Because it is so common and rarely causes any problems for patients, many authorities consider fissured tongue to be a normal variation of the tongue rather than some form of disease.

 

Geographic Tongue

A relatively common but poorly-understood condition that is often seen together with fissured tongue is something called geographic tongue (erythema migrans, benign migratory glossitis). This is a benign (not serious) condition has a tendency to involve the upper and lateral (side) aspects of the tongue, although it can occur in other areas of the mouth as well. It usually affects middle-aged and older adults. A cause is unknown.

 

Many patients have no symptoms at all, but about 10 to 15% of patients will describe soreness or mild pain when the geographic tongue is active, especially when exposed to acidic or spicy foods. Use of a topical corticosteroid rinse (like dexamethasone elixir) in a swish-and-spit fashion two to three times a day often helps relieve the swelling and/or soreness.

 

The tongue in many, but not all, patients with geographic tongue often has numerous folds or ridges on the upper surface as well as red spots that appear to move from one area to another, feel slightly raised and are tender.These red areas usually have a slightly white or yellow-white, raised line around their edges.

 

Although geographic tongue typically runs a waxing and waning course, it rarely has symptoms beyond mild sensitivity. It does not represent an infection (sexually-transmitted or otherwise) and cannot be passed along to anyone else. It is also not related to oral cancer.

 

Find more information at the American Academy of Oral & Maxillofacial Pathology.

 

Burning Mouth Syndrome

Burning mouth syndrome (BMS) is a relatively common and harmless problem that affects peri- and post-menopausal women primarily (although about 10 to 20% of the patients whom we see with this condition are men). While it is an annoying condition, it is typically not progressive (does not get worse and worse), does not represent a form of cancer, and cannot be transmitted to anyone else. It often waxes and wanes in severity, and it has not been associated with any particular preceding event.

Even though the condition is called burning mouth syndrome, it really is a problem that affects several types of what are called sensory nerves in the oral region. The senses that can be affected include:

• pain: This is the burning or scalded sensation that many patients will experience. In many cases, the burning sensations are least notable in the morning and build in intensity throughout the day.
• taste: either loss of taste or taste phantoms,  tasting salt, bitter, sweet or sour even when there is nothing in the mouth
• texture: a sensation of swelling, sliminess, dryness or roughness.

Any one, two or all three types of sensory nerves can be affected, and sometimes the altered sensations will come and go independently. Patients may experience only one component (such as taste) or several components. A sensation of dryness or swelling is often described, even though actual swelling is not seen, and the amount of saliva does not seem to be reduced.

 

We often describe the process to our patients as being similar to having your arm fall asleep, which is another situation in which the nerves are sending annoying messages to the brain. Of course, with your arm, return to normal sensation is rather quick. And, actually, research has shown that the discomfort goes away by itself for more than half of burning mouth patients eventually, although the amount of time varies from person to person and is unpredictable. This unpredictable nature of the condition makes it hard to figure out if a particular drug that is given to treat burning mouth is actually helping, because in some cases, the condition would have gone away anyhow.

 

We are still trying to develop an effective treatment for burning mouth syndrome. From our perspective, there is no medically proven treatment for burning mouth syndrome. In other words, there have been no scientific, double-blind, placebo-controlled studies that have proven that any particular treatment actually works any better than placebo (sugar pill).

 

There is one alternative treatment that has brought relief to some of our patients. They report that it tends to reduce the number of bad days they have with their BMS. This treatment is based on the use of the drug capsaicin (Zostrix) to treat people who have severe pain (neuralgia) associated with shingles (recurrent varicella zoster virus infection or chickenpox). It is cheap, has little to no side effects, and will not interact with any other medication you may be taking.

 

Capsaicin has been shown to reduce the levels of nerve signals needed to transmit pain to the brain as well as shrink the number and size of pain fibers a bit. In the commercial product (Zostrix), capsaicin is very concentrated and too powerful for use in the mouth. It is available without a prescription, however, in the form of hot peppers and hot pepper sauce.

 

We have patients dilute three to five drops of any commonly available tabasco or hot sauce in a teaspoon of water. Some people have to start with one to two drops because the sauce is too irritating. Some people use the hot sauce without any water. Some start with three to five drops and work up to equal parts sauce and water over a period of several weeks. We instruct them to swish this mixture around in their mouth to coat the tongue and hold for 30 to 40 seconds, then expectorate. Repeat this swish and spit process three times a day. Over a variable time course (usually two to three weeks) many patients note that the painful sensations diminish.

 

This treatment does not cause the symptoms to disappear, but the relative relief makes the condition more tolerable and no one argues with the cost.

 

Find more information at the American Academy of Oral & Maxillofacial Pathology.

 

Hairy-Coated Tongue

Accumulation of keratin (the normal product of the top of the tongue) on the tongue can result in what is known as coated tongue, a harmless but sometimes annoying condition. If the amount of keratin is such that hair-like projections are formed on the top of the tongue, the condition is referred to as hairy tongue.

Black hairy tongue represents an overgrowth of certain pigment-forming bacteria which give the tongue a dark appearance. Black tongue may be a result of smoking, poor oral hygiene, use of certain antibiotics (penicillin, tetracyclines) or the chronic use of antacids and some types of mouthwash. Most of these causes can be directly attributed to changes in the bacteria that normally live in the mouth.

 

Some things you can do to remove the discoloration include:

• Use a tongue scraper
• Brush your tongue with a toothbrush twice a day
• Rinse your mouth with dilute hydrogen peroxide (one part peroxide to five parts water).  Be sure to rinse with water afterward.
• Brush your tongue with dilute hydrogen peroxide (one part peroxide to five parts water). Rinse with water afterward.

Find more information at the American Academy of Oral & Maxillofacial Pathology.

 

Taste Changes

Alterations in taste are not uncommon, but can have a large number and variety of causes. These can range from common things like gum disease to less common things like vitamin deficiencies, a medication side-effect, or even a condition known as burning tongue syndrome.  Your physician will likely be aware of this and ask a detailed history. However, it is not a bad idea to first have your dentist or a dental specialist look in your mouth for any signs of gum disease or oral infection that might be contributing to your problem.

 

Changes in taste as well as smell can be very challenging. A few specialized centers have been set up in the US to help diagnose and treat affected patients when the common causes have been eliminated.

 

When should you be concerned about conditions in your mouth?

• if the condition worsens or does not improve
• if the condition lasts longer than one or two weeks
• If you are experiencing the symptoms above, we would advise you to have the area examined by a dentist or dental specialist, such as an oral pathologist, to help you with a diagnosis and treatment, if needed.

 

How to find a dental care provider:

Dental & Health Care Centers that Don’t Require Insurance (Bureau of Primary Health Care)
Find a Dentist (Academy of General Dentistry)
Find a Dentist: ADA Member Directory (American Dental Association)
Find a Local Dental Organization (American Dental Association)