Glossitis is an inflammatory process in the tissues of the tongue, accompanied by a change in its structure and color. It is manifested by discomfort, burning, swelling, hyperemia of the tongue, increased salivation, loss of taste sensations, pain when chewing, swallowing food, difficulty in speech. It may be complicated by abscessing of the tongue, the formation of phlegmon of the neck. Chronic recurrent glossitis leads to papillomatous, warty, papillary and other growths on the tongue. The treatment is based on the correction of the causal disease and local therapy with anesthetics, vitamin A, antiseptics, etc.
Glossitis is an infectious inflammatory disease of the tongue caused by bacterial or viral microflora, disease is one of the cases of stomatitis and often occurs in combination with it.
Inflammation of the tongue can be both an independent disease, the cause of which is bacterial invasion, and a symptom of systemic pathologies. The cause of local glossitis is microorganisms, including viruses. The herpes virus very often, in addition to the classic symptoms of mucosal lesions, causes glossitis and stomatitis.
The development is facilitated by a burn of the oral cavity or the constant use of excessively hot drinks. Mechanical injuries of the tongue and oral cavity, especially of a chronic nature, are ideal entry gates for infectious agents capable of causing glossitis. People who smoke and abuse strong alcoholic beverages are at risk. Hot food, spicy and spicy dishes, a passion for mouth fresheners, a specific reaction to toothpaste, caramel – all this can provoke glossitis.
When poisoning with heavy metal salts, disease is a classic symptom of poisoning. Neglect of oral hygiene, the use of other people’s toothbrushes, the fascination with mouthwash balms, combined with each other, increase the risk of glossitis.
Injury to the tongue by the sharp edges of destroyed teeth, sharp edges of dentures or edges of fillings, prolonged and frequent exposure to chemical stimuli, electric current on the tongue leads to the formation of chronic glossitis. Chronic form is promoted by dysbiosis and a decrease in general and local immunity, as well as conditions in which autoantibodies are formed in the body.
The first symptoms of glossitis are a burning sensation, discomfort and a foreign body in the mouth. Later, the tongue becomes bright red or burgundy, slightly swollen. As the swelling increases, salivation also increases. Taste sensations are blunted or completely lost, sometimes with disease there is a perversion of taste. Eating becomes difficult and painful. Due to the swelling of the tongue, the speech of patients with glossitis becomes indistinct, patients try to practically not use the tongue in the formation of sounds in order to reduce painful sensations.
In the absence of treatment, disease is chronicled, which is characterized by persistent and dense edema and a change in its structure, sometimes with neglected glossitis, mushroom-like growths form on the tongue.
Pathology caused by pathogenic microflora is primarily manifested by symptoms of acute inflammation: swelling, hyperemia, soreness and local fever. With this disease of a viral nature, bubbles appear on the surface of the tongue, which, when opened, leave painful erosions. The lack of treatment and the presence of immunodeficiency contributes to the rapid spread of the process and its transition to the oral mucosa. Glossitis of candidiasis nature is manifested by a white coating on the tongue, which can be loose or dense and fixed, hyperplastic changes of the tongue are also noted.
Neglected glossitis is complicated by abscess. The onset of abscessing is indicated by the appearance of acute pulsating pain of a localized nature. Speech becomes slurred, the tongue itself is enlarged unevenly, swelling and soreness are more pronounced in the area of the future abscess. As the abscess forms, salivation increases.
With the complication of glossitis with phlegmon, edema and the area of purulent melting of tissues is more pronounced and passes to the bottom of the mouth and neck. Pain syndrome is pronounced, the process of chewing food is disrupted, sometimes even to the point of refusing to eat. Speech and breathing are difficult, sometimes there are attacks of suffocation. With glossitis complicated by phlegmon, general symptoms of intoxication are expressed: weakness increases, regional lymph nodes increase, the temperature rises.
Specific and vivid clinical manifestations allow the dentist to make a diagnosis based on a visual examination. Cytological, bacteriological, histological, biochemical and serological diagnostic methods are used to determine the depth and nature of the lesion, as well as to identify the disease that caused glossitis. To exclude the syphilitic nature of glossitis, a scraping microscopy for pale treponema and an RPR test are performed. Identification of other pathogens is carried out by PCR diagnostics and ELISA.
Deep glossitis is localized in the area of the bottom of the oral cavity and in most cases the inflammatory process passes into the chin and neck area. In the absence of treatment, deep glossitis abscesses.
