Glossitis

Gastroenterology

Clinicals - History

Fact Explanation
Swollen tongue The term glossitis refers to a condition of the tongue in which it's swollen and change in colour with smooth surface of the tongue. There are many causes for this condition such as Allergic reactions to oral care products, foods, or medicine, Sjogren syndrome, infection from bacteria, yeast or viruses (including oral herpes), injury (such as from burns, rough teeth, or bad-fitting dentures), skin conditions that affect the mouth, irritants such as tobacco, alcohol, hot foods, spices, or other irritants, hormonal factors, familial and due to various vitamin deficiencies. Swollen tongue
The term glossitis refers to a condition of the tongue in which it's swollen and change in colour with smooth surface of the tongue. There are many causes for this condition such as Allergic reactions to oral care products, foods, or medicine, Sjogren syndrome, infection from bacteria, yeast or viruses (including oral herpes), injury (such as from burns, rough teeth, or bad-fitting dentures), skin conditions that affect the mouth, irritants such as tobacco, alcohol, hot foods, spices, or other irritants, hormonal factors, familial and due to various vitamin deficiencies.
Difficulty with chewing, swallowing, or speaking Because of the swollen and sore tongue there could be difficulties in chewing, swallowing and speaking. Difficulty with chewing, swallowing, or speaking
Because of the swollen and sore tongue there could be difficulties in chewing, swallowing and speaking.
Sore and tender tongue This is mainly seen in glossitis associated with nutritional deficiencies There are inflammatory changes char
acterized by bright red plaques which may then evolve into the atrophic form, noted as atrophy of the lingual papillae, affecting more than 50%
of the tongue’s surface. A burning sensation of the mouth is reported.
Sore and tender tongue
This is mainly seen in glossitis associated with nutritional deficiencies There are inflammatory changes char
acterized by bright red plaques which may then evolve into the atrophic form, noted as atrophy of the lingual papillae, affecting more than 50%
of the tongue’s surface. A burning sensation of the mouth is reported.
Colour change in the tongue This is mainly seen in glossitis associated with nutritional deficiencies There are inflammatory changes char
acterized by bright red plaques in vitamin B 12 deficiency and pale tongue in iron deficiency.
Colour change in the tongue
This is mainly seen in glossitis associated with nutritional deficiencies There are inflammatory changes char
acterized by bright red plaques in vitamin B 12 deficiency and pale tongue in iron deficiency.
Difficulty in speaking and other features of blocked airway Swollen tongue can cause respiratory difficulties and block the air way. Difficulty in speaking and other features of blocked airway
Swollen tongue can cause respiratory difficulties and block the air way.
Dry mouth Sometimes there could be symptoms of underlying disease such as Sjogren's syndrome and patient may complain of dry mouth. Dry mouth
Sometimes there could be symptoms of underlying disease such as Sjogren's syndrome and patient may complain of dry mouth.
Fatigue, Weakness, Shortness of breath on exertion When the underlying disorder is nutritional deficiency such as iron or vitamin B12 deficiency, there could be anemic symptoms due to low hemoglobin level in the circulation. Fatigue, Weakness, Shortness of breath on exertion
When the underlying disorder is nutritional deficiency such as iron or vitamin B12 deficiency, there could be anemic symptoms due to low hemoglobin level in the circulation.

