Mouth conditions, sore tongue

Question 1

Probability diagnosis

Answer 1

Geographic tongue (migratory glossitis)

Atrophic glossitis

Trauma (bites, teeth, hot food/drink)

Aphthous ulceration

Herpes simplex virus (children)

Fissured tongue

Question 2

Disorders not to be missed

Answer 2

Cancer

HIV

Question 3

Pitfalls (often missed)

Answer 3

• Anaemia: iron, vitamins B6 and B12, folate deficiency
• Glossopharyngeal neuralgia
• Lichen planus
• Fissured tongue (rarely causes soreness)
• Median rhomboid glossitis
• Hand, foot, mouth infection
• Behçet syndrome
• Crohn disease
• Coeliac disease

Question 4

Masquerades checklist

Answer 4

Depression

Diabetes (Candida)

Drugs (mouthwashes, aspirin)

Anaemia (various)

Question 5

Is the patient trying to tell me something?

Answer 5

Possible with glossodynia.

Question 6

Key clinical features

Answer 6

Enquire about;

• trauma
• dental problems
• nutrition
• drugs
• associated general symptoms.

The cause is usually obvious upon examination but there are some obscure cancers.

The causes are similar to that of a sore throat or mouth.

Question 7

Investigation may include:

Answer 7

FBE

serum vitamin B12, folate and ferritin levels

swab and biopsy of a suspicious lesion.

Question 8

Diagnostic tips

Answer 8

Look for evidence of trauma, especially from a sharp tooth or dentures.

Take note of ;

• self-medications, especially sucking aspirin
• hx of skin lesions (e.g. lichen planus)
• underlying diabetes or other immunosuppression.

Any non-healing or chronic ulcer requires urgent referral.

Glossodynia (painful tongue) characteristically presents with a burning pain on the tip of the tongue, without physical signs.

Consider depressive illness as an underlying cause.

Shared care with a dental or oral medical specialist is important.