Desquamative glossitis or a symptom of “geographical language”. On visual inspection, the tongue is indented with lines and furrows, which outwardly resembles the outlines of continents. More often desquamative glossitis is observed in pregnant women, in people with chronic diseases of the gastrointestinal tract. Worm infestations, parasitic diseases, blood diseases, metabolic disorders and liver diseases contribute to the formation of desquamative glossitis. The pathogenesis of desquamative glossitis is the focal destruction of the epithelium, which leads to the formation of bright red spots on the surface and sides of the tongue. From subjective sensations, moderate soreness and burning are noted.
Diamond-shaped (median) glossitis occurs against the background of chronic diseases of the gastrointestinal tract. The risk group includes patients with gastritis with low acidity. Clinically, this form is manifested by thickening of the epithelium with the formation of diamond-shaped areas in the basal region of the tongue. The color of the affected areas varies from bright red to bluish. Diamond-shaped glossitis is prone to chronization with frequent relapses.
Sometimes disease has other clinical manifestations, when the affected areas atrophy and become smooth, I diagnose flat diamond-shaped glossitis (usually does not require treatment). With the tubercular course of diamond-shaped glossitis, lumpy dense outgrowths are found on the tongue. Papillomatous or warty form of diamond-shaped glossitis is manifested by the appearance of whitish-pink hyperplastic growths on the surface of the tongue, having a wide base and flattened tops.
Villous glossitis is manifested by the proliferation of filamentous papillae, followed by keratinization. As a result, the papillae become like villi. Such a course of glossitis is observed with candidiasis and constant traumatization of the tongue. Smoking and taking certain medications can also provoke the development of villous glossitis.
Folded glossitis is a congenital anomaly of the tongue. Clinically manifested by folds on the back of the tongue, with the deepest fold located longitudinally along the median line of the tongue. The folded tongue does not cause unpleasant sensations, treatment is required only with a significant number of folds and is carried out for aesthetic purposes.
Gunter’s glossitis is a symptom of B12-deficient and folate-deficient anemia. The surface of the tongue is smoothed, over time the papillae atrophy, and the tongue looks like polished, shiny. The color of the tongue with Gunther’s glossitis is bright crimson.
Interstitial glossitis is one of the symptoms of syphilis in the tertiary period. Part of the muscle tissue of the tongue is replaced by interstitial (connective). The tongue looks like a quilt, where the areas of muscle tissue are elevated, and the grooves of connective tissue tighten the tongue. In the absence of anti-syphilitic treatment, there is a complete degeneration of muscle tissue into connective tissue. Interstitial glossitis is a precancerous disease and very often the cells are malignified, which ends with oncological diseases of the tongue.
Treatment of glossitis requires correction of the main diseases: syphilis, anemia, pathology of the gastrointestinal tract, etc. To reduce the pain syndrome during meals, the patient is shown pureed soups, mucous porridges and various purees. Before and after meals, as well as during the day, rinsing of the oral cavity with a solution of furacilin, a weak solution of potassium permanganate or 0.05% chlorhexidine solution is indicated. If the pain syndrome is pronounced with glossitis, then they resort to applications with anesthetics – a 2% solution of trimecaine, pyromecaine or lidocaine. If there are signs of dryness of the tongue, to reduce pain, the surface of the tongue is lubricated with a mixture of anesthetic and glycerin.
Fibrin and necrotic plaque in glossitis is removed with a cotton swab moistened with proteolytic enzymes such as trypsin and chymotrypsin. If erosions and ulcers are painful, then it is better to use applications to remove plaque. After the procedures, the oral cavity must be treated with antiseptic solutions to prevent secondary infection and complication. Jelly-like and gel-like healing agents accelerate the regeneration process in glossitis, and medications with vitamin A have the same effect. A mixture of vitamin A and rosehip oil, in addition to accelerating cell regeneration, reduces pain.
Pronounced phenomena of hyperkeratosis in glossitis require surgical intervention. Antibacterial, anti-inflammatory and antifungal drugs are prescribed according to indications. Immunomodulators and general tonic agents are indicated for all patients with immunodeficiency. Hormonal drugs during glossitis therapy are prescribed in exceptional cases if there is difficulty breathing. Prednisone and hydrocortisone in the form of ointments are prescribed in short courses so as not to cause atrophy of the cells of the tongue.
With effective correction of the underlying disease, pathology respond well to treatment. An unfavorable outcome with complications in the form of phlegmon, abscesses and oncological diseases of the tongue is observed in the absence of treatment of glossitis and diseases that were the main cause. Prevention of glossitis is compliance with oral hygiene, regular dental examinations. The exclusion of spicy food from the diet and the refusal to smoke and from the use of strong varieties of alcohol reduces the risk of glossitis.
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