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This article discusses the approach to diagnosis and management of disorders of the tongue. These disorders include glossodynia, geographic tongue and smooth tongue, fissured tongue, and black hairy tongue and furred tongue. A brief review of the examination of the tongue is also included.
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The conditions discussed in this article are those most likely to cause a patient to seek emergency care, primarily for pain. All the characteristics given for the conditions to aid in the diagnosis do not necessarily need to be present and other characteristics not mentioned may in fact be present. A complete differential diagnosis, especially of more obscure lesions, was also not attempted. An attempt was made to provide the practitioner with enough information to develop a working diagnosis from which to alleviate the patient's discomfort. A definitive diagnosis may not be available in an emergency setting. However, it must be emphasized that the final responsibility of the dentist is to make a definitive diagnosis at a later time if one cannot be made when emergency treatment is sought. Alleviating pain without dealing with the underlying cause may be more detrimental to the patient's health in the long run, as palliative therapy may mask a more severe condition.
100 patients suffering from glossodynia without pathologic changes of the oral mucosa and 16 patients with suspected allergic contact stomatitis underwent patch testing using standard patch test and dental materials. The results were compared with those of patients in dental occupations suffering from hand eczema. As there is no clinical relevance of allergens in patients with glossodynia, patch testing seems to be unnecessary. On the other hand, patch test results of patients with stomatitis and dentures often suggest a causal allergy. In most of those cases, this was confirmed by complete healing after changing the denture bases, whereas in glossodynia such replacements never brought about a convincing improvement of the symptoms.
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Eight cases of glossodynia arising in the context of an endogenous depression are reported and the case histories of four of them are presented. Somatic features, in particular the sensation of having a burned tongue, were by far the most prominent and tended to relegate the depressive symptoms to the background. The clinical picture can usefully be classified as the coenesthetic form of a depressive psychosis of late life. A good treatment response can be achieved with antidepressants, possibly in combination with neuroleptics.
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