Fissured tongue is usually a normal variant of tongue appearance and is not considered a pathologic entity. It generally presents in healthy people; however, it is also seen in association with conditions such as Down syndrome and geographic tongue. If the sole manifestation is that of fissured tongue, then no investigations or treatment are usually necessary.
Hairy tongue occurs when the physiologic balance between keratin production and shedding through normal oral function is chronically disrupted with consequent elongation of the keratinized component of the filiform papillae that cover the tongue dorsum. Poor oral intake during illness or oral discomfort secondary to oral ulcerative conditions are examples of situations where physiologic keratin shedding secondary to mechanical debridement may be reduced. Smoking, coffee or tea, or poor oral hygiene are examples of predisposing factors.
Improving oral hygiene, stopping smoking, and using a tongue scraper appropriately aids management of hairy tongue.
Geographic tongue appears as well-demarcated red areas of the dorsal and lateral tongue, with white scalloped borders. Its etiology is unknown and no treatment, other than symptomatic relief, is generally necessary.
Fissured tongue is a common, benign clinical condition of unknown etiology usually affecting the dorsum of the tongue. On physical examination, numerous grooves or fissures are seen on the dorsal surface of the tongue; these are usually a few millimeters in depth. They may occur in isolated areas of the tongue or may cover the entire dorsum.
Hairy tongue is a common, benign clinical condition with the hairy appearance on the dorsal tongue caused by keratin retention on the top of the filiform papillae. Hairy tongue presents on the dorsal surface as diffuse hair-like projections, particularly in the midline. The color of the elongated papillae may range from yellow to brown-black. There may be a difference in the color of the elongated papillae due to the exogenous staining from different foods, tobacco, and chromogenic bacteria.
Geographic tongue is a common, benign clinical condition that predominantly affects the lateral margins, the tip, and the dorsal surface of the tongue. Rarely, it may occur at other sites within the mouth, such as the buccal mucosa, the labial mucosa, and the soft palate. Geographic tongue presents as well-delineated areas of erythema with raised white circinate edges.
History and exam
Key diagnostic 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)
- discoloration (hairy tongue and fissured tongue)
- burning sensation (geographic tongue)
- oral mucosal pain (hairy tongue)
- 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 syndrome (fissured tongue)
- Down syndrome (fissured tongue)
- orofacial granulomatosis (fissured tongue)
- oxidizing mouthwash use (hairy tongue)
- drug abuse (hairy tongue)
1st investigations to order
- clinical diagnosis
Investigations to consider
- tongue biopsy
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