Page 7 - GP Fall 2022_Neat

Where is the Worry Line? Inflammatory Lesions vs. Mucous
Membrane Diseases: Diagnosis, Prognosis and Treatment Plans

Authors: Esther Tingué, RDH, BS, MA and Gwen Cohen-Brown, DDS, FAAOMP

With the focus of dentistry changing from surrounded by a serpiginous (snakelike), Age/Sex/Race: Geographic tongue can
restorative procedures to disease preven- raised, slightly white halo. Over time, these present in children, however it is more of-
tion, oral healthcare providers find them- areas of atrophy spontaneously resolve and ten seen in adolescents and adults. It has a
selves in the position to identify oral dis- migrate, giving the tongue a variegated slightly higher incidence in white and black
ease and to prevent disease progression appearance. Patients may complain of dis- patients over Hispanic or Asian. There is a
in healthy patients. Patients often present comfort in the depapillated areas and may slight female prevalence.
with sore irritated mucosa, but the symp- have sensitivity to acidic or spicy foods,
toms of peeling, redness and blisters can be which is secondary to the lack of filiform Treatment: No treatment is necessary, but
attributed to many different etiologies. This papilla in the areas of depapillation. If the topical steroid gels or antihistamine rinses
paper presents a reproducible approach to lateral margins or ventral tongue are affect- can reduce tongue or mucosal sensitivity.
the differential diagnosis and treatment of ed as well, it is sometimes referred to as It is important for the patient to know that
specific common oral lesions, especially ectopic geographic tongue (Figures 1, 2). this is a treatment, not a cure. It has also
those diseases that mimic each other. The been noted that geographic tongue can flare
focus will be the clinical management of with stress and become more active and
common oral lesions (i.e., relevant labo- more painful.
ratory tests, treatment modalities and an-
ticipated prognosis following appropriate Comparison of Geographic Tongue vs.
therapy). Ectopic Geographic Tongue
Geographic Tongue (Benign Migratory Geographic tongue and ectopic geograph-
Glossitis, Erythema Migrans, Wander- ic tongue are essentially the same disease,
ing Rash) vs. Ectopic Geographic Tongue the main difference being where the lesions
occur. Ectopic geographic tongue does not
Etiology: Geographic tongue, also referred Figures 1 and 2. Geographic Tongue. develop on the dorsal surface of the tongue
to as benign migratory glossitis, was first and the erythematous center of the lesion
acknowledged by French physician Pierre Ectopic Geographic Tongue: When the is not due to the loss of filiform papillae.
François Olive Rayer in 1831. Rayer de- condition includes lesions at extra-glossal Ectopic geographic tongue may develop
scribed this condition as “a wandering rash oral sites, different terms, in addition to anywhere in the mouth except for the dor-
of the tongue.” Geographic tongue is a be- ectopic geographic tongue have been used sal surface of the tongue. If it is seen with-
nign inflammatory condition typically lim- in the past. These include geographic sto- out typical geographic tongue, it should be
ited to the dorsum of tongue, affecting 3% matitis, erythema migrans, erythema areata evaluated to determine if it is a mixed leu-
of the US population, and is of unknown migrans, and stomatitis areata migrans koplakia/erythroplakia lesion and should
etiology with a strong familial tendency. (Figures 3-5). be followed to confirm that it is not a pre-
Geographic tongue occasionally extends malignant or malignant lesion. There is no
towards the lateral borders of the tongue, treatment for either geographic tongue or
affecting the anterior one-third of the ectopic geographic tongue other than palli-
tongue most frequently. The appearance of ative treatment if there is discomfort.
a geographic tongue is variable from one
person to the next and changes over time, Hairy Tongue vs. Black Hairy Tongue
hence the name of the condition. Geo- (Lingua Villosa Nigra, Nigrities Linguae)
graphic tongue is often seen with patients
who have psoriasis, fissured tongue, and Etiology: Hairy Tongue is a benign con-
is oddly inversely associated with tobacco dition resulting from elongation of the
use. It is seen in patients with psoriasis fre- filiform papillae due to keratin build-up.
quently (40%), however the inverse is not This can result from inadequate exfoliation
true. If you have a geographic tongue, you (e.g., from decreased oral intake, poor oral
will not necessarily develop psoriasis. It is hygiene or dry mouth related to anticholin-
hypothesized that Vitamin B deficiency ergic drugs) and accelerated keratinization
2
(ariboflavinosis) can cause several changes (as may occur with irritation from smok-
in the mouth, and one potential side effect
of Vitamin B deficiency may include geo- ing). It is usually symptomless. Darker
2
graphic tongue. Other conditions associat- coloration typically results from the trap-
ed with geographic tongue include atopic ping of debris and bacteria in the elongated
dermatitis, Reiter’s syndrome, celiac dis- strands of the keratinized filiform papillae.
ease and lichen planus. Hairy tongue can be the result of overuse
of mouthwash, products with bismuth, or
Clinical: In geographic tongue, the dor- colored candies, and it will reflect the col-
sal tongue develops areas of papillary at- ors of the products used. Insufficient des-
rophy that appear as smooth, bare patches quamation of the filiform papillae leads to

Figures 3-5. Ectopic Geographic Tongue. www.nysagd.org l Fall 2022 l GP 7