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Key Features

  • Glossitis

    • Inflammation of the tongue with loss of filiform papillae leads to glossitis

    • May be secondary to nutritional deficiencies (eg, niacin, riboflavin, iron, or vitamin E), drug reactions, dehydration, irritants, food and liquids, and possibly autoimmune reactions or psoriasis

  • Glossodynia

    • Burning and pain of the tongue; it may occur with or without glossitis

    • In the absence of clinical findings of glossitis, it has been termed "the burning mouth syndrome"

    • Glossodynia has been associated with diabetes mellitus, drugs (eg, diuretics), tobacco, xerostomia, and candidiasis as well as the causes of glossitis

Clinical Findings

  • Rarely painful

  • Glossitis: red, smooth-surfaced tongue

  • Glossodynia: Consider imaging of the brain, brainstem, and skull base with MRI when

    • Symptoms are unilateral

    • Symptoms cannot be related to a specific medication

    • Symptoms and signs involve regions supplied by other cranial nerves, suggesting neuropathology

Diagnosis

  • Clinical

Treatment

  • Glossitis

    • If the primary cause cannot be treated, consider empiric nutritional replacement therapy

  • Glossodynia

    • Reassurance that there is no infection or tumor

    • Anxiolytic medications and evaluation of possible psychological status may be useful

    • Treating possible underlying causes, changing long-term medications to alternative ones, and smoking cessation may resolve symptoms

    • Effective treatments for burning mouth syndrome include alpha-lipoic acid and clonazepam

    • Clonazepam is most effective as a rapid dissolving tablet placed on the tongue in doses from 0.25 mg to 0.5 mg every 8–12 hours

    • Behavioral therapy has also been shown to be effective for burning mouth syndrome

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