Geographical tongue

Geographic tongue occurs when parts of the tongue are missing layers of small bumps called papillae. They normally cover the entire upper layer of your tongue. Why do you lose these papillae with geographic tongue? Nobody knows for sure. However, because geographic tongue tends to run in families, genetics may be a common link.

Geographic tongue has also been seen more frequently in people with psoriasis and in those with fissured tongue. In fissured tongue, cracks and grooves appear on the tops and sides of the tongue.

Seeing a dentist or doctor is the best way to rule out a more serious problem. In most cases, he or she can diagnose geographic tongue from a description of your symptoms and from examining your mouth and tongue. You may need tests to rule out other medical conditions.

In most cases, any pain or discomfort will get better without treatment. But if you have severe, on-going pain, medication can help. A zinc supplement may be recommended.

There can be other reasons for a sore or painful tongue. Usually it is caused by something obvious and visible, although there are a few less obvious causes you should be aware of that may need treating.

If the pain is persistent and you haven’t accidentally bitten or burnt your tongue, see your GP or dentist. There may be an underlying infection or deficiency that needs treating, and your GP or dentist may be able to advise on pain relief while you wait for it to get better.

If you have a mouth ulcer that fails to heal within a few weeks, or if you have a red patch on your tongue with a white border that changes shape within weeks, see your licensed health practitioner or dentist. You may need to be referred to a specialist.

Oral thrush:  Oral thrush is a yeast infection in the mouth caused by a fungus. It can cause a burning sensation on the tongue, as well as sore white plaques that can be scraped off.

You are more likely to develop oral thrush if you:

• have recently taken antibiotics
• have a weakened immune system
• have diabetes

You should see your practitioner if you think you have oral thrush. If it is left untreated, the symptoms will persist and your mouth will continue to be uncomfortable. If you wear dentures, your chances of getting oral thrush are lowered if you clean your dentures as often as you would clean your regular teeth (at least every morning and night).

Anaemia:  Anaemia is a condition where the amount of haemoglobin in the blood is below the normal level, or there are fewer red blood cells than normal. It can sometimes cause a sore tongue, as well as an altered sense of taste.

There are several different types of anaemia and each one has a different cause, although iron deficiency anaemia is the most common type. Treatment for iron deficiency anaemia involves taking iron supplements to boost low levels of iron in the body, which in turn cures the tongue pain. See your practitioner if you think you have anaemia.

Aphthous mouth ulcers:  Aphthous mouth ulcers are painful sores that can occur anywhere within the mouth and tend to keep coming back. You may be able to manage the pain avoiding anything that worsens it, such as spicy foods or mouthwash.  The ulcers tend to recur less often as you get older, and usually eventually go away for good.

Less commonly, tongue pain may be caused by:

• a viral infection such as hand, foot and mouth disease or cold sores
• median rhomboid glossitis, where a smooth red inflamed patch develops on the middle or back of the tongue, thought to result from a yeast infection
• glossodynia or ‘burning mouth syndrome’, a burning pain on the tip of the tongue that is often seen in people with depression
• glossopharyngeal neuralgia, where repeated episodes of severe tongue pain are believed to be caused by nerve irritation
• lichen planus, a long-term skin condition that causes an itchy rash that can also affect the mouth, causing a white lacy pattern and painful patches on the tongue
• Behçet’s disease, a rare condition that causes inflammation of the blood vessels and can also  lead to mouth ulcers
• pemphigus vulgaris, a rare and serious condition that causes painful blisters to develop on the skin, as well as inside the mouth, nose, throat, anus and genitals
• drugs such as reserpine or aspirin sucked for toothache, and certain mouthwashes
• Moeller’s glossitis, a form of inflammation of the tongue
• cancer of the tongue, although this is rare

If you have sores in obscure places as well as on the tongue, you may have a skin disease such as pemphigus vulgaris or lichen planus.