Treatment of Tongue Fissure (Fissured Tongue)
No treatment is required for fissured tongue, as it is a benign, asymptomatic anatomical variant that does not cause morbidity or mortality. 1
Understanding Fissured Tongue
Fissured tongue (lingua plicata) is characterized by grooves and fissures of varying depth on the dorsal surface of the tongue. 1, 2 This condition:
- Occurs in approximately 30.5% of the adult population, making it one of the most common tongue conditions 3
- Increases in prevalence and severity with age, appearing rarely in children under 10 years old 4, 2
- Is more common in males than females 2
- Does not represent a congenital anomaly but rather develops over time, possibly related to subepithelial inflammation and edema 4
Clinical Management Approach
Primary Management
- Reassurance is the cornerstone of management - patients should be informed that fissured tongue is a benign variant requiring no treatment 1
- No medications, topical agents, or interventions are indicated 1
Symptomatic Cases (Rare)
If patients report discomfort or symptoms:
- Evaluate for food debris accumulation in the fissures, which can cause irritation 1
- Recommend gentle tongue brushing to maintain oral hygiene and prevent debris accumulation
- Assess for associated conditions, particularly geographic tongue (present in 12.7% of the population and strongly correlated with fissured tongue) 3
When to Investigate Further
Consider additional evaluation only if:
- Atypical features are present - such as pain, bleeding, or ulceration within the fissures 1
- Symptoms suggest nutritional deficiency - evaluate for atrophic glossitis, which may indicate vitamin B12, folate, or iron deficiency 1
- Concern for candidal infection - particularly if white patches or burning sensation are present, which may indicate median rhomboid glossitis requiring antifungal therapy 1
- Suspicion of malignancy - any growths or persistent ulcerations require biopsy and referral to oral and maxillofacial surgery or otolaryngology 1
Key Clinical Pearls
- Fissured tongue is strongly associated with geographic tongue (areas of atrophy with raised white borders), and these conditions may represent different stages of the same inflammatory process 4, 3
- Smoking increases prevalence of fissured tongue 2
- The condition is permanent - fissures do not resolve with treatment, as none is effective or necessary 1
- Patient education prevents unnecessary anxiety and overtreatment 3