Fissured tongue is a benign alteration that can be called scrotal languish, puckered tongue or cracked tongue. It is characterized by numerous fissures on the dorsal surface of the tongue which vary in size and depth. This alteration can be congenital, although it can appear at any stage of life and worsen with age.
Fissured tongue has an average worldwide incidence of over 21% of the population, with no racial predilection. Reported cases show a greater trend in males and younger patients. Fissured tongue is considered a variation of normal tongue anatomy, which can be associated with various syndromes such as Melkersson-Rosenthal syndrome. In this case, it is an alteration secondary to granulomatous inflammation of the soft tissues that make up the face and lips.
Clinical features
- Cracks are visible on the back of the tongue which may extend to the side edges and be deep enough to divide the tongue into lobes.
- The lesions are usually asymptomatic, although poor hygiene as well as the characteristics of the tongue can cause bad breath and tissue inflammation due to the accumulation of food debris in the cracks.
- It can be complicated by pathologies such as migratory glossitis and candidiasis.
Etiology
The causes of a fissured tongue are very diverse. Some of them are very common and easy to remedy. While others remain unknown.
- Diet is the main cause of fissured tongue. To be healthy, your tongue needs nutrients such as vitamin B12 or iron. If you don’t eat vitamin-rich food regularly, you could end up with a cracked tongue at any time.
- The amount of water you drink also influences the health of your tongue. Dehydration being one of the most common causes of fissured tongue. You must then drink at least 1.5 liters of water a day and supplement with foods rich in water.
- Sometimes stress and anxiety cause cracking of the tongue. Such a psychological state prevents you from sleeping which makes it difficult for your body to absorb the nutrients necessary for a healthy tongue.
- Cracked tongue can also be a sign of other diseases. This is the case with psoriasis that manifests in the mouth. In addition, diabetes, hormonal disorders and various infections can also cause cracking of the tongue.
- In rare cases, your tongue may crack due to a genetic cause. In other words, fissured tongue is hereditary and comes from your ancestors.
Histopathologie
It is rare that a biopsy is indicated in this alteration because its clinical characteristics are sufficient to establish the diagnosis. However, histopathological examination shows an increase in the thickness of the lamina propria, loss of filiform papillae on the lingual surface, microabscesses with the presence of neutrophils and an inflammatory infiltrate in the lamina propria.
Diagnosis and treatment
Fissured tongue can be associated with other disorders such as: Down syndrome, acromegaly, Sjögren’s syndrome, psoriasis, geographic tongue and Melkersson Rosenthal syndrome (a syndrome characterized by the triad: labial edema, facial nerve palsy and fissured tongue). Generally, fissured tongue is diagnosed accidentally, during a routine clinical examination; most patients do not require care for this pathology.
Treatment is to avoid complications including infections (usually caused by fungi) and halitosis, so it is the dentist’s job to educate the patient on an irritant-free diet, good oral cavity hygiene (with emphasis on the dorsal side of the tongue) and avoid alcoholic beverages and tobacco.
In case of acute pain in the tongue when ingesting food, a topical anesthetic may be indicated on the surface of the tongue, such as lidocaine and benzocaine, or intralesional infiltrations of steroids.
Randy Montinard
Dental Hygienist
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