Geographic tongue is a condition where the “dorsal” (top) surface of the tongue develops these irregular-looking, map-like patterns of red patches. To top it off, those patches can move or morph, changing shapes or affecting different parts of the top of the tongue. Hence the name “geographic tongue.” Clinically, this condition is called “benign migratory glossitis.”
These patches can sometimes cause a burning or stinging sensation. Even though the condition is not harmful and is usually painless, it can sometimes be associated with other medical conditions, such as psoriasis or eczema. The cause of geographic tongue is not completely understood, but it’s thought to be related to our body’s inflammatory or immune response.
Geographic tongue happens when those raw patches develop. You can see the smooth, pinkish-red surface surrounded by the remaining papilla; they resemble continents and oceans on a paper map. There might even be a thickish white border around the edges of each raw, red patch. Only in this case, you’re not reading a map; you’re looking at the top of your tongue.
The exact cause of geographic tongue is not something you can pinpoint as an “aha” moment, but it is thought to be related to inflammation and changes in our bodies because of an immune response, illness, or deficiency. The good news is that these oral mucosal lesions aren't contagious or caused by poor oral hygiene, so you won’t spread it by kissing or sharing food. Some people may be more prone to developing geographic tongues because of underlying factors such as genetics or conditions like psoriasis.
Here are some of the clinical characteristics of geographic tongue:
The symptoms can be uncomfortable, but they are generally painless or at least on the mild side. Some people may not even be aware they have geographic tongue, as it can go undetected unless you’re specifically looking for it or the condition is severe.
If you are experiencing symptoms of geographic tongue, it's important to visit a dentist as soon as possible. Dentists have the training and experience to diagnose a plethora of oral conditions, so they can provide the best advice for your unique needs. They can help rule out other causes of tongue irritation, provide treatment options, and help manage the condition if that’s what it is.
Geographic tongue tends to flare up and go away in phases. Sometimes it’s worse than others. As you pay attention to your symptoms you may be able to link them to one of the following scenarios (and if you can link the two, it can make it easier to manage your symptoms when they do develop.) On that note, always make sure you’re sharing your health history and medication list with your dental team. Even though you might feel as though your health conditions aren’t related to the way your mouth looks, the oral-systemic health link is closer than you might realize.
When you inherit a genetic condition from your parent, you usually have the advantage of knowing what has (or hasn’t) worked well for other family members. It also gives your family dentist and physician the “heads up” to look for the condition during your routine exams, so that they can intercept early symptoms while they’re less severe and more manageable.
Some people believe that their geographic tongue symptoms are most prominent during hormonal changes, such as menses, pregnancy, and/or menopause.
Fortunately, most hormone-related oral symptoms are short-lived and resolve on their own in time. If you notice that symptoms are severe or directly correlated with medications, such as birth control pills or hormone replacement therapy, be sure to discuss your concerns with your medical professional (your pharmacist might have some advice too!)
A nutritional or vitamin deficiency can vary from not getting enough sunlight to eating too few leafy green vegetables. The specific nutrients that are thought to influence geographic tongue the most include:
Fortunately, this one is easy! It’s time to up your intake of these specific nutrients either through a vitamin supplement, or, even better, fresh, whole foods.
Most of these nutrients are also found in your “fortified” breakfast cereals. Just be sure to pick one that isn’t loaded with tons of sugar or artificial sweeteners.
Active oral infection, redness, and swelling will always occur if your oral hygiene isn’t up to par. Because dental plaque is loaded with bacteria, our body naturally wants to attack it if we aren’t cleaning it away every day. That’s why conditions like gingivitis and gum disease are so common.
Your tongue is no stranger to bacterial buildup. Every time you eat, tons of tiny little food particles get tucked away between those finger-like projections across the surface of your tongue. If you aren’t sure how to clean them off the right way, you could be more prone to bad breath, tongue infections, and a red, irritated tongue.
Brushing twice a day and flossing every day are a given. But you also need to make sure you’re using a tongue scraper. Tongue scrapers do just what you think they do: scrape away buildup, food, plaque, and germs on your bumpy tongue surface.
To use a tongue scraper, place it as far back as comfortable on your tongue. Apply light to medium pressure, then pull or scrape the tool toward the tip of your tongue. Take a peek at it, and you’ll honestly be flabbergasted by what you see. Rinse it off before using it another one to two swipes.
Since you might want to avoid scraping over any geographic tongue flare-ups, use an alcohol-free mouth rinse as well.
