Treatment of Glossitis
Glossitis treatment depends on identifying and correcting the underlying nutritional deficiency, with supplementation of the specific deficient hematinic (iron, vitamin B12, folic acid, or other B vitamins) being the primary therapeutic approach. 1, 2, 3
Diagnostic Evaluation Required Before Treatment
Before initiating therapy, obtain the following laboratory tests to identify the specific deficiency:
- Complete blood count to assess for anemia and macrocytosis 2, 4
- Serum iron levels 1, 2
- Serum vitamin B12 levels 2, 4
- Serum folate levels 2
- Consider testing for serum gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA), as these are positive in 26.7%, 28.4%, and 29.8% of glossitis patients respectively 2
- Hyperhomocysteinemia testing, present in 11.9% of atrophic glossitis patients 2
Do not diagnose a specific nutritional deficiency based on clinical appearance alone, as multiple deficiencies commonly coexist. 5
Specific Nutritional Replacement Therapy
Iron Deficiency
- Iron replacement therapy per standard protocols for iron deficiency anemia 1
- Iron deficiency is present in 16.9% of atrophic glossitis patients 2
Vitamin B12 Deficiency
- For pernicious anemia (the most common cause of B12 deficiency glossitis): Administer 100 mcg intramuscular or deep subcutaneous injection daily for 6-7 days, then alternate days for seven doses, then every 3-4 days for 2-3 weeks, followed by 100 mcg monthly for life 6, 4
- Oral vitamin B12 is not dependable for pernicious anemia and should not be used 6
- Vitamin B12 deficiency is present in 5.3% of atrophic glossitis patients 2
- GPCA-positive patients have higher frequencies of vitamin B12 deficiency 2
Folic Acid Deficiency
- Folic acid supplementation should be administered concomitantly if deficiency is identified 6
- Folic acid deficiency is present in 2.3% of atrophic glossitis patients 2
Other B Vitamin Deficiencies
- Riboflavin, niacin, and pyridoxine deficiencies can all cause glossitis and require specific replacement 5, 2, 3
- Specific tests are available if these deficiencies are suspected 5
Combination Therapy Approach
Supplementation with vitamin B-complex capsules plus corresponding deficient hematinics achieves complete remission of oral symptoms and glossitis in many patients. 2
Treatment of Associated Candidal Infection
If median rhomboid glossitis is present (suggesting candidal infection):
- Nystatin oral suspension (100,000 units four times daily for 1 week) 1, 7
- Miconazole oral gel (5-10 mL held in mouth after food four times daily for 1 week) 8, 7
- For resistant cases: Fluconazole 100 mg/day for 7-14 days 1, 8, 7
Supportive Symptomatic Management
- Apply white soft paraffin ointment to affected areas every 2-4 hours for protection and moisturization 8, 9, 7
- Warm saline mouthwashes daily for oral hygiene 8, 9, 7
- Benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating, for pain relief 8, 9, 7
- Avoid alcohol-containing mouthwashes, which cause additional pain and irritation 9, 7
Treatment Response and Follow-up
- Expect partial improvement in symptoms within 3 months of appropriate supplementation 4
- Complete remission of glossitis can be achieved with correction of underlying deficiencies 2, 3
- If no improvement after 2 weeks of treatment, reevaluate the diagnosis and patient compliance 8, 7
Critical Clinical Pitfall
Early identification and treatment of nutritional deficiency through oral symptoms can prevent serious and irreversible systemic and neurologic damage, particularly with vitamin B12 deficiency. 5, 4 The glossitis may be the first presenting sign of pernicious anemia or other significant systemic conditions requiring lifelong management 6, 4.