Geographic Tongue: Predictions on the Future

May 2021

Geographic tongue, often abbreviated GT, is a benign condition that presents with redness and white patches on the top of the tongue.


Geographic tongue (GT) is a common benign condition with no known cause. The redness and white patches often have identifiable patterns, which can be helpful in diagnosis. There are typically no complications other than those related to oral hygiene such as dry mouth or increased tooth decay. Complications from GT are rare but may include an infection or ulcers.


The cause of geographic tongue is unclear, but it is thought to be secondary to the alteration of the epithelium, which leads to atrophy and hyperkeratosis. The most common treatments include eating a soft diet and using medications such as l-lysine supplements or topical steroids for pain relief.


Geographic tongue can occur at any age, though most commonly occurs in young adults. It affects both sexes equally and occurs worldwide with no racial predilection. Geographic tongue occurs approximately 5% of the time in people under 40 years old and 4% in those older than 40.


There are several different patterns of redness and white patches on the tongue. These include:

The patient with Geographic Tongue can have as many as 5 different types of patches on the tongue. In every pattern, there is redness and white patches on the top of the tongue. Typically these changes have a hairy appearance, appearing relatively smooth and shiny in comparison to normal skin. These changes are often at the base of the tongue where there is a fold (buccal fold). This causes the surface there to be flatter than normal. The redness of these changes may be mild or it may appear more intense when looked at in bright light, which gives it an overall darker appearance that is noticeable even in photos.


The diagnosis of geographic tongue is made on the basis of a clinical assessment, which includes the patient's medical history; a physical examination; and diagnostic studies such as a biopsy or an x-ray. There are no specific tests that can confirm the diagnosis. If the examination and history are normal, then imaging studies should be considered to rule out other causes of redness and white patches on the tongue.


The main concern is the appearance in photographs, which may lead to surgery or biopsy if the condition does not resolve. Surgery may be considered if there is a high level of suspicion for cancer-associated conditions, such as melanoma or carcinoma. Itching and burning were the most common symptoms in patients with geographic tongue (GT). In most cases, GT is an asymptomatic condition, but where it causes discomfort, it may affect quality of life. The cause of GT is not clear. There has been some suggestion that living in certain parts of the world (e.g. Australia) predisposes to developing GT; however this has yet to be confirmed.


Some people with geographic tongue develop an itchy, burning or sore tongue that comes and goes. The area will be red and swollen, although it may be slightly raised and have a small blister-like spot. The swelling typically spreads across a narrow band on the back of the tongue. As time goes on, this tends to go away, but can reappear in the same area or in another area if you eat something hot or acidic.

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