An Overview of Geographic Tongue

A Benign Inflammatory Condition

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Table of Contents

Benign Migratory Glossitis, also called Geographic Tongue, is a harmless (benign) inflammatory condition affecting the tongue's mucous membrane. It causes discolored bald patches on the tongue's surface that often appear in an "island-like" distribution, making the tongue's surface look like a map.

Symptoms

While the appearance of geographic tongue is unusual and may be alarming if someone has not experienced it before, the condition is completely benign. In fact, some people may not even realize they have the condition until it is noticed during an exam such as a routine dental cleaning. Common characteristics include:

  • Bald patches or lesions on the tongue's surface
  • Discoloration of the tongue, usually white patches
  • Raised areas on the tongue with a defined border
  • Occasionally, lesions may appear in other mucosal areas of the body such as the labia

People who experience geographic tongue often have periods of remission when they don't have any lesions at all. When lesions are present on the tongue, they may come and go at random, change size or shape, change location, change color (usually they appear as white, yellow, pink, or red). They may affect only one area of the tongue or several areas.

Changes to the lesions associated with geographic tongue often take place over the course of several days. Some changes can occur over the course of a single day, often in a matter of hours.

For most people, the condition is painless. However, some people who experience geographic tongue report sensitivity to hot or spicy foods, acid food like citrus fruit, alcohol, and tobacco.

While people often worry that the lesions associated with geographic tongue may predispose them to more serious health issues, there is no evidence that the condition increases a person's risk for more serious diseases, such as oral cancer.

While the changes in appearance caused by the condition may come and go, they do not cause permanent damage to the tongue and the condition is not believed to have any long-term health consequences.

Causes

The exact cause of geographic tongue is unknown. However, there are many proposed theories and potential associations that have been explored.

Many people with the condition have reported that it seems to appear during times of stress. Others have noted that the condition may occasionally appear in families, implying there may be certain genetic or environmental components. One study exploring the possible connection with psoriasis identified a gene variant in interleukin-1 beta (IL-1B) as a predisposing factor for developing geographic tongue.

In some cases, certain parafunctional habits such as teeth grinding have been linked to the development of geographic tongue. Additionally, people who have a condition known as fissured tongue also appear to be more likely to have geographic tongue. There are several other potential causes of geographic tongue as well:

  • Diet-related causes (food sensitivities and nutrient deficiencies)
  • Allergies (metals and environmental)
  • Hormone-related causes (use of oral contraceptives)
  • Dermatologic conditions (psoriasis and eczema)
  • Autoimmune disorders and other inflammatory conditions
  • Chronic diseases (diabetes)
  • Hereditary disorders (chronic granulomatous disease)

While many theories are being explored, current research has yet to establish a definitive cause for geographic tongue, and links to certain conditions (such as psoriasis) remain speculative.

Diagnosis

Geographic tongue affects both men and women of all ages and racial backgrounds. It appears to occur more frequently in children. While the condition is believed to affect a very small percentage of the population, many people may not realize they have it.

Geographic tongue is often diagnosed incidentally; a doctor or dentist may notice the condition during a routine exam.

However, sometimes people may specifically seek medical care when they notice the condition because they are worried it is a sign of a serious health problem, such as an infection or cancer.

A diagnosis of geographic tongue is usually made by visually examining the mouth and your doctor asking questions, such as when the lesions appeared and if they are causing pain. There are a few other conditions that may look similar to geographic tongue that a doctor may want to rule out, including:

  • burns from chemicals
  • psoriasis
  • a fungal infection such as candidiasis
  • lichen planus
  • contact stomatitis (sensitivities or allergic reactions to substances such as toothpaste)
  • rarely, oral cancers

As the condition is harmless and usually painless, doctors usually do not order any specific tests to diagnose the condition. If there is uncertainty about the diagnosis, or if a doctor wants to rule out another condition with a similar appearance, they may take a tissue sample from the tongue for biopsy.

However, in most cases, the characteristic appearance of geographic tongue lesions are adequate to make a confident diagnosis and rule out other conditions.

Treatment

Geographic tongue does not require any treatment because it is benign, resolves on its own, and usually doesn't cause pain. If someone with the condition notices sensitivity to certain foods, drinks, or substances (such as tobacco or toothpaste) they may want to take note of what irritates the lesions and avoid them during times when the condition is present or flaring up.

If someone experiencing geographic tongue is having consistent pain or sensitivity, a doctor may prescribe topical treatments such as corticosteroids or retinoids. If the pain is severe, topical anesthetics or agents that numb the tongue may be offered. Mouth rinses can also be used to soothe any discomfort associated with the condition.

Depending on the cause, some people who experience geographic tongue may benefit from trying medication to treat allergies (antihistamine). For people who have a chronic health condition (such as psoriasis) and experience geographic tongue as a result, usually treating the underlying condition resolves the lesions.

A Word From Verywell

Benign migratory glossitis, also called geographic tongue, is a harmless inflammatory condition affecting the tongue's mucous membrane. Most people who have geographic tongue may not even realize they have it. The condition usually doesn't require treatment, as the lesions do not increase one's risk for more serious conditions and typically do not cause pain. However, if someone does experience pain from the lesions, they may benefit from treatment with topical steroids, antihistamines, or soothing mouth rinses. Most cases resolve on their own and do not cause any long-term health effects.

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Article Sources

  • Geographic tongue. Genetic and Rare Diseases Information Center.

  • GEOGRAPHIC TONGUE. American Osteopathic College of Dermatology

  • Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Benign migratory glossitis or geographic tongue: an enigmatic oral lesion. The American Journal of Medicine. 2002;113(9):751-755. doi:10.1016/s0002-9343(02)01379-7

  • Masferrer E, Jucgla A. Geographic Tongue | NEJM. New England Journal of Medicine.