- Email: [email protected]
Geographic Tongue
Accepted Manuscript Title: Geographic Tongue Author: Tanay Chaubal, Ranjeet Bapat PII: DOI: Reference:
S0002-9343(17)30692-7 http://dx.doi.org/doi: 10.1016/j.amjmed.2017.06.016 AJM 14168
To appear in:
The American Journal of Medicine
Please cite this article as: Tanay Chaubal, Ranjeet Bapat, Geographic Tongue, The American Journal of Medicine (2017), http://dx.doi.org/doi: 10.1016/j.amjmed.2017.06.016. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Authors: Dr. Tanay Chaubal a, Dr. Ranjeet Bapat b a
MDS (Periodontology and Oral Implantology), Department of Periodontics, D.Y.Patil University School of dentistry, Nerul, Navi Mumbai, Maharashtra state, India, Zip code – 400706. b MDS (Periodontology and Oral Implantology), Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia, Zip code – 57000. E-mail: Dr. Tanay Chaubal – [email protected] Dr. Ranjeet Bapat – [email protected]
Corresponding Author: Dr.Tanay V. Chaubal, Address: 6/ Jagruti, Sudarshan colony, Thane east, Maharashtra state, India. Pin: 400603. Mobile no: +919820950853 E-mail: [email protected] Source of financial support or funding: None Conflict of interest statement: None Author Contributions: All authors had access to the data and were involved in writing the manuscript.
1) Dr. Tanay Chaubal – conception of study, acquisition of data and drafting of article. 2) Dr. Ranjeet Bapat – acquisition of data and final guarantor of article. 3) Article Type – Clinical communication to the editor Keywords: Geographic tongue Running title: Geographic tongue
Page 1 of 6
To the Editor:
A 45 year old female patient presented to our clinic with a painless, erythematous lesion on her tongue. Medical history was negative with absence of any allergies or habits. The patient recalled that she had a similar lesion on her tongue 6 months earlier which resolved spontaneously. Clinical examination of the dorsal surface of the tongue revealed multiple erythematous patches with annular, well-demarcated white borders (Figure, Black arrows). Hemoglobin level of 13 gm/dl (normal range – 12 to 15 gm/dl) and total red blood cell count of 4.8 million cells/μl eliminated anemia. Negative periodic acid Schiff stain performed by taking a smear sample from the tongue eliminated candidial fungal infection. Taking into consideration the history, laboratory findings and the typical waxing and waning pattern of the lesion, the diagnosis arrived at was geographic tongue. The lesion regressed spontaneously after 1 month. We advised the patient to maintain oral hygiene with regular follow up visits. Evaluation after 6 months revealed no recurrence of the lesion. Geographic tongue is also known as benign migratory glossitis due to the ability of the lesion to migrate over time from one location to another. It is a benign condition commonly seen on the tip, lateral borders and dorsum of the tongue.1 Geographic tongue has a prevalence rate of 3% in the United States. 2 The etiology of geographic tongue is not well understood. Clinically it is characterized by a central erythematous zone consisting of atrophy of the filiform papillae while the white zone shows regenerating filiform papillae along with keratin. Histologically there is epithelial degeneration in the erythematous zone and elongated rete pegs with hyperkeratosis in the white zone. The connective tissue shows infiltration of polymorphonuclear leukocytes and lymphocytes.3 Most cases of geographic tongue are self healing. Differential
Page 2 of 6
diagnosis of geographic tongue includes leukoplakia, lichen planus and candidiasis. Leukoplakia is caused by chronic irritation from rough teeth, improper fillings, tobacco use, smoking or HIV associated oral hairy leukoplakia. Biopsy is taken of the lesion and the uninvolved mucosa to rule out cancer. Removal of the etiologic factor results in regression of the leukoplakia in a few weeks to a month. Geographic tongue may have variable appearances and symptoms which need to
be
differentiated
from
other
lesions
of
the
tongue.
Page 3 of 6
References 1) Jainkittivong A, Langlais RP. Geographic tongue: clinical characteristics of 188 Cases. J Contemp Dent Pract 2005; 6(1):123-135. 2) Shulman JD. Prevalence of oral mucosal lesions in children and youths in the USA. Int J Paediatr Dent 2005;15(2):89-97. 3) Rhyne TR, Smith SW, Minier AL. Multiple, annular, erythematous lesions of the oral mucosa. J Am Dent Assoc 1988; 116(2):217-218.
