Glossitis (Atrophic and Inflammatory) Inflamed Swollen Tongue

What is Glossitis?

Glossitis is the medical term for inflammation of the tongue. It generally implies a swollen, red and often painful tongue as these are common features of the inflammation process. However the term glossitis may also be used to refer to a red tongue, even without swelling, as may be seen in atrophic changes that is associated with certain vitamin deficiencies.

In glossitis, the typical rough appearance of the tongue caused by the papillae (refer to Tongue Anatomy) is lost due to the swelling. This makes the tongue look enlarged and smooth. Glossitis may either be primary where it is related to a disease or condition affecting the tongue or secondary where it is symptom or complication of other disorders.

In atrophic glossitis, inflammation may not be present but the mucosal lining of the tongue becomes excessively thin. The papillae of the tongue also shrinks. This exposes the underlying blood vessels that supply the tongue leading to the typical redness associated with inflammatory glossitis. These atrophic changes, however, do leave the tongue prone to a host of diseases that may cause additional symptoms like swelling (due to inflammation), cuts and open sores (ulcers) and patches on the tongue.

What are the Symptoms of Glossitis?

The tongue is a highly vascularized, muscular and sensitive organ. The inflammatory process may affect its functioning and structure leading to signs and symptoms such as :

  • Swollen tongue
  • Redness or pale tongue
  • Difficulty speaking
  • Difficulty swallowing
  • Pain and/or burning of the tongue
  • Loss of taste sensation (partial or complete) – inflammation may also disrupt the taste sensation leading to the perception of a bad taste in the mouth (cacogeusia) and other taste disorders (dysgeusia).

Other features  that may be present, which may or may not be related to the glossitis includes :

  • Ulcers – open sores on the tongue
  • Patches on the tongue – white patches, plaques, dark (brown or black) patches
  • Blisters on the tongue
  • Dryness of the mouth, including the tongue
  • Difficulty breathing if severe swelling of the tongue blocks the airways (medical emergency)
  • Skin lesions on the face, especially around the mouth
  • Swelling and cracking at the corners of the mouth (angular stomatitis) which may also lead to darkening over time

What Causes of Glossitis?

Infections

Bacterial and viral infections are the more common infectious causes of glossitis. It is often associated with other features like mouth sores (blisters, ulcers), pain and sometimes fever. Among the possible infectious causes, a herpes simplex infection of the mouth commonly results in glossitis.

Fungal infections of the tongue are less common and more frequently seen in immunocompromised patients (HIV, uncontrolled diabetes mellitus). Although various tongue symptoms may be seen in fungal infections of the tongue, glossitis is not present in every case. Secondary infections, particularly bacterial, often follows trauma to the tongue especially with piercings that are becoming a more common trend.

Trauma

Trauma is a common cause of glossitis and is usually acute with a clearly evident aetiology. It may be due to mechanical or chemical factors that irritate or injure the tongue :

  • Burns
  • Foods, drinks and supplements – spices, acidic, concentrated artificial dyes and flavorants, chewable vitamins
  • Dental care products (oral hygiene) – concentrated or toxic formulations
  • Smoking – tobacco, narcotic drugs
  • Tobacco and betel leaf/nut chewing
  • Alcohol – causes chemical trauma (especially with home/illegal brews, herbal tinctures which are not diluted) and leads to vitamin deficiencies (atrophic glossitis)
  • Jagged teeth and poorly fitting dental appliances/prosthetics like bridges, implants, dentures and retainers – tends to cause ulcers on the sides of the tongue (lateral aspect)
  • Tongue piercings (poorly done), especially when infected

Allergies

Many of the same factors responsible for trauma of the tongue may also lead allergic glossitis. This is more likely to occur in hypersensitive individuals.

  • Oral hygiene products
  • Foods, drinks, chewing gum, candy with certain flavorants, dyes or preservatives
  • Certain medication *
  • Dental prosthetics

* Drug side effects may also cause glossitis which is not an allergic reaction. This may be seen with certain types of bronchodilators (asthma, COPD) and ganglion blockers.

Deficiencies

Vitamin and mineral deficiencies are a common cause of atrophic glossitis. Thinning of the mucosal lining of the tongue and atrophy of the papillae exposures the underlying vasculature causing redness of the tongue. While atrophic glossitis is usually not inflammatory, various other disorders may affect the tongue due to the compromised surface and lead to inflammation (swollen tongue). In pernicious anemia, the tongue may appear pale.

  • Vitamin B12 – pernicious anemia
  • Riboflavin (vitamin B2)
  • Niacin (vitamin B3) – pellagra
  • Pyridoxine (vitamin B6)
  • Folic acid (vitamin B9)
  • Iron – iron-deficiency anemia
  • Vitamin C deficiency

Skin Diseases

Many of these skin diseases also involve the mucous membranes of the mouth, including the mucosal lining of the tongue.

  • Lichen planus
  • Pemphigus vulgaris
  • Erythema multiforme

Other Causes

  • Syphilis
  • Sjogren’s syndrome and other causes of a dry mouth
  • Alcoholism

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