Fissured, hairy, and geographic tongue - BMJ Best Practice
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Fissured tongue is usually a normal variant of tongue appearance and is not considered a pathologic entity. It generally presents in healthy people; however, it is also seen in association with conditions such as Down syndrome and geographic tongue. If the sole manifestation is that of fissured tongue, then no investigations or treatment are usually necessary.
Hairy tongue occurs when the physiologic balance between keratin production and shedding through normal oral function is chronically disrupted with consequent elongation of the keratinized component of the filiform papillae that cover the tongue dorsum. Poor oral intake during illness or oral discomfort secondary to oral ulcerative conditions are examples of situations where physiologic keratin shedding secondary to mechanical debridement may be reduced. Smoking, coffee or tea, or poor oral hygiene are examples of predisposing factors.
Improving oral hygiene, stopping smoking, and using a tongue scraper appropriately aids management of hairy tongue.
Geographic tongue appears as well-demarcated red areas of the dorsal and lateral tongue, with white scalloped borders. Its etiology is unknown and no treatment, other than symptomatic relief, is generally necessary.
KSS discloses his salary is partially-funded by the University of Bristol and Health Education England. He has also received an educational grant from the Elizabeth Wiley Foundation.
Professor Konrad S. Staines would like to gratefully acknowledge Professor Aisha Sethi, the previous contributor to this topic. AS declares that she has no competing interests.
Head of the Department of Oral and Maxillofacial Surgery and Oral Pathology
VU University Medical Centre and Academic Centre for Dentistry
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Peer reviewer affiliations and disclosures pertain to the time of the review.
Schlager E, St Claire C, Ashack K, et al. Black hairy tongue: predisposing factors, diagnosis, and treatment. Am J Clin Dermatol. 2017 Aug;18(4):563-9.Abstract