Luciano Schiazza M.D.
Geographic tongue (also known as benign migratory glossitis, glossitis areata exfoliativa, glossitis areata migrans, lingua geographica, stomatitis areata migrans, transitory benign plaques of the tongue, or erythema migrans) is an inflammatory, harmless condition of the surface ot the tongue that affects about 2% of the population. It may occur in any race, age or sex. However, it appears more commonly in females than males and more frequently in adults.
The tongue is normally covered with tiny, pinkish-white, small protrusions called papillae. With geographic tongue, patches on and around the sides of the tongue are missing papillae and appear as irregularly shaped, smooth, red “islands” often with a slightly white, yellow-white, graysh-white, raised borders. These patches give the tongue a map-like or geographic appearance.
Although geographic tongue may look alarming, it doesn't cause health problems.
The red patches may disappear and reappear, often heal in one area and then migrate to a different part of the tongue, changing in size and shape in a short period of time (hourly to dayly). They may persist days to weeks to months and clear up, usually waxing and waning in severity. It has an unpredictable course. The tongue can sometimes cause discomfort (burning or stinging sensation) for increased sensitivity (feels like, as it has been scalded) to certain substances (hot, spicy, salty or acidic foods- tomato, eggplant, chard and spinach, walnuts, pecans, sharp cheeses, sour foods, mint, candy and citrus-). The discomfort may come and go over time.
Chemicals, such as mouth washes and teeth whiteners, can also aggravate the condition. The condition may worsen at certain times of a women's menstrual cycle or during pregnancy.
It is not caused by an infection so people affected by geographic tongue don't have to be worried about passing this on to anyone else.
It is often noticed coexistence of another disorder called fissured tongue, characterized by the appearance of deep fissures, or grooves, on the surface of the tongue.
The cause of geographic tongue is unknown but some factors have been linked with the condition:
It occurs occasionally in patients with psoriasis, especially pustular psoriasis
There are associations with diabetes, anaemia and stress
It is more commonly found in people who are affected by environmental sensitivity, such as atopy (asthma and/or eczema and/or rinithis)
In some patients particular foods seem to be a trigger, especially cheese
Some people have a family history of the disorder, suggesting a genetic involvement
Variation with the menstrual cycle and while taking oral contraceptive pills suggests hormonal factors
It may be a connection with celiac disease
Geographic tongue has never been demonstrated to undergo trasformation to cancer. Of course, if any oral sore develops which doesn’t behave like geographic tongue, it would be to have evaluated by health care practitioner.
About treatment, geographic tongue is a benign condition that usually resolves itself without causing any problems for the patient so most people do not require treatment, because the consition is usually asymptomatic and insignificant. The patient should be reassured that there is, in fact, nothing seriously wrong.
There is no known cure. If there are associated medical conditions, treatment of these may improve the appearance of the tongue.
Geographic tongue can sometimes cause tongue discomfort: it may be treated with a mouth gargle or rinse containing antiseptic and anaesthetic agents. Topical corticosteroids may have to be prescribed to control the discomfort for those few patients who are very bothered by the problem.
It is important for reducing discomfort to avoid or limit subastnces that commonly aggravate sensitive oral tissues, including:
Hot, spicy, acidic, salty foods and sauces (especially those containing chili peppers or chili powder)
Acidic fruits ( citrus fruit, tomatoes and pineapples cause the worst reaction)
Vegetables (eggplant, chard, spinach)
Strong cheese such as those in the Bleu or Swiss cheese family
Other foods such as oregano, the seasoning used in tomato sauces and on fish or poultry, strongly flavored candies, such as peppermint or cinnamon hard candy.
Toothpaste that contains tartar-control additives, heavy flavoring or whitening agents.