Last reviewed: 3 Feb 2021
Last updated: 10 Nov 2017



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)
  • Melkersson-Rosenthal's syndrome (fissured tongue)
  • Down's syndrome (fissured tongue)
  • poor oral hygiene (hairy tongue)
  • oxidising mouthwash use (hairy tongue)
  • increasing age (fissured tongue)
  • increasing age (hairy tongue)
  • hyposalivation (hairy tongue)

Diagnostic investigations

Treatment algorithm


Consultant Senior Lecturer in Oral Medicine

School of Oral and Dental Science

University of Bristol




KSS declares that he has no competing interests.

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

Peer reviewersVIEW ALL

Consultant Dermatologist

St Mary's Hospital

Imperial College Healthcare NHS Trust




NOD declares that she has no competing interests.

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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