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Tongue conditions

Last updated: May 21, 2021

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The tongue's appearance holds a wealth of information about a patient's general health status, and specific changes (e.g., strawberry tongue) can provide valuable clues in the diagnosis of diseases such as scarlet fever, candidiasis, Kawasaki syndrome, nutritional deficiencies, and certain cancers. Accordingly, the ability to identify tongue findings may become crucial in making the right diagnosis and initiating the proper treatment early in the course of a disease.

Tongue conditions

Common tongue conditions
Features Etiology Treatment
Leukoplakia
  • Persistent white plaques that cannot be scraped off
  • Not fully understood
  • Associated with alcohol and tobacco use
Oral cavity cancer
Oral lichen planus
  • Thin, gray-white lines forming a reticular pattern (Wickham striae)
  • Painful, atrophic, and erosive lesions may be present.
Oral candidiasis/oral thrush
  • White lesions that can be scraped off, giving way to red, inflamed, or bleeding areas
Atrophic glossitis
  • Treatment of the underlying condition
Erythroplakia [2]
  • Not fully understood
  • Associated with tobacco and alcohol use
  • Tobacco and alcohol use cessation
  • Carbon dioxide laser excision

Oral hairy leukoplakia

  • Benign, painless, irregularly shaped white plaques with feathery or hairy appearance
  • Most commonly located on the lateral tongue, but can also occur on the floor of the mouth, palate, or buccal mucosa
  • Patches cannot be scraped off (in contrast to oral thrush)
  • Treatment of the underlying condition
Herpetic gingivostomatitis
  • HSV-1
  • Predominantly affects children

Tongue findings

Common tongue findings
Finding Features Associated conditions and factors Treatment
Geographic tongue (benign migratory glossitis)
  • Solitary, irregular patches of red and white tongue discoloration that resemble a geographic map
  • Lesions migrate and patients experience exacerbations and remissions over time
  • Caused by loss of filiform lingual papillae
Median rhomboid glossitis [4][5]
Fissured tongue [2]
  • One or more deep grooves located on the dorsum of the tongue
  • Possibly halitosis and discoloration if food gets trapped in the fissures and causes inflammation
  • In case debris causes inflammation, it may be necessary to rinse or brush the affected area.
Black hairy tongue [2][6]
  • Brown, black, or yellowish discoloration of the tongue with fuzzy appearance
  • Brushing affected area with toothbrush
  • Practicing good oral hygiene
  • Avoiding alcohol and tobacco
White tongue
  • Temporary white or gray accumulation of debris on the dorsum of the tongue
  • Accumulation of dead cells, food residue, and bacteria, promoted by:
    • Poor oral hygiene
    • Dehydration
    • Mouth breathing
    • Smoking, alcohol consumption
  • Practicing good oral hygiene
  • Avoiding alcohol and tobacco
Strawberry tongue
Tongue fasciculations
  • Involuntary twitching of the tongue
  • Treatment of the underlying condition
Telangiectasias
  • No specific treatment for the tongue abnormality
Bluish-black patches
  • Treatment of the underlying condition
Macroglossia
  • Mild cases: speech therapy
  • Severe cases: surgery (reduction glossectomy)
  • Treatment of the underlying acquired cause (e.g., radiotherapy for tumors)
Squamous cell papilloma

  1. Gupta S, Jawanda M. Oral lichen planus: An update on etiology, pathogenesis, clinical presentation, diagnosis and management. Indian J Dermatol. 2015; 60 (3): p.222. doi: 10.4103/0019-5154.156315 . | Open in Read by QxMD
  2. Mangold AR, Torgerson RR, Rogers RS. Diseases of the tongue. Clin Dermatol. 2016; 34 (4): p.458-469. doi: 10.1016/j.clindermatol.2016.02.018 . | Open in Read by QxMD
  3. Goldman RD. Acyclovir for herpetic gingivostomatitis in children.. Can Fam Physician. 2016; 62 (5): p.403-4.
  4. Goregen M, Miloglu O, Buyukkurt MC, Caglayan F, Aktas AE. Median rhomboid glossitis: a clinical and microbiological study.. European journal of dentistry. 2011; 5 (4): p.367-72.
  5. Panta P, Erugula SR. Median rhomboid glossitis-developmental or candidal?. Pan African Medical Journal. 2015; 21 . doi: 10.11604/pamj.2015.21.221.5733 . | Open in Read by QxMD
  6. Grigoriy E Gurvits. Black hairy tongue syndrome. World Journal of Gastroenterology. 2014; 20 (31): p.10845. doi: 10.3748/wjg.v20.i31.10845 . | Open in Read by QxMD
  7. Reamy BV, Derby R, Bunt CW. Common tongue conditions in primary care.. Am Fam Physician. 2010; 81 (5): p.627-34.