The tongue is often injured. Sometimes these damages are so insignificant that we do not notice them, but these mucosal defects are the entry point for infection. Glossitis is an inflammation of the tongue that is caused by various bacteria and viruses. The disease causes a number of unpleasant symptoms that interfere with normal eating, and sometimes even interfere with talking. Glossitis is dangerous due to its complications. If measures are not taken in time, diffuse purulent inflammation may occur, spreading far beyond the oral cavity.
The disease is very common. Most often occurs in people with reduced immunity, smokers, and patients who do not pay due attention to oral hygiene.
Forms
Types of glossitis:
- deep;
- desquamative;
- diamond-shaped;
- villous;
- folded;
- Gunter's;
- syphilitic or interstitial.
The most dangerous is deep glossitis. The pathological process begins on the lower part of the tongue, and if left untreated, spreads to the floor of the oral cavity. In the case of abscess formation, the purulent process can spread to the neck, which is a life-threatening condition.
Desquamative glossitis is better known as “geographic tongue.” Irregularly shaped areas of peeling alternate with normal ones, so the tongue looks like a geographical map. This type of disease is typical for patients with chronic lesions of the digestive system, allergies, helminthic infestations, and can also occur during pregnancy.
Diamond-shaped lesions are typical for patients with chronic gastropathology. The disease is recurrent.
Villous glossitis occurs due to hypertrophy of the papillae of the tongue. This disease is one of the manifestations of a fungal infection - candidiasis, and can also occur in smokers.
The disease may be congenital. Such anomalies include a folded shape. This glossitis does not cause unpleasant symptoms and does not require special treatment.
Gunter's tongue is not an independent pathology, but one of the manifestations caused by anemia resulting from a lack of vitamin B 12 and folic acid in the body. The disease develops gradually. The mucous membrane of the tongue becomes smooth, the papillae decrease in size, and the tongue acquires a crimson hue.
Interstitial glossitis is also a secondary manifestation and is characteristic of patients with syphilis. The pathological process proceeds deeply, affecting muscle tissue. If left untreated, the muscles are replaced by connective tissue, which is an irreversible process. This form can transform into a malignant tumor.
Having seen photos of glossitis of different etiologies, you can be convinced that the clinical symptoms of this disease are varied, so only a specialist can make a differential diagnosis.
Glossitis of the tongue can be either an independent disease or one of the clinical symptoms of another pathology. For proper treatment, it is necessary to find out whether the disease is a primary inflammatory process, or arose as a result of changes in other organs and systems.
Manifestations of neoplasms in the oral cavity
Kaposi's sarcoma is a vascular tumor (lympho- and hemovascular), which, in the absence of HIV infection, is characterized by a low-grade course, occurring in residents of African countries. In AIDS, Kaposi's sarcoma can appear in young people as red, rapidly turning brown spots that are initially found on the legs, but tend to spread. They differ from the classic version by increased malignancy and dissemination on the skin, mucous membranes, and internal organs.
The characteristic brown spots of Kaposi's sarcoma on the face are the “calling card” of AIDS patients, occurring in 30% of HIV-infected individuals, regardless of country of residence. The lesion elements are initially represented by single, and more often multiple, spotted, papular (nodular) formations of pink, red, purple colors on the skin (Fig. 10).
Rice. 10. Kaposi's sarcoma with ulcerations and hyperplasia.
In the oral cavity, Kaposi's sarcoma is most often localized on the palate; in the early stages of development it looks like a blue, red, black flat spot. In subsequent stages, the lesions darken, begin to rise above the surface, become lobulated, and finally ulcerate, which is especially typical when located in the oral cavity. The entire surface of the hard and soft palate can change, becoming deformed due to the formation of both tuberosity and ulcerative defects. The mucous membrane of the gums may also be involved in the process. Moreover, in some cases, the lesion element looks like epulis (Fig. 11).
Rice. 11. Kaposi's sarcoma in the form of epulis.
The etiological factor of Kaposi's sarcoma is still unclear.
People with AIDS may develop squamous cell carcinoma, which is usually located on the tongue and occurs in young people. Treatment with immunosuppressive drugs reduces the incidence of malignancy in tumors, including intraoral carcinoma.
