Glossitis
Related Subjects:
|Macroglossia
|Microstomia
|Glossitis
|Medical Teeth
|Gum hypertrophy
|Angular Stomatitis - Cheilitis
|Oral Aphthous Ulcers
|Oral Leukoplakia
👅 About
- Glossitis = inflammation of the tongue, often smooth, red, and sore due to loss of papillae.
Also called atrophic glossitis. “Geographical tongue” describes patchy focal papillary loss.
🧪 Aetiology
- Loss of tongue papillae occurs due to nutritional deficiencies or systemic disease.
- Inflammation may be primary or secondary to infections (e.g. Candida).
🍊 Causes
- B12/Folate deficiency: Classic cause - often with megaloblastic anaemia; B12 deficiency may also cause neuropathy.
- Iron deficiency: Common; check for chronic blood loss (e.g. GI malignancy, menorrhagia).
- Coeliac disease: Malabsorption of iron and B12/folate → glossitis.
- Other causes: Pernicious anaemia, hypothyroidism, candidal infection, drug reactions, atrophic lichen planus.
🧠 Clinical Features
- Appearance: Smooth, red, sore tongue with papillae loss.
- Symptoms: Pain, burning, altered taste. Severe pain may suggest superimposed candidiasis.
- Associated signs: Angular stomatitis, pallor, nail changes → iron deficiency; neurological deficits → B12 deficiency.
🔬 Investigations
- 🩸 Blood tests: FBC, MCV (macrocytosis vs microcytosis), serum ferritin, folate, B12.
- 🧪 Other tests: TFTs, coeliac screen (anti-endomysial / anti-TTG antibodies), U&E if systemic disease suspected.
💊 Management
- Correct deficiencies: Replace iron, folate, or B12 as indicated (IM hydroxocobalamin for B12 in UK practice).
- Nutritional support: Balanced diet with adequate micronutrients.
- Treat secondary causes: Antifungal therapy if candidiasis; treat coeliac disease with gluten-free diet.
- Symptomatic relief: Topical agents for pain; good oral hygiene.
🌟 Teaching Pearls
- Glossitis + angular cheilitis + iron deficiency = consider Plummer–Vinson syndrome (premalignant, linked to oesophageal carcinoma).
- B12 deficiency → think pernicious anaemia, malabsorption, vegan diet.
- Always investigate iron deficiency in adults for occult GI bleeding.
📚 References
- Kumar, V., Abbas, A.K., & Aster, J.C. (2020). Robbins and Cotran Pathologic Basis of Disease (10th ed.).
- NIH: Glossitis
- Mayo Clinic: Glossitis
- ADA & WHO: Oral health and nutritional deficiencies.
