Summary
Definition
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
1st investigations to order
- clinical diagnosis
Investigations to consider
- tongue biopsy
Treatment algorithm
geographic tongue
fissured tongue
hairy tongue
Contributors
Authors
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
Bristol
UK
Disclosures
KSS is employed by an NHS Trust, University of Bristol. He performs non-remunerated work for the Royal Colleges (UK).
Acknowledgements
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
London
UK
Disclosures
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
Amsterdam
The Netherlands
Disclosures
IVDW declares that he has no competing interests.
Differentials
- Melkersson-Rosenthal's syndrome (fissured tongue)
- Oral hairy leukoplakia (hairy tongue)
- Acute pseudomembranous candidiasis (hairy/geographic tongue)
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