Management of Fissured Tongue
Fissured tongue is a benign condition that requires no treatment in the vast majority of cases. 1, 2
Understanding Fissured Tongue
Fissured tongue is a common benign condition characterized by grooves of varying depth along the dorsal and/or dorsolateral aspects of the tongue. 3, 4 This condition:
- Occurs in approximately 15.5% of the US population 1
- Is one of the three most common tongue conditions alongside geographic tongue and black hairy tongue 1, 2
- Increases in prevalence with age, being very rare in children under 10 years old 4
- May be associated with geographic tongue in many cases 4, 5
Primary Management Approach
No active treatment is required for uncomplicated fissured tongue. 1, 2 The condition is benign and does not necessitate medical intervention in asymptomatic patients.
When Symptoms Develop
If patients develop painful fissures or secondary complications, management should focus on:
Symptomatic Relief
- Apply lubricating agents such as petrolatum or lip balm to affected areas to protect fissures and promote healing 6
- Use topical anesthetics like lidocaine for pain relief during the healing process 6
- Maintain adequate hydration by drinking sufficient fluids to keep the mouth and lips moist 6
Pain Management
- Topical anesthetics (lidocaine) provide first-line pain control 6
- Oral pain medications such as acetaminophen or ibuprofen may be considered for more severe pain 6
- Avoid irritating foods and substances including spicy foods, citrus fruits, hot drinks, alcohol, and smoking 6
Oral Hygiene Maintenance
- Practice regular gentle brushing using a soft toothbrush 6
- Use alcohol-free mouthwash to prevent further irritation 6
- Ensure proper fit and cleanliness of dental prostheses for denture wearers 6
Evaluation for Underlying Conditions
If fissures are persistent, recurrent, or atypical despite appropriate treatment, evaluate for:
- Nutritional deficiencies (iron, folic acid, vitamin B12, riboflavin, niacin) 6, 2, 5
- Candida infection requiring antifungal therapy 6, 1
- Bacterial infection 6
- Systemic conditions affecting skin integrity 6
- Associated conditions such as hypertension or diabetes 3
Laboratory Considerations
While routine testing is not indicated, some patients with fissured tongue syndrome may have slightly lower levels of vitamin B12, ferritin, and folate, though frank anemia is uncommon. 5 Consider checking these levels only if clinical suspicion exists for nutritional deficiency.
Important Clinical Pearls
- Fissured tongue may represent subepithelial edema rather than a purely congenital anomaly, particularly when associated with swollen filiform papillae 4
- The condition often coexists with geographic tongue, and some evidence suggests fissured tongue may be a consequence of geographic tongue 4
- Central longitudinal fissuring is the most common pattern 3
- Reassure patients that this is a benign condition requiring no treatment unless symptomatic 1, 2