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Atrophic Glossitis• Margareta Chandra (07120010002)• Renny Surya W (07120010008)• Melda Fitria (07120010012 )

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Synonyms

• Aropic glossitis, bald tongue of pernicious anaemia, glossitis atrophicans, glossitis superficialis Moelleri, ulcerous glossitis in pernicious anaemia.

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Description• Atrophic glossitis is one of the clinical features of

primary macrocytic anaemia. Hunter's glossitis is caused by B12 or folic acid deficiency. It is characterized by glossitis, glossodynia, glossopyrosis, and altered sense of taste, which may undergo spontaneous remission but invariably reappears.

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• Ultimately, atrophy of the intrinsic musculature causes a decrease in the size of the tongue, the tongue assumes a beefy red colour and a smooth, clean, shining appearance. Similar atrophic changes are found in the gastric mucosa, accompanied by achlorhydria or achylia gastrica.

• Usually seen in women.

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• Atrophic glossitis is considered to be a marker for nutritional deficiency. Patients with atrophic tongue had significantly lower weight, bodymass index, triceps skinfold, arm muscle circumference and increased Katz index values for independence in daily activities.

• Patients with atrophic tongue had significantly reduced concentrations of serum cholesterol, ascorbic acid and calcidiol. Tongue atrophy had a sensitivity for serious malnutrition 0.30, for serious and moderate malnutrition together 0.70. The specificity for malnutrition was 0.76.

• Interpretation. We conclude that atrophic tongue is common in elderly people and a marker for malnutrition and reduced muscle function.

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Etiology• Nutrition (lack of B vitamins in diet)• oral yeast infection known as thrush (candadiasis), In older

patients with weak immune function, the mouth acts as a good incubator for yeast cells.  These accumulate under a denture and often cover the tongue leaving a white coating that is easily scraped off revealing red tissue underneath. 

• mechanical abrasion of the tongue  

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Symptoms – Tongue dryness – Intermittent Tongue Burning– Paresthesias of taste – Tongue Pain may be severe in advanced st

ages

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Signs

– Smooth, slick, sore Tongue with lost papillae

– Atrophied hyperemic papillae (small punctate red dots)

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Causes

– Anemia • Folic Acid deficiency Anemia • Vitamin B12 Deficiency Anemia • Iron Deficiency Anemia

– Other possible Vitamin Deficiencies • Pyridoxine deficiency • Riboflavin deficiency • Niacin deficiency

– Anti-cancer drugs

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Acute Glossitis (bright scarlet red, painful, inflamed tongue with prominent papillae)

• low Folic Acid (mild) • low iron (mild) • low Niacin (pellagra) (mild) • low Riboflavin (mild) • high Vitamin B6 (mild) • low Vitamin B12 (mild)

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Atrophic Glossitis (smooth, small, glistening, non-painful tongue with atrophy of the filiform papillae)

• low Biotin (rare) • low Folic Acid (chronic or in remission) • low Iron (chronic) • low Niacin (chronic) • low Protein • low Riboflavin • low Vitamin B6 • low Vitamin B12 (chronic or in remission) • low Vitamin C • low Vitamin E

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With Magenta color (deep, purplish-red tongue)

• low Biotin (rare) - also swollen and painful • low Niacin (pellagra) (more common) - also swollen, raw and fi

ssured • low Pantothenic Acid - usually painless • low Riboflavin (more common) - also dry; painless or sore; ma

y be swollen • with Black color• low Niacin (pellagra) (less common) • low Riboflavin (less common)

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Treatment• For lack of B vitamins: The addition of daily doses of folic acid, niacin, vitamin B12, py

roxidine, riboflavin, and even Iron, all in the form of a simple daily multiple vitamin tablet may help to restore the tongue and relieve the burning on eating.

• For Thrush (candidiasis): Mycelex troches, or a single Diflucan tablet and anti-fungal medi

cations.  • For mechanical abration: Building a new denture and repairing or removing rough, broken

teeth. Sometimes it is as easy as scraping hardened dental calculus off the insides of the lower front teeth.

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References

• http://www.whonamedit.com/synd.cfm/521.html• http://www.doctorspiller.com/

sores_lumps_bumps.html• http://www.fpnotebook.com/ENT207.html

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