Last reviewed: 30 Oct 2021
Last updated: 05 Mar 2021



History and exam

Key diagnostic factors

  • presence of risk factors
  • grooves and fissures on the dorsal tongue (fissured tongue)
  • hairy projections on the dorsal midline tongue (hairy tongue)
  • well-demarcated areas of erythema on the dorsal tongue (geographic tongue)
  • atrophic red central zone within patches (geographic tongue)
  • lesions that seem to migrate (geographic tongue)

Other diagnostic factors

  • halitosis (hairy tongue and fissured tongue)
  • bad taste in mouth (hairy tongue)
  • discolouration (hairy tongue and fissured tongue)
  • burning sensation (geographic tongue)
  • oral mucosal pain (hairy tongue)

Risk factors

  • tobacco use (hairy tongue)
  • coffee/tea consumption (hairy tongue)
  • poor oral hygiene (hairy tongue)
  • increasing age (hairy tongue and fissured tongue)
  • hyposalivation (hairy tongue)
  • Melkersson-Rosenthal's syndrome (fissured tongue)
  • Down's syndrome (fissured tongue)
  • orofacial granulomatosis (fissured tongue)
  • oxidising mouthwash use (hairy tongue)
  • drug abuse (hairy tongue)

Diagnostic investigations

Treatment algorithm



Konrad S. Staines, BChD, FDS RCS (Eng), MOMED RCS (Edin), FHEA

Consultant Senior Lecturer in Oral Medicine

School of Oral and Dental Science

University of Bristol




KSS is employed by an NHS Trust, University of Bristol. He performs non-remunerated work for the Royal Colleges (UK).


Dr Konrad S. Staines would like to gratefully acknowledge Professor Aisha Sethi, the previous contributor to this topic. AS declares that she has no competing interests.

Peer reviewers

Nuala O'Donoghue, MBBS

Consultant Dermatologist

St Mary's Hospital

Imperial College Healthcare NHS Trust




NOD declares that she has no competing interests.

Issac van der Waal, DDS, PhD

Professor of Oral Pathology

Head of the Department of Oral and Maxillofacial Surgery and Oral Pathology

VU University Medical Centre and Academic Centre for Dentistry


The Netherlands


IVDW declares that he has no competing interests.

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