Fissured, hairy, and geographic tongue

Last reviewed: 23 Aug 2023
Last updated: 15 Jun 2023



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)
More key diagnostic factors

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)
Other diagnostic factors

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 syndrome (fissured tongue)
  • Down syndrome (fissured tongue)
  • orofacial granulomatosis (fissured tongue)
  • oxidizing mouthwash use (hairy tongue)
  • drug abuse (hairy tongue)
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • tongue biopsy
More investigations to consider

Treatment algorithm


geographic tongue

fissured tongue

hairy tongue



Konrad S. Staines, BChD, FDS RCS (Eng), SFHEA

Consultant & Honorary Professor in Oral Medicine

Bristol Dental School

University of Bristol




KSS discloses his salary is partially-funded by the University of Bristol and Health Education England. He has also received an educational grant from the Elizabeth Wiley Foundation.


Professor 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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