What is the treatment for geographic tongue?

Treatment of Geographic Tongue

Geographic tongue typically requires no treatment as it is a benign, self-limiting condition that may spontaneously exhibit periods of remission and exacerbation with good prognosis. 1

Understanding Geographic Tongue

Geographic tongue, also known as benign migratory glossitis, is a common superficial inflammatory disorder affecting the tongue epithelium. It typically presents as:

• Irregular central erythematous patches on the tongue due to loss of filiform papillae 1
• Elevated whitish band-like borders that can change location, size, and pattern over time 1
• Histologically shows nonspecific inflammation 1

Symptoms and Presentation

• Most cases are asymptomatic and do not require treatment 1, 2
• When symptomatic, patients may experience burning sensation (reported in 9.2-47% of cases) 2
• Diagnosis is primarily clinical (98.81% of cases) 2

Treatment Approaches

For Asymptomatic Patients

• No treatment is required as the condition is benign and self-limiting 1, 2
• Reassurance about the benign nature of the condition 2

For Symptomatic Patients

• Topical corticosteroids may help reduce inflammation and discomfort 3

  • Options include betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit solution four times daily 3
  • Clobetasol 0.05% ointment mixed in Orabase can be applied to dried mucosa for localized areas 3

• Pain management:

  • Benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 3
  • Topical anesthetic preparations such as viscous lidocaine 2% applied 3-4 times daily 3

For Cases with Secondary Infection

• If candidal infection is present (found in 7.6% of cases), treatment with antifungal agents is recommended 2
  • Nystatin oral suspension 100,000 units four times daily for 1 week 3
  • Miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 3

Addressing Underlying Factors

Several factors have been associated with geographic tongue that may be addressed:

• Stress management, as stress has been shown to worsen symptoms, particularly in younger patients 4
• Evaluation of nutritional status, particularly zinc levels, as patients with geographic tongue have shown lower levels of salivary zinc compared to control groups 5
• Assessment for associated conditions such as psoriasis, allergies, and anxiety 2

Supportive Measures

• Oral hygiene with warm saline mouthwashes daily 3
• Avoiding spicy, acidic, or hot foods that may exacerbate symptoms 2
• Antiseptic oral rinses such as 0.2% chlorhexidine digluconate mouthwash twice daily if needed 3

When to Refer

• If symptoms persist despite treatment 2
• If diagnosis is uncertain or there is concern for other conditions 2
• If there are signs of associated systemic conditions requiring multidisciplinary care 1

Prognosis

• Generally excellent with spontaneous periods of remission and exacerbation 1
• Condition may persist for months to years but remains benign 1, 2