Alternative Names: Tongue inflammation; Tongue infection

Causes, incidence, and risk factors:

Changes in the appearance of the tongue may be a primary tongue disorder, or it may be a symptom of other disorders. Glossitis occurs when there is acute or chronic inflammation of the tongue. It causes the tongue to swell and change color. Finger-like projections on the surface of the tongue (papillae) are lost, causing the tongue to appear smooth. Also see geographic tongue.

The causes of glossitis include:

• Bacterial or viral infections (including oral herpes simplex)
• Mechanical irritation or injury from burns, rough edges of teeth or dental appliances, or other trauma
• Exposure to irritants such as tobacco, alcohol, hot foods, or spices
• Allergic reaction to toothpaste, mouthwash, breath fresheners, dyes in candy, plastic in dentures or retainers, or certain blood-pressure medications (ACE inhibitors)
• Disorders such as iron deficiency anemia, pernicious anemia and other B-vitamin deficiencies, oral lichen planus, erythema multiform, aphthous ulcers, pemphigus vulgaris, syphilis, and others

Occasionally, glossitis can be inherited.

Symptoms:

• Tongue swelling
• Smooth appearance to the tongue
• Tongue color usually dark "beefy" red
  • Pale, if caused by pernicious anemia
  • Fiery red, if caused by deficiency of B vitamins
• Sore and tender tongue
• Difficulty with chewing, swallowing, or speaking

Signs and tests:

An examination by a dentist or health care provider shows a swollen tongue (or patches of swelling). The nodules on the surface of the tongue (papillae) may be absent. Detailed questions may be asked to determine the possible source of tongue inflammation, if injury or other local cause is not readily apparent. Blood tests may confirm systemic causes of the disorder.

Treatment:

The goal of treatment is to reduce inflammation. Treatment usually does not require hospitalization unless tongue swelling is severe.

Good oral hygiene is necessary, including thorough tooth brushing at least twice a day, and flossing at least daily.

Corticosteroids such as prednisone may be given to reduce the inflammation of glossitis. For mild cases, topical applications (such as a prednisone mouth rinse that is not swallowed) may be recommended to avoid the side effects of swallowed or injected corticosteroids.

Antibiotics, antifungal medications, or other antimicrobials may be prescribed if the cause of glossitis is an infection. Anemia and nutritional deficiencies must be treated, often by dietary changes or other supplements. Avoid irritants (such as hot or spicy foods, alcohol, and tobacco) to minimize the discomfort.

Support Groups:

Expectations (prognosis):

Glossitis usually responds well to treatment if the cause of inflammation is removed or treated. This disorder may be painless, or it may cause tongue and mouth discomfort. In some cases, glossitis may result in severe tongue swelling that blocks the airway.

Complications:

• Discomfort
• Airway blockage
• Difficulties with speaking, chewing, or swallowing

Calling your health care provider:

Call for an appointment with your health care provider if symptoms of glossitis persist for longer than 10 days.

Call your health care provider if tongue swelling is severe and breathing, speaking, chewing, or swallowing difficulties are present. Blockage of the airway is an emergency situation that needs immediate attention.

Prevention:

Good oral hygiene (thorough tooth brushing and flossing and regular professional cleaning and examination) may be helpful to prevent these disorders. Minimize irritants or injury in the mouth when possible. Avoid excessive use of any food or substance that irritates the mouth or tongue.