Irregularly shaped (maplike or geographic) pale red patches are seen on the tongue (Fig. 34-1). Close examination reveals that the filiform papillae are flatter or denuded in these areas. The patches slowly migrate over the tongue surface and heal without scarring.

The disorder may come and go but may be constantly present in some persons.

The cause is unknown, but the lesions seem to be more extensive during a systemic illness. It has been suggested by some authors that geographic tongue is a form of psoriasis.

Some patients complain of burning and tenderness, especially when eating sour or salty foods.

If inflammation is present, the gingiva appears shiny, red, smooth, soft, and friable, with easy bleeding. If noninflammatory, it is firm with loss of stippling and contains a reddish-purple hue.

Improvement is common if the underlying cause is treated.

Systemic diseases include primary amyloidosis, sarcoidosis, acromegaly, Kaposi’s sarcoma, Wegener’s granulomatosis, leukemia, aplastic anemia, lymphomas, Crohn’s disease, scurvy, and neurofibromatosis.

Drug causes include phenytoin, calcium channel blockers, and cyclosporine. Less common drugs include lithium, tacrolimus, sertraline, birth control pills, ketaconazole, erythromycin, and other antisiezure medicines in addition to phenytoin. Poor dental hygiene with chronic gingivitis may be causative. It can be congenital, idiopathic, or physiologic in pregnancy or puberty.

Pain, tenderness, halitosis, poor speech, difficult mastication and unsightly appearance are all reasons to initiate therapy.

Therapy is focused on the treatment of the underlying cause as well as aggressive oral hygiene. Surgical reduction is the last approach to be considered.

One or more lesions develop at the same time and heal without scarring in 5 to 10 days. They can recur at irregular intervals. It is the most common oral inflammatory disease (affects 20% of population). It usually begins in adolescence and peaks in incidence in the third to fourth decade, after which the disease becomes less severe and less frequent.

Lesions are usually located on nonkeratinized mucosa (buccal, labial sulci, lateral and ventral tongue, soft palate, oropharynx).

There are three subtypes: (1) minor lesions (80%) are less than 5 mm to 1 cm, especially buccal and labial, and heal spontaneously in 7 to 10 days without a scar, (2) major (10%) are 5 to 10 mm deep, heal in weeks to months and often scar; other names are Sutton’s ulcers or periadenitis mucosa necrotica recurrens, and (3) herpetiform (10%) occur on dorsal tongue, palate, or other keratinized mucosa, are small (1 to 3 mm) and grouped on coalescent ulcers, and heal in 1 to 4 weeks.

The cause is unknown, but certain foods, especially chocolate, nuts, and fruits, can precipitate the lesions or may even be causative. Trauma from biting or dental procedures can initiate lesions (pathergy). Some cases in women recur in relation to menstruation. A viral cause has not been proved. A pleomorphic, transitional L-form of an α-hemolytic Streptococcus sp (Streptococcus sanguis) has also been implicated as causative. Stress, nutritional deficiency, smoking cessation, and allergy may be triggers. Numerous underlying illnesses include Behçet’s disease, human immunodeficiency virus (HIV), inflammatory bowel disease, cyclic neutropenia, FAPA (fever, aphthous stomatitis, pharyngitis, adenitis), and MAGIC (mouth and genital ulcers with inflamed cartilage and gluten-sensitive enteropathy). The disease can also be a sign of deficiencies of iron, zinc, folate, and B vitamins 1, 2, 6, and 12.