Index
It is a benign condition that affects the upper surface of the tongue.
Symptoms of a fissured tongue
A normal tongue is relatively flat throughout its length. A fissured tongue is marked by a deep, prominent groove in the middle.
There may also be small grooves or fissures on the surface, which makes the tongue appear wrinkled. There may be one or more fissures of different sizes and depths.
Causes
Fissured tongue is not uncommon in the general population and can appear in different stages of fissure at any given time.
Both genetics (congenital anomaly) and environmental factors have been cited for their occurrence. However, the etiology is still uncertain and debated.
Additional considerations that can increase oral inflammation in general are flavoring agents such as cinnamon. Flavorings are known to cause hypersensitivity reactions.
Chewing gum, candy, breath mints, and certain highly flavored toothpastes can also cause problems for the patient with hyperkeratosis and sensitivity reactions.
One study suggests that large papillae in fissures cause swelling and edema. Hypothyroidism may be a consideration as the tongue can become enlarged with this condition and the tongue may not have the necessary oral space, thus folding in on itself and contributing to fissures.
Certain medications ( antihistamines , decongestants, heart medications, and anti-anxiety agents) can cause xerostomia.
Many types of drugs, both established and newly developed, as well as combinations, are known to contribute to xerostomia. Dryness can contribute to cracks.
Conditions associated with a fissured tongue
- Psoriasis.
- Granulomatosis orofacial.
- Pernicious anemia.
- Nutritional deficiencies
- Low serum levels of vitamin A.
- Down syndrome.
- Mellitus diabetes.
- Autoimmune disease states.
- Síndrome de Melkersson-Rosenthal (MRS).
- Association of geographic languages.
- Acromegalia.
- Sjogren’s syndrome (due to decreased salivation).
- Certain medications taken for various disease states.
epidemiology
Fissured tongue is not common in children, but has been reported to increase with age in adults. The studies reported the results of a group of 668 Danish people aged 65 to 95 years, and 9.1% of this population was diagnosed with a cleft tongue.
The authors attributed the percentage to a female predilection, xerostomia, and low and unstimulated salivary secretion in all groups. Other sources cite a population of up to 5% as affected by FT, and others report a male predilection.
Pathogenesis
It can be associated with various conditions as mentioned above, but the papillae of the tongue vary. Some tongues have large, swollen papillae that vary in size, smoothness, and the types of papillae most affected.
Pedersen found that atrophy of the lingual papillae is a clinical indicator of medication-induced xerostomia. The tongue can be affected in multiple areas, but most commonly on the dorsal surface with a propensity toward the central line.
Differential diagnostic considerations
- Inflammatory reactive lesions (hypersensitivity reactions).
- Infections
- Premalignant lesions and neoplasms.
- Syndromes and family conditions.
Treatment of fissured tongue
Clinical suggestions for a fissured tongue
- Assess any systemic disease state that is associated with cleft tongue.
- Evaluate the patient for xerostomia (certain medications and conditions can cause dryness).
- Recommend a soft bristle brush to clean the tongue (suggest a children’s toothbrush as the head is smaller, the bristles are softer and will flex to reach the crevices).
- Replace the toothbrush if there is a disease, virus or candida. Toothbrushes can also be cleaned every few days with hydrogen peroxide simply by pouring liquid over the brush head, followed by rinsing the brush with hot water.
- Regular use of a tongue cleaner. Educate the patient on the use of the device.
- Advise the patient to rinse with water frequently. Drinking pure water cleanses the tongue and oral tissues. Water also hydrates all of the body’s systems.
- Check periodically for signs of candida. Burning is often a sign of candida along with a white / yellow coating on the surface of the tongue.
- Antimicrobial mouthwash may be suggested. An alcohol-free rinse is recommended.
- Discontinue flavoring agents like wintergreen, peppermint, and cinnamon that can cause inflammation or chronic irritation / inflammation. Certain brands of toothpastes, mints, gums, candy, or mouthwashes may contain these flavoring agents in higher amounts. Work with the patient to find the best product for them.
- Advise the patient to keep a record of unhealthy foods and any products that may cause the cracking to become more severe or cause burns.
- Encourage the patient to keep and keep scheduled dental hygiene appointments and oral cancer exams.
One study discusses the fact that the depth and clinical appearance of fissured tongue vary so widely that it is difficult to determine when to classify a tongue as “fissured” and equally difficult to determine any measure to classify these features.
A case of cleft tongue suggested several considerations that should be included for a differential diagnosis.
The Binmadi study authors were able to attribute the fissuring to psoriasis and cautioned dental health care providers to consider psoriasis in their differential diagnosis when evaluating the geographic tongue and tongue with noticeable cracking.
Patient education
In addition to ruling out the conditions that can be associated with a fissured tongue, the physician must educate the patient on the best techniques to reduce inflammation and keep the cracks as free of debris as possible.
Brushing the tongue with a soft bristle brush that allows the bristles to enter the crevices is optimal. Since many patients use an electric toothbrush, this type of brush can be too abrasive to reach deep crevices.
So a separate soft brush would be best (soft brush for kids). The use of a tongue cleaner may also be recommended.
Although patients brush their tongues lightly in most cases, maintaining deep crevices will require a more concentrated effort to remove debris.
Baking soda rinses and, in the case of inflammatory tongue surfaces, antibacterial rinses may be recommended. Some hypersensitivities to flavoring agents can also cause more inflammation, redness, and edema in the oral tissues.
Removing these can improve the tissues of the tongue. Most osteopathic and Chinese medicine doctors believe that fissures indicate a lack of hydration within the body, as well as nutritional deficiencies in certain food groups, such as vegetables.
Patients may be concerned about the possibility of oral cancer and need confirmation that malignancy is not a problem associated with a fissured tongue.
There may be psychological and self-awareness problems for the patient due to the appearance of the tongue. Those areas with a fissured appearance towards the tip or anterior third of the tongue may be more visible to the patient and noticed by others.
Perhaps the patient has received comments, raising these concerns. It is necessary to help the patient to limit inflammation, confirm any etiology, and hopefully decrease the appearance of fissures.
Intraoral features
A fissured tongue is sometimes called a scrotal tongue, folded tongue, or grooved tongue, and may be associated with the entity known as a geographic tongue. The fissure can be so deep that there is a lobulated appearance.
Histology
Rete ridges show hyperplasia and inflammation in the lamina propria. The fissuring is often exhibited along with the features of the geographic tongue.
There is loss of keratin hairs in the filiform papillae with prominence of the fungiform papillae. The geographic tongue is characterized by microabscesses in the upper epithelial layers.
Dental implications
As the population ages and life expectancy increases, more older adults are likely to be treated with medications for chronic conditions. The literature suggests that tongue fissuring increases with age.
The fissured tongue can cause debris to accumulate in the deep cracks and grooves on the surface of the tongue, making debridement difficult for the patient.
Cracks that harbor debris and bacteria make halitosis a possibility. The accumulation of debris in the cracks can also affect taste and food choices.
Taste sensation is especially important from a nutritional perspective in older adults. Patients may notice a sore or burning tongue with different food sources or the use of certain dental products that are highly scented.