Clinicals - Examination

Fact Explanation
Red , tender and swollen tongue inflammatory changes characterized by bright red plaques which then evolve into the atrophic form, noted as atrophy
of the lingual papillae, affecting more than 50% of the tongue’s surface is seen commonly with nutritional deficiencies.
Red , tender and swollen tongue
inflammatory changes characterized by bright red plaques which then evolve into the atrophic form, noted as atrophy
of the lingual papillae, affecting more than 50% of the tongue’s surface is seen commonly with nutritional deficiencies.
Smooth surface of the tongue Smooth tongue because of the smooth, glossy appearance with a red or pink background and seen in atrophic glossitis. The smooth quality is caused by the atrophy of filiform papillae. Atrophic glossitis is primarily a manifestation of underlying conditions such as nutritional deficiencies of iron, folic acid, vitamin B12, riboflavin, and niacin Smooth surface of the tongue
Smooth tongue because of the smooth, glossy appearance with a red or pink background and seen in atrophic glossitis. The smooth quality is caused by the atrophy of filiform papillae. Atrophic glossitis is primarily a manifestation of underlying conditions such as nutritional deficiencies of iron, folic acid, vitamin B12, riboflavin, and niacin
Map-like appearance to the surface of the tongue This is seen in Geographic tongue or benign migratory glossitis. The exact cause of geographic tongue is unknown but attributed to lack of vitamin B. It also may be due to irritation from hot or spicy foods, or alcohol. The change in pattern on the surface of the tongue occurs when there is a loss papillae, on the tongue. These areas look flat as a result. Map-like appearance to the surface of the tongue
This is seen in Geographic tongue or benign migratory glossitis. The exact cause of geographic tongue is unknown but attributed to lack of vitamin B. It also may be due to irritation from hot or spicy foods, or alcohol. The change in pattern on the surface of the tongue occurs when there is a loss papillae, on the tongue. These areas look flat as a result.
Fissuring of the tongue There could be development of deep grooves due to physiologic deepening of normal tongue fissures. These occur commonly with aging and require no treatment, unless trapping of food and bacteria leads to inflammation of the fissures. Fissured tongue has been associated with Down syndrome, acromegaly, psoriasis, and Sjögren syndrome. Fissuring of the tongue
There could be development of deep grooves due to physiologic deepening of normal tongue fissures. These occur commonly with aging and require no treatment, unless trapping of food and bacteria leads to inflammation of the fissures. Fissured tongue has been associated with Down syndrome, acromegaly, psoriasis, and Sjögren syndrome.
Angular stomatitis These symptom of fissuring of corners of the mouth are mainly seen associated with nutritional deficiency of Vitamin B12 and also iron. Angular stomatitis
These symptom of fissuring of corners of the mouth are mainly seen associated with nutritional deficiency of Vitamin B12 and also iron.
Pallor Pallor develops with anemia secondary to iron and vitamin B12 deficiency. Pallor
Pallor develops with anemia secondary to iron and vitamin B12 deficiency.

Investigations - Diagnosis

Fact Explanation
Full blood count To evaluate the hemoglobin status as anemia due to various nutritional deficiencies can cause glossitis. Red cell indices can also point towards the diagnosis with low mean corpuscular volume (MCV), Mean corpuscular hemoglobin (MCH), will be low in iron deficiency anemia but high MCV is seen in vitamin B12 deficiency anemia. Furthermore changes in the white cell count can also direct towards infections. Also low white cell count and platelet count is observed in vitamin B12 deficiency. Full blood count
To evaluate the hemoglobin status as anemia due to various nutritional deficiencies can cause glossitis. Red cell indices can also point towards the diagnosis with low mean corpuscular volume (MCV), Mean corpuscular hemoglobin (MCH), will be low in iron deficiency anemia but high MCV is seen in vitamin B12 deficiency anemia. Furthermore changes in the white cell count can also direct towards infections. Also low white cell count and platelet count is observed in vitamin B12 deficiency.
Serum iron studies Iron deficiency anemia is a recognized cause for glossitis and serum iron studies including, serum ferritin, total iron binding capacity (TIBC), Serum iron can be done. TIBC will be high but others will be low. Serum iron studies
Iron deficiency anemia is a recognized cause for glossitis and serum iron studies including, serum ferritin, total iron binding capacity (TIBC), Serum iron can be done. TIBC will be high but others will be low.
Serum vitamin B 12 level Vitamin B12 deficiency can also cause glossitis and low serum vitamin B 12 will be shown Serum vitamin B 12 level
Vitamin B12 deficiency can also cause glossitis and low serum vitamin B 12 will be shown
Serum folate/ Red cell folate level In folic acid deficiency, serum folate will be low, but in the presence of vitamin B12 deficiency, this will be normal. Therefore most reliable investigation is red cell folate which is invariably low in both deficiencies. Serum folate/ Red cell folate level
In folic acid deficiency, serum folate will be low, but in the presence of vitamin B12 deficiency, this will be normal. Therefore most reliable investigation is red cell folate which is invariably low in both deficiencies.
Blood picture In the presence of vitamin B12 deficiency, macrocytosis is seen which are oval with hypersegmented neutrophils sometimes with leukopenia and thrombocytopenia. In iron deficiency anemia, microcytic anemia is seen. Blood picture
In the presence of vitamin B12 deficiency, macrocytosis is seen which are oval with hypersegmented neutrophils sometimes with leukopenia and thrombocytopenia. In iron deficiency anemia, microcytic anemia is seen.
Bone marrow aspiration This is carried out in anemia, and in vitamin B12 deficiency anemia, hypercellular bone marrow with megaloblasts with giant and abnormal metamyelocytes are seen. Bone marrow aspiration
This is carried out in anemia, and in vitamin B12 deficiency anemia, hypercellular bone marrow with megaloblasts with giant and abnormal metamyelocytes are seen.
Serum unconjugated bilirubin These levels are high because marrow cell breakdown is high Serum unconjugated bilirubin
These levels are high because marrow cell breakdown is high
Serum hydroxy Butyrate These levels are high because marrow cell breakdown is high Serum hydroxy Butyrate
These levels are high because marrow cell breakdown is high
Serum lactate dehydrogenase level (LDH) These levels are high because marrow cell breakdown is high Serum lactate dehydrogenase level (LDH)
These levels are high because marrow cell breakdown is high
Serum creatinine, Blood urea nitrogen level Renal function tests will give abnormal results when the cause is Amyloidosis and renal amyloidosis is common. Serum creatinine, Blood urea nitrogen level
Renal function tests will give abnormal results when the cause is Amyloidosis and renal amyloidosis is common.
Urine analysis Urine full report may show proteinuria in the presence of renal amyloidosis. Urine analysis
Urine full report may show proteinuria in the presence of renal amyloidosis.
Antibody test for Celiac disease Anti-endomysial antibody levels can be done in a patient with suspected Celiac disease. Antibody test for Celiac disease
Anti-endomysial antibody levels can be done in a patient with suspected Celiac disease.
Rhematoid factor, Anti nuclear antibody level These levels are commonly high in Sjogren's syndrome. Rhematoid factor, Anti nuclear antibody level
These levels are commonly high in Sjogren's syndrome.
Schirmer test This test is done when Sjogren's syndrome is suspected in which a bent piece of filter paper is placed into the lower conjunctiva and left there for five minutes. A definitive positive result can be considered if the paper is wet less than 5 mm after five minutes. In normal people the paper will be wet to 15 mm or beyond after five minutes, Schirmer test
This test is done when Sjogren's syndrome is suspected in which a bent piece of filter paper is placed into the lower conjunctiva and left there for five minutes. A definitive positive result can be considered if the paper is wet less than 5 mm after five minutes. In normal people the paper will be wet to 15 mm or beyond after five minutes,

