I have been told by my dentist that I have a geographic tongue. The irritation on my tongue is continual, but it is not always in the same spot. The discomfort worsens at certain times of the month. I have been told that nothing can be done about this condition, but it is too aggravating to stop seeking help. Can you give me any advice?

B.

There is, indeed, a condition known as "geographic tongue." The name reflects the fact that the tongue looks a bit like a continental map, with irregular patches of smooth tongue intermixed with rougher areas in which the taste buds are normal. The medical term for it is "benign migratory glossitis." What does "benign migratory glossitis" mean? "Glossitis" means "tongue inflammation." The condition is benign (that means it is NOT going to turn into anything more worrisome) and migratory (the smooth areas vary in location from time to time). It is a common problem, affecting about 1 in 100 individuals. The cause of this condition is unknown.

Geographic tongue is usually not a painful condition. If it is painful, you should bring it to the attention of your physician. Certain other conditions (some of which ARE painful) can be confused with geographic tongue. Three of the more common alternative diagnoses are thrush, oral lichen planus and glossopyrosis.

Yeast infection (thrush) is perhaps the most common infection involving the surface of the tongue, and it is a painful condition. With thrush, there are usually small, white, raised patches on the tongue, and these white patches may have red borders. The white patches are difficult to scrape off and may bleed if you try to scrape them. Other mucus membranes may be infected, too.

Oral lichen planus usually involves the mucus membranes on the inner surface of the cheeks but may on occasion involve the tongue surface. Oral lichen planus, like geographic tongue, is a rather mysterious condition. Pain is more common with oral lichen planus than with geographic tongue, however.

Finally, with glossopyrosis (burning tongue), the tongue looks normal but HURTS, particularly in response to hot or spicy foods, citrus juices or toothpaste. Glossopyrosis usually occurs in post-menopausal women. There are a number of potential causes, including yeast infection, estrogen deficiency and deficiencies of vitamin B or folic acid.

Successful treatment first requires a correct diagnosis. Consultation with an ear, nose and throat doctor or a dermatologist would therefore be a very good idea. Thrush can be successfully treated using appropriate antifungal drugs. Oral lichen planus will sometimes respond to topical application of steroid medications. These are prescription drugs, and are NOT the same as the anti-itch steroid creams that you can buy over the counter. Geographic tongue usually does not require medication, but when painful it, too, can be treated with topical steroids. Glossopyrosis will typically improve if the root cause (such as vitamin deficiency) can be detected and corrected.