Thin white line of thickened epithelium on lateral borders of tongueĬaused by chewing trauma to lateral tongueĬlose observation, biopsy to rule out malignancy No treatment if asymptomatic, topical steroid for symptomatic ulcerative lesionsĬonsider evaluation and treatment for coexisting candidal infection biopsy needed for definitive diagnosis of lichen planus Manifests as reticular, white, lacy pattern on dorsal tongue or as shallow, scattered, erythematous ulcerations White, hairy appearing lesions on lateral border of tongueĮpstein-Barr virus super infection associated with immunocompromise, human immunodeficiency virus infection No treatment necessary, but gentle brushing or scraping of tongue may be helpfulĪssociated with tobacco use, poor oral hygiene, antibiotic use Hypertrophy of filiform papillae, tongue discoloration (white, tan, black) No treatment necessary, but topical steroid gels or antihistamine rinses can reduce tongue sensitivityĪssociated with fissured tongue, inversely associated with tobacco use Usually no treatment gentle brushing of tongue if symptomatic inflammation occursĪssociated with Down syndrome, psoriasis, Sjögren syndrome, Melkersson-Rosenthal syndrome, geographic tongueīare patches on dorsal tongue surrounded by serpiginous, raised, slightly discolored border Treat nutritional deficiency or other underlying conditionĬaused by underlying disease, medication use, or nutritional deficiencies (e.g., iron, folic acid, vitamin B 12, riboflavin, niacin)ĭeep grooves, malodor and discoloration may occur with inflammation or trapping of food Smooth, glossy appearance with red or pink background

Smooth, shiny, erythematous, sharply circumscribed, rhomboid shaped plaque usually asymptomatic, but burning or itching possible dorsal midline location Tongue lesions of unclear etiology may require biopsy or referral to an oral and maxillofacial surgeon, head and neck surgeon, or a dentist experienced in oral pathology. Several trials have also confirmed the effectiveness of surgical division of tongue-tie (ankyloglossia), in the context of optimizing the success of breastfeeding compared with education alone. Burning mouth syndrome often involves the tongue and has responded to treatment with alpha-lipoic acid, clonazepam, and cognitive behavior therapy in controlled trials.

Tongue growths usually require biopsy to differentiate benign lesions (e.g., granular cell tumors, fibromas, lymphoepithelial cysts) from premalignant leukoplakia or squamous cell carcinoma.

Oral hairy leukoplakia, which can be a marker for underlying immunodeficiency, is caused by the Epstein-Barr virus and is treated with oral antivirals. Atrophic glossitis is often linked to an underlying nutritional deficiency of iron, folic acid, vitamin B 12, riboflavin, or niacin and resolves with correction of the underlying condition. Median rhomboid glossitis is usually associated with a candidal infection and responds to topical antifungals. Geographic tongue, fissured tongue, and hairy tongue are the most common tongue problems and do not require treatment. Examination of tongue morphology and a careful assessment for lymphadenopathy are also important. Recognition and diagnosis require a thorough history, including onset and duration, antecedent symptoms, and tobacco and alcohol use. Although easily examined, abnormalities of the tongue can present a diagnostic and therapeutic dilemma for physicians.

Drug appily on tongue