Investigations - Management

Fact Explanation
Full blood count Patient can be followed up with periodical hemoglobin level to see the efficacy of treatment with iron, vitamin B12, folate. Full blood count
Patient can be followed up with periodical hemoglobin level to see the efficacy of treatment with iron, vitamin B12, folate.
Serum iron studies This levels can be done to assess the efficacy of treatment with nutritional supplements. Serum iron studies
This levels can be done to assess the efficacy of treatment with nutritional supplements.
Serum Vitamin B 12 level This levels can be done to assess the efficacy of treatment with nutritional supplements. Serum Vitamin B 12 level
This levels can be done to assess the efficacy of treatment with nutritional supplements.
Serum Red cell folate This levels can be done to assess the efficacy of treatment with nutritional supplements. Serum Red cell folate
This levels can be done to assess the efficacy of treatment with nutritional supplements.
Reticulocyte count With treatment, reticulocytosis should be seen within 3-5 days with a peaking in 4-10 days. Reticulocyte count
With treatment, reticulocytosis should be seen within 3-5 days with a peaking in 4-10 days.
Serum LDH Elevated lactate dehydrogenase (LDH) and rapid fall of indirect bilirubin levels is seen. Prolonged elevated LDH level indicates failure of the therapy, or possible development of iron deficiency, or even an error in diagnosis. Serum LDH
Elevated lactate dehydrogenase (LDH) and rapid fall of indirect bilirubin levels is seen. Prolonged elevated LDH level indicates failure of the therapy, or possible development of iron deficiency, or even an error in diagnosis.
Serum unconjugated bilirubin This level should also fall rapidly with treatment. Serum unconjugated bilirubin
This level should also fall rapidly with treatment.
Serum potassium level With treatment for severe cobalamin or folate deficiency, serum potassium level may fall rapidly and can result in sudden death. Hence potassium levels should be monitored carefully. Supplementation of potassium may be needed especially if older patients on diuretics. Serum potassium level
With treatment for severe cobalamin or folate deficiency, serum potassium level may fall rapidly and can result in sudden death. Hence potassium levels should be monitored carefully. Supplementation of potassium may be needed especially if older patients on diuretics.
Rhematoid factor, Anti nuclear antibody level These antibody levels are needed to screen for Sjogren's syndrome as these are commonly elevated. Rhematoid factor, Anti nuclear antibody level
These antibody levels are needed to screen for Sjogren's syndrome as these are commonly elevated.
Anti-endomysial antibody levels Anti-endomysial antibody levels can be done in a patient with suspected Celiac disease. Anti-endomysial antibody levels
Anti-endomysial antibody levels can be done in a patient with suspected Celiac disease.

