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Geographic Tongue: What to Do if You Have It

Geographic tongue is an oral lesion and affects 1% to 3% of the global population. It's a harmless condition characterized by island-like red, bald patches on the tongue surface. Geographic tongue is often transient and doesn't need professional treatment. Read more about it and what to do if you have it.

Key takeaways:

What is a geographic tongue?

The tongue is coated with papilla: finger-like cells that help with chewing and tasting. Without these papillae, the tongue loses its natural appearance, standard color, and texture. Loss of papillae can result in an inflammatory condition of the tongue (glossitis) known as geographic tongue.

In a person with this condition, the tongue surface has multiple reddish-pale, island-shaped patches surrounded by an irregular white or gray border. The central red zones represent areas of lost papillae, and the white zones represent areas with regenerating papillae. These patches can come and go, and vary in shape, size, and location. The condition derives its name from these mobile "map-like patterns", and can occur in varying prevalence across ethnicities and ages.

Symptoms of a geographic tongue

People with geographic tongues often don't have any apparent symptoms and the problem typically resolves on its own. In others, the common symptoms can be:

  • Migratory. A geographic tongue is migratory in nature; it keeps changing its site. Due to this, it is also known as benign migratory glossitis, erythema migrans, annulus migrans, and a "wandering rash of the tongue".
  • Appearance. Red and bald patches, bordered by white lines-its unique map-like appearance makes for an easy diagnosis.
  • Discomfort. Some people experience discomfort, burning sensation, altered taste, and sensitivity to hot, spicy, and sour foods.
  • Lesions. The lesion can resolve within days - or persist for many weeks or months at a stretch.

Lateral and dorsal portions of the tongue are the most affected sites. Occasionally, extra-lingual lesions can be found on the lips, cheek mucosa, and the floor of the mouth. These extra-lingual lesions are known as migratory stomatitis.

Geographic tongue happens significantly more in women, children between the ages of 4 and 5 and among young adults aged 20 to 29.

Despite these symptoms, the good news is that geographic tongue is not linked to any long-term health concerns in healthy people.

Geographic tongue – who is at risk?

The exact cause behind this lesion is yet to be deciphered. However, experts have associated a geographic tongue with certain health conditions.

  1. Mental health. Research reveals that people suffering from mental diseases are at a high risk of developing a geographic tongue.
  2. Families. This condition can run in families, suggesting a strong genetic and hereditary link.
  3. Contraception. Women taking oral contraceptive pills risk getting a geographic tongue, most probably due to the synthetic hormonal supplements in the pills.
  4. Allergies. Several studies have found a correlation between geographic tongue and allergic diseases like asthma, eczema, hay fever, allergic rhinitis, and individuals with higher levels of immunoglobulin E. 24.1% of individuals with geographic tongues suffer from allergies.
  5. Vitamins. People deficient in zinc, iron, folic acid, and vitamins B6 and B12 often suffer from geographic tongue.
  6. Diabetes. Studies show a fourfold increase in the incidence of geographic tongue among people with Type 1 diabetes.
  7. Fissured tongue. This is a condition with deep grooves and fissures over the tongue, that is linked with geographic tongue. They often occur together.
  8. Psoriasis. Geographic tongue is more common among those who have psoriasis (a skin ailment that generates scaly areas) and reactive arthritis (Reiter's syndrome).
See your dentist. While geographic tongue, by itself, is not harmful, associated health diseases can aggravate the lesions. If you suffer from any of the above health conditions, it's best to check with your dentist every six months.

Should you be concerned?

Because of the tongue's altered look, people with this condition often suffer anxiety and fear, although the condition is not harmful. There is no need to worry about a geographic tongue turning into something serious. A geographic tongue does not spread on touch. The lesions do not leave behind any scars.

If the appearance of the tongue bothers you, consider a visit to an oral pathologist. Your doctor may advise blood tests to rule out vitamin and zinc deficiencies, or recommend a biopsy if geographic tongue has been present for quite some time.

Does geographic tongue ever go away?

A geographic tongue cannot be prevented. Even if it resolves, chances are that the lesions can relapse; one out of every 10 persons with geographic tongue experience discomfort, burning, or soreness. It's best to be aware of the condition and start living with it.

What to do if you have a geographic tongue?

Geographic tongue often does not require treatment. If you have a recurring lesion, a dentist or an oral pathologist is the first person you want to contact. They will guide you appropriately depending on your symptoms and severity.

  • Patient reassurance. This is the first step to managing a geographic tongue. Be assured that it is self-limiting and harmless. It is not contagious, nor can it lead to cancer.
  • Avoid alcohol and hot, spicy, and sour meals. Acidic fruits and beverages, soft drinks, and any food that triggers discomfort must be avoided.
  • Maintain proper oral hygiene. Brush and floss regularly.
  • Avoid smoking. Studies highlight that smoking triggers discomfort in geographic tongue patients.
  • Take medications under expert supervision only. Certain medicines like topical corticosteroids, antihistamines, cyclosporine, vitamin A, zinc, and topical tacrolimus have all been beneficial for symptomatic lesions. Acetaminophen (Paracetamol/Tynelol) helps to reduce pain.
  • Reduce stress levels. Yoga and exercise are two great ways to minimize anxiety.
  • Contraception. Consult your gynecologist if you notice these red patches while on hormonal pills. They will guide you to an alternate therapy.
Treat the symptoms. There is no standard gold therapy for managing the symptoms of geographic tongue. Experts' advice is often based on individual symptoms and associated health conditions. It is best to consult a dentist and discuss your symptoms to get an optimized treatment plan.
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