Glossitis & Glossodynia

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

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

Clinical

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