Geographic Tongue: Everything You Need to Know

Geographic tongue is an inflammatory condition marked by large red spots with irregular white borders on the tongue. The pattern of multiple spots, which are varying sizes and shapes, often looks like the countries on a map, which is where the condition gets its name. 

Also known as benign migratory glossitis, geographic tongue affects between 1 and 2.5 percent of the population. People of any age can develop it, including children.

Medical experts don’t know what causes it, but several factors can make you more likely to develop it, including conditions like reactive arthritis and type 1 diabetes.

Causes 

Scientists have yet to discover a cause of geographic tongue. They are paying close attention to some factors that they believe play a role, including:

• Hormonal changes. Women who take oral contraceptives (birth control pills) are more likely to develop geographic tongue than women who do not take these medications. Pregnant women are also at greater risk of developing this condition, further reinforcing the idea that hormones may play a role in this process. 

• Nutritional deficiencies, especially vitamins B6 and B12 as well as zinc, iron and folic acid. 

• Allergies and related conditions like eczema and hay fever. This may be because of persistently higher levels of inflammation within the body.

• Stress. Symptoms of geographic may fade when stress levels are lower, but this finding has not been consistent across all studies.

Some researchers even consider geographic tongue to be a variation in the normal appearance of the tongue. If this is true, the condition would have no underlying cause.

Symptoms 

If you have geographic tongue, you might notice the following symptoms: 

• Red patches on your tongue. These patches are irregular, not always clustered, and can appear on the sides and bottom of the tongue and its surface.

• Red patches on your gums, on the insides of your cheeks and on the roof of your mouth. Sometimes people will also develop red lesions with whitish borders in other areas of their mouth. The lesions may be more sensitive than the surrounding tissues.

• A lack of papillae on the affected parts of your tongue. Normally, a tongue is covered in small, finger-like protrusions called papillae, which help you taste and feel the temperature of your food when you eat. People with geographic tongue do not have papillae on the red parts of their tongue.

Some people who have geographic tongue report extra sensitivity on their tongues. You may notice mild pain or a tingly sensation when eating something acidic or spicy. You may also find that brushing your tongue against sharp objects like the tips of your teeth or a broken filling is especially uncomfortable. This sensation does not bother most patients much, but it may affect some people’s ability to enjoy certain foods or tolerate objects like orthodontic devices in their mouths.

Diagnosis 

Doctors diagnose geographic tongue with a simple visual inspection. There is no need for a biopsy or any other invasive testing procedure unless your doctor sees signs of another condition (such as oral cancer).

During the examination, your doctor will inspect your tongue. They may shine a light in your mouth to get a better look at the lesions or gently touch your tongue to check for differences in sensation. They may also check your temperature and lymph nodes to see if there are any signs of infection present.

Lesions associated with geographic tongue may come and go over time. You may see the lesions today, but by the time you get to your doctor, they may disappear.

If this happens to you, take a picture of your tongue when the lesions are easy to see. This will give you something to show your doctor in case the lesions fade again by the time your appointment date arrives.

Risk Factors

Studies have shown that people with certain conditions are more likely to develop geographic tongue than the general population. These conditions include: 

• Psoriasis, an autoimmune disease that causes patches of flaky, silvery skin to appear on your body. Because of their similar appearance and frequent co-occurrence, some researchers believe that geographic tongue is actually an oral form of psoriasis.

• Reactive arthritis (also called Reiter's syndrome), a type of arthritis triggered by a bacterial infection in your body.

• Diabetes, especially type 1 diabetes.

• Fissured tongue, a genetic condition that causes deep grooves to appear on the top of your tongue.

Young adults are also more likely to develop geographic tongue than children or older adults.

Complications

While many patients find its appearance alarming and worry that it may be an early sign of oral cancer, geographic tongue is a completely benign condition. It has no associated complications and does not require any treatment.

Do I Need to See a Doctor?

If you think you have geographic tongue, it’s best to see your doctor as soon as possible to confirm that diagnosis. While geographic tongue rarely requires treatment, there are other, more serious conditions that can look a lot like it. It’s important to have your doctor rule those conditions out so you know that your overall health is not in danger.

It’s also a good idea to consult your doctor if your geographic tongue is affecting your quality of life. If you feel self-conscious about how your condition makes your tongue look or have trouble enjoying your favorite foods due to tongue pain, there are treatments available that can help.

Is it Contagious?

Geographic tongue is not a viral condition, so it cannot be passed from person to person. You cannot spread it to anyone if you have it, and you cannot catch it from anyone else either.

Treatments and Home Remedies

There is no cure for geographic tongue. There is also no way to get rid of the red patches it causes. These patches may fade on their own, but this is not guaranteed.

However, there are treatments available to help control any sensitivity you experience because of to your condition. These include: 

• Over-the-counter pain medications, especially NSAIDs.

• Topical anesthetics.

• Topical corticosteroids.

• Mouthwashes with antihistamine components.

You can also reduce the discomfort you feel by avoiding acidic or spicy foods. Limiting your consumption of alcoholic beverages and quitting smoking can also help.

If you experience anxiety about how your geographic tongue affects your appearance, psychological treatments like cognitive behavioral therapy can help you feel less self-conscious. Letting go of your anxieties will help you live a fulfilling life, even if your geographic tongue never goes away.