Causes of glossitis
Glossitis occurs under the influence of provoking factors. The most common of these is damage to the mucosa. Damage can occur due to the consumption of hard, spicy, hot foods. Often the tongue is injured by crowns, tooth fragments, braces or improperly made removable dentures. For infection to penetrate, a microscopic defect is sufficient, which does not cause discomfort and is visually invisible.
The source of infection in the oral cavity increases the likelihood of inflammation during injury. These include carious teeth, gum inflammation, stomatitis, and chronic tonsillitis. Failure to comply with hygiene rules, using someone else's utensils, toothbrushes, and dirty hands while eating increase the risk of infection entering the oral cavity. Children who can put dirty hands and foreign objects into their mouths are at particular risk.
Smoking and alcohol reduce local immunity and make the mucous membrane more vulnerable. In this group of patients, glossitis occurs more often than in other people.
Constant exposure to chemicals that destroy the mucous membrane eventually leads to chronic inflammation. Glossitis can even be caused by poor-quality toothpaste or mouthwash.
Dysbacteriosis, carriage of the herpes virus, reduced immunity are predisposing factors in the occurrence of glossitis.
How to treat glossitis?
Treatment of glossitis is always comprehensive and carried out by a dentist. Also, if necessary, the help of a therapist, allergist, gastroenterologist, ENT doctor, endocrinologist is required.
Treatment depends on the course and form of the disease and includes the following measures:
- Elimination of pockets of infection in the mouth (treatment of caries, its complications, replacement of old fillings, crowns)
- Professional oral hygiene – removing plaque and tartar to reduce irritation and reduce the number of microorganisms.
- Teaching the patient how to properly brush teeth at home, selecting appropriate products (paste, brush, brushes)
- Gentle diet (spicy, salty, hot, irritating foods must be excluded)
- If there is a general disease, it must be cured
Clinical manifestations
The first thing those suffering from glossitis encounter is pain, burning, and severe discomfort in the oral cavity. Over time, the intensity of these manifestations increases, making it difficult to eat food. Taste sensations are dulled and may be completely absent. Some patients have a phenomenon called perverted taste.
The tongue swells, which causes severe discomfort. The patient's speech is impaired, any movements of the tongue bring pain. Hyperthermia and deterioration in general health are possible.
Upon examination, you can reveal an enlargement of the tongue, a change in its color to a brighter one, up to crimson. Ulcers, blisters, spots, erosions, plaque, and lesions with altered epithelial structure may appear on the mucous membrane.
The most dangerous complication of glossitis is phlegmon. A focus of purulent inflammation is formed, which rapidly spreads to the chin and neck. Soft tissues are destroyed. Such patients require emergency medical care.
Fungal infections
Candidal stomatitis is diagnosed in the vast majority of AIDS patients (up to 75%) and manifests itself in several clinical forms.
Pseudomembranous candidiasis often begins as acute, but with AIDS it can continue or recur, and therefore is considered as a chronic process. Fungal infection is characterized by the presence of a yellowish coating on the oral mucosa, which may be hyperemic or unchanged in color. Plaque is tightly held on the surface of the epithelium and is difficult to remove. This exposes bleeding areas of the mucosa. The favorite localization of plaque is the cheeks, lips, tongue, hard and soft palate (Fig. 1).
Rice. 1. Pseudomembranous candidiasis. Raid in the sky.
Erythematous, or atrophic, candidiasis develops in the form of bright red spots or diffuse hyperemia, and in AIDS it has a chronic course. The palate is most often affected and acquires an uneven bright red color. The epithelium becomes thinner and erosions may appear. Localization of lesions on the dorsum of the tongue leads to atrophy of the filiform papillae along the midline (in contrast to this picture, age-related changes in the tongue are characterized by diffuse atrophy; in syphilis, atrophy of the filiform papilla takes the form of foci of a mowed meadow) (Fig. 2).
Rice. 2. Erymatous candidal glossitis.
