Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2012  |  Volume : 30  |  Issue : 2  |  Page : 173--175

Benign migratory glossitis with fissured tongue


M Goswami, A Verma, M Verma 
 Department of Pediatric Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India

Correspondence Address:
M Goswami
Department of Pediatric Dentistry, Maulana Azad Institute of Dental Sciences, MAMC Complex, BS Zafar Marg, New Delhi - 110 002
India

Abstract

Symptomatic benign migratory glossitis (BMG) or «DQ»geographic tongue«DQ» is a rare occurrence in pediatric dentistry though asymptomatic BMG is comparatively common. BMG presents itself as an ulcer-like region on the dorsum of the tongue, which may recur at different sites on the tongue, creating a migratory appearance. Asymptomatic cases usually resolve on their own but symptomatic cases need treatment. Fissured tongue is a benign condition characterized by deep grooves on the dorsum of the tongue and, in many cases, is associated with geographic tongue. This article presents a case of symptomatic geographic tongue with fissured tongue with a history of asthma.



How to cite this article:
Goswami M, Verma A, Verma M. Benign migratory glossitis with fissured tongue.J Indian Soc Pedod Prev Dent 2012;30:173-175


How to cite this URL:
Goswami M, Verma A, Verma M. Benign migratory glossitis with fissured tongue. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2019 Jul 17 ];30:173-175
Available from: http://www.jisppd.com/text.asp?2012/30/2/173/100008


Full Text

 Introduction



Benign migratory glossitis (BMG) is a condition referred to by a variety of names, such as geographic tongue, erythema migrans, annulus migrans, wandering rash of the tongue. This condition was first reported by Rayer in 1831. [1]

It is a benign, inflammatory disorder occurring most commonly on the dorsum of the tongue, possibly extending onto the lateral borders. The characteristic appearance includes multifocal, circinate, irregular erythematous patches bounded by a slightly elevated keratotic band or line. The erythematous patches represent loss of filiform papillae and a thinning of the epithelium. The white border is composed of regenerating filiform papillae and a mixture of keratin and neutrophils. The surface is non-ulcerated, but appears ulcerated due to the loss of the surface papillae and keratin. These well-defined, elliptical lesions vary in size from a few millimeters to several centimeters. The location and pattern undergo change over time, thereby accounting for the name "migratory." This apparent migration is due to a concurrent epithelial desquamation at one location and proliferation at another site. Fissured tongue is a condition characterized by grooves that vary in depth and are noted along the dorsal and lateral aspects of the tongue.

This article presents a case of a child with symptomatic BMG along with fissured tongue.

 Case Report



An 11-year-old female patient reported for a routine dental checkup. Review of her medical history revealed that she has been suffering from asthma for the past 6 years. The patient reportedly had an asthmatic attack 6 months back and was advised an antihistamine, diphenhydramine hydrochloride. The patient reported that every month for 2-3 days, she experienced mild oral discomfort and burning sensation which increased on consumption of hot and spicy food. These symptoms would resolve spontaneously without treatment. It is significant to note that since the patient was on antihistaminic, the symptoms did not exacerbate but showed remission with time.

Her dental history was insignificant. On examination of tongue, multifocal, patchy, sharply demarcated, and irregular areas of surface erosion with depapillation were noted. The periphery showed whitish serpiginous lines enclosing the lesion. The tongue was also characterized by grooves (fissures) along the dorsal and the lateral aspects. A large and deep central fissure was seen separating the dorsal surface of the tongue into two halves [Figure 1].

The patient stated that she was aware of the roughness in her tongue from as long as she could remember. No abnormalities were observed in scalp, hair, nails, palms, soles, and eyes. On observing the oral lesions in the patient, her parents and siblings were called for a detailed oral examination, but no such lesions were evident in them.{Figure 1}

Only symptomatic treatment with topical Lignocaine gel was advised as the symptoms used to resolve on their own. Proper cleaning of the fissured tongue was also demonstrated to the patient. She was observed every 15 days [Figure 2] and [Figure 3].{Figure 2}{Figure 3}

 Discussion



The prevalence of BMG in the general population is between 1.0 and 2.5%. It is more prominent in adults than in children. [2] Redman [3] observed a 1% prevalence of BMG in schoolchildren, with an equal distribution between males and females. The most commonly affected site is the tongue; however, other oral mucosal soft tissue sites may be affected.

Geographic tongue (or BMG) has been reported with increased frequency in patients with psoriasis [4] and in patients with fissured tongue. Geographic tongue and fissured tongue have been reported in association with chronic granulomatous disease. [5]

The etiology of geographic tongue is not clear. Some consider BMG to be a congenital anomaly and others believe it to represent an acute inflammatory reaction. Redman [3] postulated a polygenic mode of inheritance for geographic tongue. Eidelman [6] concluded that geographic tongue was a familial condition in which heredity plays a significant role. Associations with human leukocyte antigens (HLA)-DR5, HLA-DRW6, and HLA-Cw6 have also been reported. [7]

BMG has also been linked to allergies. A study of atopic patients with a history of asthma or rhinitis by Marks and Czarny [8] found a 50% prevalence of BMG in these patients and concluded that they may have a similar pathogenesis. A study by Barton [9] and associates concluded with about 95% certainty that patients with BMG have reported an allergy. Marks and Tait [10] demonstrated an increased incidence of tissue type HLA-B15 in atopic patients with geographic tongue.

Fissured tongue is a rare inherited disorder where the tongue has deep grooves which can vary in size and depth. Although a definitive etiology is unknown, a polygenic mode of inheritance is suspected because the condition is seen clustering in families who are affected. Patients are usually asymptomatic, and the condition is noted on routine intraoral examination as an incidental finding. The lesions associated with fissured tongue are usually asymptomatic unless debris is entrapped within the fissure or when it occurs in association with geographic tongue (a common finding).

The association between fissured tongue and BMG supports a genetic basis for the development of the condition. The fissures may act as stagnation areas on the tongue surface in which glossitis may begin.

The diagnosis of BMG usually is based on the history and clinical presentation which would include characteristic migratory pattern and chronic nature. The differential diagnosis of BMG in children should include atrophic candidiasis, drug-induced reactions, local trauma, and severe neutropenia. Psoriasis, chemical burns, atrophic lichen planus, malignancy, and systemic lupus erythematosus can produce similar lesions.

No medical intervention is required when the lesion is asymptomatic. Symptomatic lesions can be treated with topical prednisolone. A topical or systemic antifungal medication can be tried if secondary candidiasis is suspected. However, successful treatment with cyclosporine and with topical and systemic antihistamines has been reported. No definitive therapy or medication is suggested for fissured tongue. If symptomatic, patients are encouraged to brush the dorsum of the tongue to eliminate debris that may serve as an irritant.

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