Management - Supportive

Fact Explanation
Patient education Patient education plays an important role to educate on good oral care such as brushing teeth thoroughly at least twice a day and floss at least once a day, to avoid irritants (such as hot or spicy foods, alcohol, and tobacco) to ease discomfort. Patient should also educated on importance of healthy diet. Patient education
Patient education plays an important role to educate on good oral care such as brushing teeth thoroughly at least twice a day and floss at least once a day, to avoid irritants (such as hot or spicy foods, alcohol, and tobacco) to ease discomfort. Patient should also educated on importance of healthy diet.
Diet Diet changes are needed and patient should be instructed to eat iron rich food, vitamin B containing food to combat nutritional deficiencies. Diet
Diet changes are needed and patient should be instructed to eat iron rich food, vitamin B containing food to combat nutritional deficiencies.
Anti inflammatory agents Corticosteroids such as prednisone may be given to reduce the inflammation of glossitis and for mild cases, topical applications such as a prednisone mouth rinse may be recommended Anti inflammatory agents
Corticosteroids such as prednisone may be given to reduce the inflammation of glossitis and for mild cases, topical applications such as a prednisone mouth rinse may be recommended
Management of acute airway obstruction When a patient presents with acute airway obstruction due to swollen tongue, urgent measures are needed to secure the airway. Management of acute airway obstruction
When a patient presents with acute airway obstruction due to swollen tongue, urgent measures are needed to secure the airway.

Management - Specific

Fact Explanation
Antibiotics Antibiotics or other medicines to treat infections such as antifungals for candidiasis, and antivirals for herpes simplex is important Antibiotics
Antibiotics or other medicines to treat infections such as antifungals for candidiasis, and antivirals for herpes simplex is important
Vitamin B 12 therapy Intramuscular Cobalamin (1000 µg) a day is given for 2 weeks, followed by a weekly dose until the hematocrit value becomes normal, and then monthly for rest of the life. Oral cobalamin (1000-2000 µg) also can be administered as an alternative method. Vitamin B 12 therapy
Intramuscular Cobalamin (1000 µg) a day is given for 2 weeks, followed by a weekly dose until the hematocrit value becomes normal, and then monthly for rest of the life. Oral cobalamin (1000-2000 µg) also can be administered as an alternative method.
Folate therapy Folate (3-5 mg) is administered orally or comparable doses can be administered parenterally and Fortification of foods and folic acid supplements have been recommended. Folate therapy
Folate (3-5 mg) is administered orally or comparable doses can be administered parenterally and Fortification of foods and folic acid supplements have been recommended.
Iron therapy Oral administration of ferrous iron salts is commonly carried out in iron deficiency anemia. ferrous sulphate is commonly used. Parenteral iron therapy is reserved for patients those who are either unable to absorb oral iron or shows no response to oral iron. Iron therapy
Oral administration of ferrous iron salts is commonly carried out in iron deficiency anemia. ferrous sulphate is commonly used. Parenteral iron therapy is reserved for patients those who are either unable to absorb oral iron or shows no response to oral iron.
Treatment of Sjogren's syndrome When the underlying disease is Sjogren's syndrome, mainly supportive therapy is given and consists of artificial tears, Saliva substitutes for dry mouth and medications such as pilocarpine, Hydroxychloroquine Treatment of Sjogren's syndrome
When the underlying disease is Sjogren's syndrome, mainly supportive therapy is given and consists of artificial tears, Saliva substitutes for dry mouth and medications such as pilocarpine, Hydroxychloroquine
Gluten free diet for celiac disease As there is no cure for celiac disease, the only treatment is a gluten-free diet. Gluten free diet for celiac disease
As there is no cure for celiac disease, the only treatment is a gluten-free diet.

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