Management of Transient Lingual Papillitis
Topical corticosteroids are the first-line treatment for transient lingual papillitis, with betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water used as a rinse-and-spit solution 1-4 times daily being the most effective option. 1
First-Line Treatments
- Topical corticosteroid preparations are recommended as the primary treatment for symptomatic transient lingual papillitis 1
- For isolated lesions, triamcinolone acetonide 0.1% in adhesive paste can be applied directly to the affected area 1
- Alternative topical corticosteroid options include beclomethasone dipropionate 50-200 μg or budesonide 50-200 μg sprayed directly on lesions 1
Pain Management
- Topical analgesics/anesthetics such as benzydamine hydrochloride 0.15% (Difflam Oral Rinse) can provide symptomatic relief, particularly before eating or toothbrushing 1
- Barrier preparations like Gengigel mouth rinse/gel or Gelclair can be used to control pain and protect the affected areas 1
- For more severe cases, following a structured pain management approach may be necessary 1
Supportive Measures
- Antiseptic mouthwashes such as chlorhexidine gluconate 0.2% (Corsodyl) or hexetidine 0.1% (Oraldene) help maintain oral hygiene and prevent secondary infection 1
- Daily inspection of oral mucosa, adequate hydration, and lip lubrication with sterile vaseline/white paraffin, lip balm, or lip cream support overall oral health 1
- A soft diet should be followed to minimize trauma to the affected areas 1
- Spicy, hot, acidic foods, smoking, and alcohol should be avoided as they can trigger or exacerbate the condition 1
Special Considerations
- For recurrent or severe cases, intralesional triamcinolone acetonide injections can achieve faster clinical remission 1
- In pediatric patients, reassurance and oral hygiene are often sufficient, but dilution of mouthwashes may be necessary to reduce discomfort 1
- Many cases of transient lingual papillitis resolve spontaneously within a few weeks without specific treatment 2
- The condition may be triggered by local irritation, such as consumption of certain foods (e.g., hard candies) 3
Clinical Characteristics and Diagnosis
- Transient lingual papillitis presents as inflammation of one or multiple fungiform papillae on the dorsolateral tongue 4
- The condition has an acute onset, is often painful, and is transient in nature 4
- Two main clinical forms exist: localized (affecting a few papillae) and generalized (affecting multiple papillae across the tongue) 4
- Diagnosis is primarily clinical, based on the characteristic appearance of inflamed fungiform papillae 4
- Biopsy is rarely needed and only indicated when there is a diagnostic dilemma 4
Patient Education
- Reassure patients about the benign and self-limiting nature of the condition 2
- Educate patients about potential triggers to avoid recurrence 3
- Emphasize the importance of maintaining good oral hygiene during the episode 1
- Inform patients that recurrences may occur, especially with re-exposure to identified triggers 3