People with severe allergy symptoms typically do best working with an allergist, who is a medical expert specializing in allergic reactions. Their treatment could involve injectable medications, over-the-counter drugs, and other prophylactic tactics to prevent the onset of allergy symptoms before they have a chance to get severe.
Look, we all experience stress. Stress is not avoidable and, in some situations, it’s necessary for a healthy immune system. But long-term stress can wear our bodies out and make us more likely to develop illnesses. Fortunately, stress management techniques such as meditation, exercise, cognitive behavioral therapy, and prescription medication can be extremely helpful. Or if possible, make lifestyle changes that can reduce your stress load overall.
A fissured tongue is when someone has visible cracks in the sides or top (dorsal) surface of their tongue. The cracks could be tiny little lines, or they might be gigantic craters resembling the Grand Canyon (not to scale, of course.)
Fissured tongues are often thought to be genetic and passed down from parent to child, as the symptom often runs in families. Keep in mind that habits such as oral hygiene or nutrition can also be learned behaviors passed down from one generation to the next, making them familial but not genetic, per se.
It’s not necessary to treat a fissured tongue. However, you do want to take steps to avoid infections, as food and bacteria can easily get caught deep inside of the cracks on your tongue. In addition to brushing, flossing, and the gentle use of a tongue scraper, consider using an alcohol-free mouthwash to rinse away any residual loose bacteria.
But surprise, surprise: people living with eczema or psoriasis are also more likely to develop geographic tongue than people without those skin conditions.
When it comes to treating skin conditions like psoriasis and eczema, dermatologists may use a variety of approaches such as topical creams or ointments, steroid injections, oral medicine (such as methotrexate or biologics,) light therapy, and phototherapy. The goal of treatment is to reduce the redness and itchiness caused by these skin conditions so that symptoms are mild or non-existent. Skin specialists like dermatologists typically have to monitor their patients closely to find the most effective combination of treatments for their individual circumstances. There typically isn’t a one-size-fits-all solution.
It’s thought that certain conditions may make a person more likely to develop geographic tongue. Some of the possible complications geographic tongue can cause include things like:
Genetics: Geographic tongue may run in families, indicating a possible genetic link.
Other health conditions: People with psoriasis, eczema, or other inflammatory skin conditions may be more likely to develop geographic tongue.
Gender: Geographic tongue is more common in women than in men.
Smoking and alcohol: People who smoke or consume alcohol may be more likely to develop geographic tongue than people who don’t.
It's important to note that having a risk factor does not necessarily mean a person will develop geographic tongue or not. People without any of these risk factors can still exhibit symptoms.
The only thing to watch for is pain, geographic tongue can sometimes make it difficult to eat or swallow. If you have burning tongue symptoms, talk to your dentist about the treatments available.
Even though there’s not a specific way to cure geographic tongue, your dentist might recommend several methods to help manage the symptoms or prevent severe flare-ups, such as:
Over-the-counter pain relievers: To alleviate burning or stinging sensations.
Topical creams or gels: To help reduce inflammation and soothe discomfort, especially before eating.
Diet modification: Avoid spicy or acidic foods that may irritate the tissues inside your mouth.
Cutting out alcohol, alcohol-containing mouthwash, and nicotine: Alcohol is a drying agent and will cause further irritation. Smoking and vaping can also be harmful.
Vitamin supplements: Deficiencies in vitamin B12 or folic acid are linked with geographic tongue, so vitamin supplements may be helpful.
Miracle mouthwash: This prescription or homemade concoction can help alleviate discomfort associated with burning mouth symptoms.
If your tongue issues are severe or worsen, your dentist may refer you to a specialist, such as an oral surgeon, immunologist, or dermatologist, for a biopsy or a secondary evaluation.
It's not entirely clear what causes geographic tongue, so it's difficult to say how to avoid it entirely. However, some steps may help to reduce the likelihood of developing the condition, including:
Despite these steps, it’s not always possible to prevent geographic tongue from developing. You may still develop the condition, but symptoms could be less severe.
It's important to note that there is no specific treatment for geographic tongue, and in most cases, the condition will go away on its own over time. However, it’s worth noting that other types of pathology—including oral cancer—could potentially mimic the appearance of geographic tongue. You can’t afford to ignore the symptoms. Plan to see your dentist regularly for oral exams and cancer screenings to rule out any cancerous or pre-cancerous tissues.
If you’ve never been diagnosed with geographic tongue and notice symptoms getting worse or persisting for more than two weeks, schedule an exam with your dentist for a professional evaluation.
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