Chronic hyperplastic candidiasis is characterized by the symmetrical arrangement of elements on the mucous membrane of the cheeks in the form of polygonal elevated foci of hyperplasia, covered with a yellow-white, cream, yellowish-brown coating. The hyperplastic form of candidiasis is much less common. Researchers attribute this manifestation to exposure to nicotine from smoking (Fig. 3).
Fig.3. Hyperplastic candidiasis.
Fungal infections of the oral mucosa can be combined with candidiasis of the corners of the mouth - angular cheilitis, which is a sign of generalization of the process.
The diagnosis, which is made on the basis of clinical manifestations, must be confirmed by laboratory tests. Active growth of a large number of colonies (hundreds) on a nutrient medium, detection of mycelium during microscopy of samples indicate the pathogenicity of the Candida fungus. In some cases, a biopsy is necessary.
Treatment of candidiasis can be systemic or local, depending on the extent of the process. Etiotropic effects are mandatory, symptomatic effects depend on clinical manifestations.
Diagnosis and treatment methods for glossitis
In most cases, the basis for diagnosis is the patient’s complaints and visual examination of the oral cavity.
When visiting a doctor, be sure to indicate when the pathological manifestations appeared and what they are associated with. If any dental treatment was performed, be sure to mention it. It is better to seek medical help at the first signs of illness. Avoid taking any medications, especially antibiotics. This may make diagnosis difficult and reduce the effectiveness of subsequent therapy.
To determine the cause of glossitis, additional diagnostic methods are used: examination of scrapings from the mucous membrane under a microscope, ELISA, PCR. These methods make it possible to determine what pathogen caused the disease, as well as to confirm or exclude syphilitic glossitis.
Determining the causative agent of the disease is the basis for successful treatment. The emphasis is on etiotropic therapy, that is, eliminating the cause of the disease. If glossitis is bacterial in nature, properly selected antibiotics will give an excellent result, but these drugs are completely useless for viral or candidal glossitis. For fungal infections, antimycotic drugs are prescribed; for viral infections, antiviral and immunomodulators are prescribed. If the cause of glossitis is anemia, treatment of the underlying disease is necessary. Special tactics are necessary for the pathological process caused by Treponema pallidum. A dermatovenerologist must be involved in the treatment of syphilitic glossitis.
An integral part of glossitis treatment is diet. In the acute period, eating food causes serious difficulties for patients, so porridges, purees, and pureed soups are recommended. Food should not be cold or hot. Solid foods, spicy, salty, sour are excluded. This avoids irritation of the mucous membrane, which minimizes discomfort and speeds up the healing process.
In some patients, the pain syndrome is significant. In such a situation, unpleasant sensations can be relieved with the help of applications with anesthetics. To moisturize excessively dry mucous membranes, products containing glycerin are used.
Local therapy includes removing plaque from the tongue and treating with antiseptic solutions. Substances such as chlorhexidine, furacilin, and potassium permanganate are widely used. To speed up the recovery of the mucous membrane, vitamin A is used topically.
Systemic antibiotics and antiviral drugs are prescribed according to indications. This tactic is used in severe cases. With a mild clinical course of glossitis, a positive result can be achieved with local treatment.
In severe cases, swelling of the tongue can be significant and make breathing difficult. In such situations, it is necessary to take glucocorticosteroids. More often they are used in the form of ointments.
During treatment you need to give up smoking and alcohol. These substances irritate the mucous membrane and prevent its regeneration.
Some patients with glossitis have keratinized areas on the tongue. Such changes cannot be treated conservatively and can only be removed surgically.
If you consult a dentist in a timely manner and follow all his recommendations, the outcome of the disease will be favorable. Glossitis responds well to treatment if its cause is determined and targeted. If the disease is not treated, it can be complicated by an abscess or phlegmon. These conditions require surgical treatment and long-term antibiotic therapy, so it is better to start treatment at the initial stage.
Answers to popular questions about glossitis
Do I need to clean my tongue?
Yes, definitely.
A lot of microorganisms accumulate on the tongue, which leads to bad breath. In case of acute glossitis, the primary task is to relieve inflammation; you can use oral baths or rinses with antiseptic solutions (chlorhexidine, miramistin), a decoction of chamomile has a positive effect (has a calming effect on inflamed tissues of the mucous membrane of the tongue and the oral cavity as a whole). Also, do not forget about careful cleaning of the surface of the tongue.
