Geographic tongue (migratory glossitis)
Trauma (bites, teeth, hot food/drink)
Herpes simplex virus (children)
Disorders not to be missed
Anaemia: iron, vitamins B6 and B12, folate deficiency
Fissured tongue (rarely causes soreness)
Median rhomboid glossitis
Hand, foot, mouth infection
Drugs (mouthwashes, aspirin)
Is the patient trying to tell me something?
Possible with glossodynia.
Enquire about trauma, dental problems, nutrition, drugs and associated general symptoms. The cause is usually obvious upon examination but there are some obscure cancers. The causes are similar to that of a sore throat or mouth. Investigation may include:
Look for evidence of trauma, especially from a sharp tooth or dentures.
When taking a history, take note of self-medications, especially sucking aspirin, a history of skin lesions (e.g. lichen planus) and consider underlying diabetes or other immunosuppression.
Any non-healing or chronic ulcer requires urgent referral.
Glossodynia (painful tongue) characteristically presents with a burning pain on the tip of the tongue, without physical signs.
Consider depressive illness as an underlying cause.
Shared care with a dental or oral medical specialist is important.