Page 4 of 6
Figure captions Figure – Dorsum of tongue showing erythematous patches with white borders (Black arrows) single column fitting
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Page 6 of 6
S0002-9343(17)30692-7 http://dx.doi.org/doi: 10.1016/j.amjmed.2017.06.016 AJM 14168
To appear in:
The American Journal of Medicine
Please cite this article as: Tanay Chaubal, Ranjeet Bapat, Geographic Tongue, The American Journal of Medicine (2017), http://dx.doi.org/doi: 10.1016/j.amjmed.2017.06.016. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Authors: Dr. Tanay Chaubal a, Dr. Ranjeet Bapat b a
MDS (Periodontology and Oral Implantology), Department of Periodontics, D.Y.Patil University School of dentistry, Nerul, Navi Mumbai, Maharashtra state, India, Zip code – 400706. b MDS (Periodontology and Oral Implantology), Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia, Zip code – 57000. E-mail: Dr. Tanay Chaubal – [email protected] Dr. Ranjeet Bapat – [email protected]
Corresponding Author: Dr.Tanay V. Chaubal, Address: 6/ Jagruti, Sudarshan colony, Thane east, Maharashtra state, India. Pin: 400603. Mobile no: +919820950853 E-mail: [email protected] Source of financial support or funding: None Conflict of interest statement: None Author Contributions: All authors had access to the data and were involved in writing the manuscript.
1) Dr. Tanay Chaubal – conception of study, acquisition of data and drafting of article. 2) Dr. Ranjeet Bapat – acquisition of data and final guarantor of article. 3) Article Type – Clinical communication to the editor Keywords: Geographic tongue Running title: Geographic tongue
Page 1 of 6
To the Editor:
A 45 year old female patient presented to our clinic with a painless, erythematous lesion on her tongue. Medical history was negative with absence of any allergies or habits. The patient recalled that she had a similar lesion on her tongue 6 months earlier which resolved spontaneously. Clinical examination of the dorsal surface of the tongue revealed multiple erythematous patches with annular, well-demarcated white borders (Figure, Black arrows). Hemoglobin level of 13 gm/dl (normal range – 12 to 15 gm/dl) and total red blood cell count of 4.8 million cells/μl eliminated anemia. Negative periodic acid Schiff stain performed by taking a smear sample from the tongue eliminated candidial fungal infection. Taking into consideration the history, laboratory findings and the typical waxing and waning pattern of the lesion, the diagnosis arrived at was geographic tongue. The lesion regressed spontaneously after 1 month. We advised the patient to maintain oral hygiene with regular follow up visits. Evaluation after 6 months revealed no recurrence of the lesion. Geographic tongue is also known as benign migratory glossitis due to the ability of the lesion to migrate over time from one location to another. It is a benign condition commonly seen on the tip, lateral borders and dorsum of the tongue.1 Geographic tongue has a prevalence rate of 3% in the United States. 2 The etiology of geographic tongue is not well understood. Clinically it is characterized by a central erythematous zone consisting of atrophy of the filiform papillae while the white zone shows regenerating filiform papillae along with keratin. Histologically there is epithelial degeneration in the erythematous zone and elongated rete pegs with hyperkeratosis in the white zone. The connective tissue shows infiltration of polymorphonuclear leukocytes and lymphocytes.3 Most cases of geographic tongue are self healing. Differential
Page 2 of 6
diagnosis of geographic tongue includes leukoplakia, lichen planus and candidiasis. Leukoplakia is caused by chronic irritation from rough teeth, improper fillings, tobacco use, smoking or HIV associated oral hairy leukoplakia. Biopsy is taken of the lesion and the uninvolved mucosa to rule out cancer. Removal of the etiologic factor results in regression of the leukoplakia in a few weeks to a month. Geographic tongue may have variable appearances and symptoms which need to
be
differentiated
from
other
lesions
of
the
tongue.
Page 3 of 6
References 1) Jainkittivong A, Langlais RP. Geographic tongue: clinical characteristics of 188 Cases. J Contemp Dent Pract 2005; 6(1):123-135. 2) Shulman JD. Prevalence of oral mucosal lesions in children and youths in the USA. Int J Paediatr Dent 2005;15(2):89-97. 3) Rhyne TR, Smith SW, Minier AL. Multiple, annular, erythematous lesions of the oral mucosa. J Am Dent Assoc 1988; 116(2):217-218.
Page 4 of 6
Figure captions Figure – Dorsum of tongue showing erythematous patches with white borders (Black arrows) single column fitting
Page 5 of 6
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