Migratory glossitis is a psoriasis-like or psoriasis-related condition of the tongue resulting in many wavy white lines on the top and sides, often with small parallel grooves near them. As in psoriasis, these lines "wander" about the tongue, shifting positions or appearances on a weekly, or sometimes on a daily, basis.
Treatment is not normally required, but antifungal and antibacterial medications may be administered if symptoms arise; topical or systemic cortisone or prednisone may also be helpful. There is no malignant potential.
Many times these lines slowly radiate from a central area of smooth red mucosa, i.e. the normal tongue papillae or "bumps" temporarily disappear. The latter appearance often imparts an appearance similar to that of a globe of the Earth, with irregular white lines representing outlines of continents, hence, the common name for this disease: geographic tongue.
Chronic inflammatory cells can be seen in variable numbers within the stroma and silver or PAS staining will often demonstrate candida hyphae or spores in the superficial layers of the epithelium.
A thickened layer of keratin is infiltrated with neutrophils, as are lower portions of the epithelium to a lesser extent. These inflammatory cells often produce small microabscesses, called Monro's abscesses, in the keratin and spinous layers. Rete ridges are typically thin and considerably elongated, with only a thin layer of epithelium overlying connective tissue papillae When rete ridges are not elongated, the pathologist should consider Reiter's syndrome as a diagnostic possibility.
Migratory glossitis is usually without symptoms, but some may complain to a Seattle dentist or cosmetic dentist of a burning or tingling sensation, often from secondary fungus or bacterial infection, possibly from a developing anemia (unrelated to the geographic tongue). Occasional patients have no white lines but have instead smooth red patches, sometimes with small grooves at their edges.
All of the microscopic features of psoriasis are present in benign migratory glossitis and migratory stomatitis, but these will not be obvious unless the biopsy is taken from a prominent serpiginous line at the periphery of a depapillated patch.
A small number of other pustular diseases actually affect the oral mucosa. True psoriasis of the oral mucosa would present, of course, a very similar appearance when looked at under a microscope. There is no liquefactive degeneration of basal cells, as seen in lichenoid lesions, and there is no ulceration except in cases of Reiter's syndrome. Other pustular diseases include pyostomatitis vegetans, stomatitis herpetiformis and the hyperplastic inflammatory response (parulis) at the orifice of a fistula extending to the surface from a dental or periodontal abscess.
Background:
Geographic tongue (benign migratory glossitis) is a benign condition that occurs in up to 3% of the general population. Most often, patients are asymptomatic; however, some patients reported increased sensitivity to hot and spicy foods.
The etiology and pathogenesis are still dimly understood. "This condition affects both males and females and is said to be more prominent in adults than in children" says Shawn Keller, a cosmetic dentist and Seattle dentist.
The typical symptom is an area of erythema, with atrophy of the filiform papillae of the tongue, surrounded by a white serpiginous, hyperkeratotic border. The patient often reports spontaneous resolution of the lesion in one area, with the return of normal tongue architecture, only to have another lesion appear in a different location of the tongue.
These lesions all present with microabscess or neutrophilic infiltration of the lower portions of the epithelium or of the underlying connective tissue papillae. None present with abscesses of the keratin or superficial layers says s cosmetic dentist and Seattle cosmetic dentist.
Also, occasional examples of subcorneal pustular dermatitis are encountered in the mouth as subcorneal pustular mucositis, but the separation of the keratin layer from the spinous layer makes it rather easy to differentiate from migratory stomatitis. Lesion activity may wax and wane over time, and patients are occasionally free of lesions. If lesions occur at other mucosal sites, the condition is termed erythema migrans.
Pathophysiology:
The most commonly affected site is the tongue; however, other oral mucosal soft tissue sites may be affected. It has been reported with increased frequency in patients with psoriasis and in patients with fissured tongue.
Although this is an inflammatory condition histologically, a polygenic mode of inheritance has been suggested by a seattle dentist because it is seen clustering in families by a dentist. Associations with human leukocyte antigen (HLA)–DR5, HLA-DRW6, and HLA-Cw6 have also been reported.
Frequency: In the US:
This condition has reportedly occurred in up to 3% of the general population in the United States.Internationally:
International frequency rates are similar to those reported in the United States.
Mortality/Morbidity:
Geographic tongue is a benign condition says a seattle dentist.
Race:
No racial or ethnic predilection is reported for this condition.
Sex:
Females have been reported to be affected twice as often as males. Exacerbations have been suggested to be related to hormonal factors.Age:
Geographic tongue can affect all age groups; however, it is more predominant in adults than in children says a dentist.