All you Need to Know About Geographic Tongue / Geographic Stomatitis

What is Geographic Tongue?

Geographic tongue is a harmless condition wherein the tongue develops a “map-like” or a “geographic” appearance on its surface.

The tongue consists of papillae which are small pinkish white bumps that are spread over the entire area of the tongue. When parts of these papillae are lost, the tongue has a smooth appearance with an edge that is raised, giving the appearance of a map.

The ‘patches’ are not restricted to specific areas and tend to ‘move’ from one part to another. Though it may seem alarming to notice such changes in the tongue, this condition is not serious and is not associated with any infection or cancer.

Geographic tongue is known by other names like:

• Erythema areata migrans
• Benign migratory glossitis (BMG)
• Erythema migrans
• Wandering rash of the tongue
• Geographic stomatitis

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What are the Causes and Risk Factors for Geographic Tongue?

Geographic tongue affects about 1 to 3% of the population and there is no known cause for the condition, the following are the risk factors

• Age - Though the condition can affect anyone, people in their middle age or advanced age are more prone to it
• Gender - More women tend to be affected than men
• Genetics - This condition has a familial inheritance pattern indicating that genes play an important role. HLA B15 is associated with the condition.
• Vitamin B - The lack of vitamin B has also been linked to the condition
• Food - The condition may arise due to irritation caused by hot, spicy food or even alcohol
• Psoriasis - People with psoriasis especially pustular psoriasis are at higher risk and should visit their dentist routinely to check for geographical tongue
• Health Conditions - The following health conditions are also said to be a risk factor for the condition:
• Diabetes
• Asthma
• Anemia
• Stress
• Hormonal - Hormonal changes have also been found to play a role in this condition. There have been reported cases of geographical tongue among women who consume oral contraceptives.
• Anti-Hypertensive Drugs - A study conducted by Dafar A and colleagues and published in the journal Acta odontologica Scandinavica 2015, found an association between the use of anti-hypertensive drugs and geographic tongue.

• Pregnancy - Pregnant women are at a higher risk of getting this condition. Studies show that higher levels of sex hormones present during pregnancy are etiological factors for geographical tongue and other mucosal conditions. The level of sex hormones was maximum during the third trimester and the incidence of geographical tongue was also highest during the same period.
• Psychological Conditions - Certain psychological conditions are associated with geographical tongue with scientists finding salivary markers for the same.
• Acid Reflux - Acid reflux that enters the mouth from stomach can trigger geographic tongue in some individuals.

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What are the Symptoms and Signs of Geographic Tongue?

Most patients have no symptoms and may not require any specific treatment. The signs and symptoms of geographic tongue are:

• The smooth red patches tend to be tender and eating spicy or hot food could lead to irritation or a burning sensation. Citrus foods could also produce similar reactions. Cigarette smoke and toothpaste are other factors that cause irritation.
• The tongue has portions without the papillae which appear smooth, giving the tongue a distinct map-like appearance.
• The ‘pattern’ or the patches keep shifting which is why they are called migratory.
• Lesions could develop not only on the tongue but also on the mouth and lips
• Geographical tongue is sometimes associated with fissured tongue which is a condition in which there are furrows on the tongue. Fissured tongue is also a painless condition.
• There could be soreness and pain

Patients with geographical tongue are prone to the presence of fungi in their tongue, especially among those who do not brush their tongue. Moreover, geographical tongue may be a predictor for Burning Mouth Syndrome (BMS).

How to Diagnose Geographic Tongue?

There are no specific tests that need to be performed to determine if the condition is geographical tongue, a dentist will determine the condition based on the physical examination.

Though the condition is harmless, some mouth ulcers may be an indicator of a more deep-seated infection requiring medical intervention. If a mouth lesion does not resolve by itself within a period of a week to 10 days, it is best to consult a dentist or a family physician who can rule out other causes.

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How do you Treat Geographic Tongue?

There is no specific treatment for the condition, it slowly resolves over a period of time. If there are any associated disease conditions then treating those conditions is a necessity.

The following measures may provide relief if there is a lot of discomforts:

• Gargling with an anti-histamine gargle liquid
• Topical application of a corticosteroid
• Intake of zinc supplements
• Toothpaste with drug such as ‘Triamcinolone’ can be used for brushing three times a day
• Pain relievers
• Rinsing the mouth with an antiseptic

The condition is harmless and is seldom worrying. However, patients are often embarrassed about the presence of lesions in their mouth and due to the map-like appearance of their tongue, leading to anxiety about recovery.

The condition normally settles down on its own but the duration of the condition varies, in some people it could take up to a year to resolve.

How do you Prevent Geographic Tongue?

A person with many affected members in the family should be wary of maintaining good oral health and adopting a lifestyle that limits chances of a geographic tongue. Preventive strategies require an individual to:

• Quit smoking
• Avoid drinking alcohol
• Stay away from hot or spicy food
• Live a stress-free life
• Get treated for acid reflux
• Abstain from consuming highly acidic food like orange juice
• Take vitamin B supplements if levels are low
• Receive proper medical care for systemic diseases like diabetes
• Brush teeth, tongue, gums with toothpaste that contains fluoride and peroxide

Geographic tongue may take a few months to recede but there are chances of recurrence. Following preventive strategies and identifying triggers that could set off another flare up would aid in avoiding recurrence.

The best preventive strategy, however, is to maintain impeccable oral health.