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Notice something different about your tongue? It might be glossitis

Medically reviewed by Neka Miller, PhD on February 18, 2020. Written by Caitlin Boyd. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


The tongue: it’s a part of the body you probably don’t think too much about. Unless, that is, you’ve noticed that your tongue is swollen and inflamed—or perhaps looks especially smooth and shiny. If that’s something you’re experiencing, it may be because of glossitis—a condition that alters the appearance and texture of the tongue. 

What causes glossitis? It turns out that there isn’t just one possible cause; on the contrary, several unrelated factors have the potential for triggering glossitis. That’s what you’ll find out more about here—so read on to learn about the possible reasons for glossitis, seeking medical care, and more.

Possible causes of glossitis

Cold sores

Cold sores, also known as fever blisters, are caused by a herpes simplex virus (HSV-1). This virus is contagious and extremely common. Some researchers estimate that up to 90% of adults are infected with HSV-1.

Cold sores generally appear around your lips. But some people also develop cold sores and swelling inside their mouths, particularly during their first outbreak. If your glossitis is linked to cold sores, prescription medication may help.

Nutritional deficiencies

Your body needs a wide variety of nutrients to work well—so if you're lacking certain vital nutrients, you may notice changes in your skin, hair, or nails. In particular, if you’re deficient in B12 or B9 (folic acid or folate), you may develop atrophic glossitis (an often painful kind of glossitis in which the tongue becomes smoother than usual), sores in your mouth, or other symptoms. 


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Infections

Various oral infections—such as oral herpes —can cause tenderness and swelling of the tongue. If you have an oral infection, your throat may also feel sore, and you may notice a burning sensation when you swallow.

Anemia

People with anemia don't have enough healthy red blood cells. As a result, the bloodstream can't deliver enough oxygen to the body’s tissues. This lack of sufficient oxygen can make one feel weak, faint, or tired. Other symptoms may include:

  • Sore or swollen tongue
  • Chest pain
  • Rapid heartbeat
  • Headaches

HIV

HIV is a contagious virus that spreads through contaminated blood and sexual contact. Once you're infected, the virus can stay dormant for several years—but over time, it can seriously damage the immune system.

A kind of glossitis known as median rhomboid glossitis is sometimes one of the first symptoms of HIV. This type of glossitis appears as a flat, reddish patch at the center of the tongue.


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Syphilis

Syphilis is a sexually transmitted infection caused by the Treponema pallidum bacterium. In addition to glossitis, symptoms of syphilis can include:

  • Sores
  • Skin rashes
  • Fever
  • Swollen lymph nodes
  • Hair loss
  • Weight loss
  • Fatigue

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Oral thrush

Oral thrush is a fungal infection that develops inside the mouth. If you have thrush, the mucous membranes in your mouth may look red or swollen. You might also have glossitis or a white coating on your tongue. Thrush is most common in people who are immunocompromised due to HIV or cancer.

Oral lichen planus

People with oral lichen planus—a chronic inflammatory condition —can develop migratory glossitis, also known as geographic tongue. Migratory glossitis causes flat, patchy lesions on the surface of the tongue. 

Seeking medical care for glossitis

If you have glossitis, speak with your healthcare provider as they can help determine the cause and let you know if treatment is recommended. 

Your healthcare provider may begin by examining your mouth and tongue. In some cases, they may diagnose the problem through a visual exam. But other tests may be necessary if a diagnosis can’t be reached with the visual exam alone. This additional testing may include lab tests that check for nutritional deficiencies or infections like syphilis. In some cases, a healthcare provider may decide to swab the mouth or take a tissue biopsy.


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Glossitis treatment will depend on the underlying cause. For example, dietary changes may be recommended if glossitis is due to nutritional deficiencies. You may also be advised to limit or quit cigarette smoking, as this can irritate the mouth and tongue—and may increase the risk of oral infections.

Common questions about glossitis

What is glossitis?

Glossitis occurs when your tongue becomes swollen or inflamed—and typically looks unusually smooth, red, or flat.

How long does glossitis last?

Some cases of glossitis clear up quickly, while others last for weeks or months—it depends on the underlying cause. If your symptoms persist, see your healthcare provider for a full evaluation.

How is glossitis treated?

Your treatment plan will depend on what’s causing your symptoms. If you have an infection, you may need prescription medications. Nutritional deficiencies are often treated with supplements or dietary changes.


References

1. Cold sore. Mayo Clinic. URL. Accessed February 18, 2020.

2. Cold and Canker Sores. University of Michigan. URL. Accessed February 18, 2020.

3. Common Tongue Conditions in Primary Care. American Family Physician. URL. Accessed February 18, 2020.

4. Glossitis. MedlinePlus. URL. Accessed February 18, 2020.

5. Anemia. Mayo Clinic. URL. Accessed February 18, 2020.

6. Osaki T, Ueta E, Arisawa K, Kitamura Y, Matsugi N. The pathophysiology of glossal pain in patients with iron deficiency and anemia. Am J Med Sci. 1999;318(5):324-329. doi:10.1097/00000441-199911000-00007

7. HIV Basics. Centers for Disease Control and Prevention. URL. Accessed February 18, 2020.

8. Syphilis - CDC Fact Sheet. Centers for Disease Control and Prevention. URL. Accessed February 18, 2020.

9. Oral thrush. Mayo Clinic. URL. Accessed February 18, 2020.

10. Oral lichen planus. Mayo Clinic. URL. Accessed February 18, 2020.