist if you suspect that their geographic tongue may be linked to a skin condition like psoriasis.
It has also been reported that some psoriasis patients who utilize systemic treatments have found improvement in their oral health and symptoms of geographic tongue, too.
While we don’t fully understand the reasons why geographic tongue occasionally manifests, your prudence in identifying this condition during routine dental hygiene appointments and examinations can make all the difference in how a patient manages their overall health.
In addition to taking a complete medical history from patients with geographic tongue, it is also of value for dental professionals to provide sympathy and knowledgeable reassurance, given that the sometimes-severe appearance of geographic tongue lesions may lead patients to believe that there is something seriously wrong.
Remain aware of your duty to consult with their other providers and be prepared to provide information in order to educate the concerned patient. Your contributions will lead not only to better oral health but also to improved overall wellness.