Common Tongue Conditions in Primary Care

Tongue conditions occur in 15.5% of the US population. The most common tongue conditions are geographic tongue, fissured tongue, and black hairy tongue; these conditions do not require treatment. Median rhomboid glossitis can be associated with a candidal infection; symptomatic lesions usually improve with use of antifungals. Atrophic glossitis is often linked to a nutritional deficiency and resolves with treatment of the underlying condition. Oral hairy leukoplakia is caused by Epstein-Barr virus and most often presents in patients with severely compromised immunity; it can be treated with oral antivirals. Growths of the tongue usually require biopsy to differentiate benign lesions (eg, traumatic fibromas, squamous cell papillomas) from leukoplakia and squamous cell carcinoma. Referral to an oral and maxillofacial surgeon, otolaryngologist, or a dentist experienced in oral pathology may be indicated. Burning mouth syndrome often involves the tongue, and if it does not resolve spontaneously, studies have shown improvement with gabapentin, topical clonazepam, capsaicin, and cognitive behavior therapy. Oral lichen planus is a chronic inflammatory disorder that can affect the tongue and is best treated with topical or systemic corticosteroids and calcineurin inhibitors. There is a lack of consensus on the definition and treatment of ankyloglossia (tongue-tie); however, some evidence supports that frenotomy can improve breastfeeding and decrease lactation-associated nipple pain.