What is the treatment for geographic tongue?

Treatment of Geographic Tongue

Geographic tongue typically requires no treatment as it is usually asymptomatic and may resolve spontaneously with periods of remission and exacerbation. 1

Understanding Geographic Tongue

• Geographic tongue (benign migratory glossitis) is a common, superficial benign inflammatory disorder affecting the tongue epithelium, characterized by irregular erythematous patches with whitish borders due to loss of filiform papillae 1
• The condition is typically asymptomatic in most cases, though some patients may experience burning sensations 2
• Geographic tongue has been associated with various factors including stress, nutritional deficiencies, and systemic conditions 1, 3

Treatment Approach

For Asymptomatic Cases

• No treatment is required for asymptomatic geographic tongue as it is a benign condition with good prognosis 1, 2
• Patient education and reassurance about the benign nature of the condition is important 2

For Symptomatic Cases

• For patients experiencing burning sensation or discomfort:
  • Topical corticosteroids can be effective in reducing inflammation and discomfort 4
  • Options include betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit solution four times daily 4
  • Fluticasone propionate nasules diluted in water can be used twice daily 4
  • Clobetasol 0.05% ointment mixed in Orabase can be applied to dried mucosa for localized areas 4

Pain Management

• For pain relief:
  • Benzydamine hydrochloride oral rinse or spray can be used every 3 hours, particularly before eating 4
  • Topical anesthetic preparations such as viscous lidocaine 2% can provide temporary relief 4
  • Barrier preparations can help protect ulcerated surfaces 4

Addressing Underlying Factors

• Stress management may be beneficial, as stress has been identified as a factor that can worsen geographic tongue symptoms 3
• Younger patients appear more susceptible to stress-related exacerbation of geographic tongue 3
• Consider nutritional supplementation if deficiencies are present:
  • Zinc supplementation may be beneficial as patients with geographic tongue have shown lower levels of salivary zinc compared to healthy individuals 5
  • Although iron and vitamin B12 affect lingual papillae, their serum and salivary levels have not shown significant differences in patients with geographic tongue 5

Follow-up and Monitoring

• If symptoms persist or worsen despite treatment, reevaluation is necessary to confirm diagnosis 4
• Consider evaluation for associated conditions such as psoriasis, allergies, or anxiety which have shown associations with geographic tongue 2
• Monitor for candidal infection, which has been reported in approximately 7.6% of geographic tongue cases and may require antifungal treatment 2

Special Considerations

• Geographic tongue in children is managed similarly to adults, with focus on reassurance and symptomatic treatment if needed 6
• The condition may coexist with other disorders such as fissured tongue, psoriasis, diabetes mellitus, gastrointestinal diseases, and burning mouth syndrome 1
• Oral hygiene measures including warm saline mouthwashes can help reduce bacterial colonization 4