There are special scrapers (semi-oval) for cleaning the tongue. They are designed to gently cleanse the tongue. Do not clean your tongue with brushes or spoons, as this can cause injury.
Which doctor should I contact to treat glossitis?
If tongue pathology is detected, you can consult a dentist. And, if necessary, the dentist will refer you for consultation to other specialists if this is due to the presence of a general disease.
What diagnostics are carried out before treating glossitis?
The specialist to whom the patient contacted conducts an examination of the oral cavity, collects a medical history, data on the general condition of the body (the presence of chronic organ diseases, etc.), prescribes tests, as well as laboratory diagnostics: a smear or culture of the oral cavity and tongue to determine pathogenic microflora.
Are glossitis inherited?
Yes, some forms can be inherited, for example, a folded tongue.
Is it possible to completely cure glossitis?
Some forms can be successfully treated, but often glossitis is a chronic and congenital disease. But with proper therapy, you can achieve minimal manifestations of the disease.
Prevention
Glossitis is easier to prevent than to treat. In order to avoid this unpleasant disease you need to follow simple rules.
The first is oral hygiene. This principle applies to both children and adults. If you wash your hands before eating, brush your teeth regularly, do not use someone else’s toothbrushes, and regularly sanitize your mouth, then the risk of developing tongue inflammation is minimal.
Try to avoid damaging the mucous membrane. Avoid eating hard foods that can damage your tongue, such as chips. Hot foods also cause epithelial defects. Spicy foods have an irritating effect. Abuse of them significantly worsens the condition of the tongue mucosa and increases the risk of infection.
Nicotine not only irritates the mucous membrane, but also impairs microcirculation, which reduces the resistance of the epithelium to the effects of infectious agents. Inflammatory diseases of the oral cavity are more common in smokers than in patients who are not adherents of this addiction. Strong alcoholic drinks also have a negative effect on the mucous membranes.
If you have symptoms of glossitis, do not self-medicate, contact a dental clinic. A competent specialist will determine the cause of the disease and prescribe treatment that will help quickly get rid of unpleasant symptoms. Remember, if glossitis is not treated, the disease can lead to serious complications and irreversible consequences.
Symptoms
One of the first symptoms of candidal glossitis is hyperemia and swelling of the tongue. Within one to two days after this, a characteristic white or sometimes brown coating appears on the tongue. These signs are accompanied by a strong burning sensation, moderate pain, speech impairment due to swelling of the tongue, increased salivation and an extremely unpleasant odor.
With a very low level of immunity, ulcers and erosions may appear on the tongue. Patients often complain of perverted taste sensations when eating food or a strong change in them.
In the absence of timely treatment, the acute form of candidal glossitis can become chronic, in which relapses will occur with any cold or seasonal loss of strength.
History of pathology
With atrophy and smoothing of the filiform papillae, the surface of the tongue resembles polished. These are the first signs of glossitis - an inflammatory disease of the muscle organ. There are several types of pathology according to the factors of appearance and clinical manifestations: rhomboid, folded and desquamative.
If the tongue is smooth, it means that the patient has encountered non-infectious Günther-Miller glossitis. The pathology was named after the doctors who first described the clinical manifestations of the disease in their works. The syndrome was first mentioned in 1851.
Diagnostic features
Most often, patients turn to the dentist to solve the problem. It will not be difficult for a professional doctor to recognize Gunter-Miller glossitis only by visual manifestations and complaints. However, it is important for a specialist to make a differential diagnosis from allergic stomatitis and acute atrophic candidiasis, with which the pathology has similar symptoms. The doctor also needs to identify why the atrophy of the papillae began and the tongue became smooth, and for this it is necessary to establish the reasons, that is, to determine the key disease.
If the diagnosis is correct, you will need to undergo tests
To confirm the diagnosis, blood and urine tests, culture and scraping may be required. Also, in some cases, it is necessary to visit specialized specialists (for example, gastroenterologist, infectious disease specialist, endocrinologist, cardiologist) and consult with them.
