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Glossitis

What Is It, Causes and More

Author: Nikol Natalia Armata, MD

Editors: Alyssa Haag, Emily Miao, PharmD, Kelsey LaFayette, DNP, RN, FNP-C

Illustrator: Jessica Reynolds, MS

Copyeditor: Stacy M. Johnson, LMSW

What is glossitis?

Glossitis refers to the inflammation of the tongue. The tongue is a muscular organ in the oral cavity, which consists of skeletal muscle and is essential for swallowing and speech. Clinically, it may present with changes in the texture and color of the tongue and may also be painful. 

There are many different types of glossitis, including atrophic glossitis, which presents as a smooth glossy tongue surface caused by loss of papillae; median rhomboid glossitis, where oral candidiasis causes a region without papillae in the central area of the tongue; geographic tongue due to patchy losses of papillae which can appear to move, giving a changing map picture; geometric glossitis, commonly seen in immunocompromised individuals (e.g., patients with leukemia), in which there is a deep fissure in the middle of the tongue, with branches; and strawberry tongue caused by hyperplastic fungiform papillae and associated with bacterial or viral infections.

What causes glossitis?

There are numerous potential etiologies for glossitis. When changes in the texture and color of the tongue are not caused by benign conditions, like dehydration or other familial variants (e.g., fissured tongue, geographic tongue, or Down syndrome), underlying pathologies may be the cause. 

One of the most common causes of glossitis is nutritional deficiencies, especially lack of iron, also known as iron-deficiency anemia. When iron levels are low in the blood, myoglobin, a  protein necessary for muscle formation, including the tongue muscle, is low, causing a change in the tongue’s appearance and glossitis. Iron-deficiency anemia leading to glossitis can be caused by lack of nutritional intake, heavy menses, where iron is lost in menstrual blood, or colon cancer. Similarly, other deficiencies of the vitamin B complex, such as B1, B2, B3, B6, B9, and B12 (i.e., pernicious anemia refers to an autoimmune B12 deficiency), may present with glossitis. Additionally, infections caused by bacteria, viruses, yeasts, and fungi can all cause glossitis. Oral herpes and overgrowth of Candida species, especially in immunosuppressed individuals, can affect the tongue’s surface. Accordingly, immunosuppressed individuals with autoimmune conditions may frequently present with oral cavity inflammation. For instance, Sjogren disease is associated with a dry mouth and glossitis, as it reduces the production of bodily fluids, including saliva. Celiac disease is an autoimmune disease where gluten triggers an immune response that damages the small intestine lining. Over time, the gluten sensitivity reaction can cause glossitis due to malabsorption and nutritional deficiency. Certain medications may also alter the texture and color of the tongue, including antibiotics (e.g., sulphanilamide), corticosteroids, methotrexate, and short-acting bronchodilators (e.g., salbutamol), and tricyclic antidepressants (e.g., desipramine). 

An individual can also notice changes in the tongue during severe allergic reactions, also known as anaphylaxis, which can suddenly make the individual’s tongue swell. Inflammation of the area can be caused by burns or cuts in the tongue (e.g., braces). Spicy foods and hot food can also cause glossitis. Similarly, irritants like tobacco and alcohol may cause tongue swelling in some individuals. Lastly, psychological factors like conversion disorders or anxiety can also be expressed with changes in the texture of the tongue. 

What are the signs and symptoms of glossitis?

The most common symptoms of glossitis include pain in the tongue, changes in tongue color (i.e., redness or a more pale appearance), swelling and tenderness of the tongue, or loss of papillae that creates a smooth surface of the tongue. The appearance of any new visible tongue lesions may also be a sign of underlying inflammation. Consequently, people with glossitis may experience chewing, swallowing, or speaking problems.

How is glossitis diagnosed?

When examining an individual with glossitis, a thorough evaluation of the individual’s medical history is necessary. The clinician may also ask about a family history of changes in the tongue surface.

An overall nutritional status, dietary restrictions, tobacco and alcohol use, and variation of symptoms with food or environmental exposure may be noted. The individual's medications could also be reviewed. An evaluation may continue with examining the tongue and overall oral cavity. The mouth may be palpated to assess for tenderness or any palpable lesions. A thorough head and neck exam may also be necessary to evaluate for any lymphadenopathy.

Additional studies may only be required depending upon the suspected etiology of the glossitis. Initial serologic studies (e.g., anti-gliadin abs, anti-tissue transglutaminase) and rheumatologic studies (e.g., rheumatoid factor, anti-ro, anti-la, etc.) may be indicated if autoimmune conditions, such as Sjogren syndrome or Celiac disease, are suspected. Blood tests, including vitamin levels, can be ordered if nutritional deficiencies are suspected. Complete blood count and HIV testing may also be necessary if immunosuppression is suspected or in the setting of infections. Biopsies may be indicated for any worrisome lesion (e.g., colonoscopy) to rule out malignancy. Suspected or known malignancy can be followed up with a CT scan of the neck, chest, or abdomen with IV contrast.

How is glossitis treated?

Most causes of glossitis require no treatment. Symptomatic relief is possible with good oral hygiene and mouth rinses. Specific supplements include oral vitamin supplementation. In severe cases of vitamin B12 deficiency, injections of vitamin B12 may be necessary. If glossitis is triggered by medication, offending medications may be discontinued. 

What are the most important facts to know about glossitis?

Glossitis refers to the inflammation of the tongue that changes the tongue’s texture and color, causes swelling and tenderness, and may even cause loss of papillae that creates a smooth surface of the tongue. Glossitis may occur due to benign conditions or indicate underlying pathology, like nutritional deficiencies, infections, allergies, autoimmune conditions, or mouth injuries. A detailed medical history and physical examination are typically required, while additional testing is rarely suggested to diagnose glossitis. Glossitis is self-limiting, and therefore conservative treatment is usually recommended. Treating the underlying cause may be helpful for the inflammation to regress.

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