Glossitis & Glossodynia

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