E.O. Oyetola, A. Oluwande and E.T. Agho
Department of Preventive and Community Dentistry, Obafemi Awolowo University, Ile Ife, Nigeria
Background: Geographic tongue (GT) is one of the commonly seen lesions in Oral Medicine Clinic. It tends to show varying pattern of presentation. Excessive immune response and immune modulation has been implicated in the pathogenesis and this justified the use of steroid in the management.
Objective: This study describes the epidemiology, clinical presentations and treatment outcomes of the 21 cases of GT seen at the Oral Medicine Clinic of Obafemi Awolowo University Teaching Hospitals’ Complex, Ile Ife (OAUTHC) over a period of 10 years and compared the findings with the results from other parts of the world.
Methods: This was a retrospective cohort review of cases of geographic tongue seen in the Oral Medicine of OAUTHC over the period of 10 years of Oral Medicine practice in the center from May 2007 to May 2017. The diagnosis of GT was made based on its typical clinical presentation. Information retrieved from the case notes included age, sex, presenting complaints, clinical findings, treatment and treatment outcomes.
Results: Only 21 cases of GT were diagnosed during the study period, giving a prevalence of 2.1% consisting of 11males and 10 females with mean age of 29.5 +13.9 years. About half (10 cases) were diagnosed following routine oral examinations while burning tongue sensation, itchy sensation and taste impairment accounted for the presenting complaints among the symptomatic cases. Lesions were mostly seen in the anterior two-third of the tongue (9 cases). All patients responded well to topical steroids.
Conclusion: This study had shown that GT was more prevalent in younger age group with slight male predilection. More than half of patients presented with symptoms. Successes were recorded with topical steroids.
Dr. E.O. Oyetola
Department of Preventive and
Obafemi Awolowo University,
Ile Ife, Nigeria
Geographic tongue (GT) also known as benign migratory glossitis, erythema migrans andannulus migrans is a benign disorder of the tongue characterized with multiple, well-demarcated, erythematous, depapillated patches surrounded by a slightly elevated whitish border, and usually restricted to the dorsum of the tongue.1,2 Geographic tongue was first described by Rayer in 1831 as wandering rash of the tongue.3 These lesions may change in location, pattern and size, hence the name ‘migratory’.4 Lesion can occur in other sites apart from the tongue, then the term ectopic geographic tongue or erythema circinata migrans is employed as first coined by Crooke in 1955.3,5
It is usually a transient and recurrent lesion of the tongue and may heal without treatment.3 GT is found in 1- 2.5% of the population, and it appears to be commoner among females in middle age group.3 The suggested etiology include emotional stress, Immunological factors, genetic factors, atopic or allergic tendency, emotional stress, tobacco consumption, hormonal disturbances, zinc deficiency, fissured tongue, psoriasis and diabetes mellitus.1,6,7
The common symptoms associated with symptomatic GT are burning sensation, taste impairment, tongue pain, cancer phobia or aesthetic concerns.2 In many cases, geographic tongue is asymptomatic. Treatment is usually required only in the symptomatic cases. There is no definitive treatment protocol or cure for this lesion but topical steroids (such as triamcinolone acetomide), retinoic acid, cyclosporine, antihistamine, tacrolimus and immune system regulators have been used in proposed treatment plans.2,6,8 Treatment is, however, not curative but modulate inflammatory and immunological responses, which is their chief mechanism of action.5
Although usually asymptomatic, the symptomatic cases could be quite disturbing and has been found to be associated with mental illness, stress and reduction in the quality of life of the affected patients.4,9 The pattern of presentation of GT, like any other lesion, shows variations especially as it relates to causative factors which will ultimately determine the specific management approach in each environment. Allergy has been implicated in the etiology, the allergens differ depending on the environment.6 Very few studies have documented associated clinical features and pattern of presentation of GT in the African population. The purpose of this study is to add to the body of knowledge of the research subject in the Nigerian population.
This was a retrospective cohort review of all the cases of geographic tongue seen in the Oral Medicine of OAUTHC over the period of 10 years of Oral Medicine practice in the center from May 2007 to May 2017.
The Obafemi Awolowo University Teaching Hospital sees on the average 72,415 new patients per annum. The Dental Hospital Unit from which this study was conducted also sees an average of 3000 patients per annum. All patients recruited for this study were diagnosed and managed by residents and trained specialists in Oral Medicine.
Clinical records (case notes) of all patients diagnosed with geographic tongue within the study period were retrieved and reviewed. The clinical diagnosis of geographic tongue was made based on clinical appearances of multiple, well-demarcated, erythematous, depapillated patches surrounded by a slightly elevated whitish border on the dorsum of the tongue as reported by Kramer et al, 1980.10 The above mentioned protocol describes our routine method of clinical diagnosis of GT in our clinic. Other information retrieved from the case notes included age, sex, presenting complaints, clinical findings, results of laboratory investigations, treatment and treatment outcomes.
Data analysis was done using STATA 12 statistical software (Statacorp, College Station, Texas, USA). Descriptive statistics was used to characterize sociodemographic variables such as age, sex, marital status and occupation. For descriptive continuous variable such as age, the mean, median, minimum value, maximum value and appropriate measures of variability were determined. For descriptive variables that are categorical such as sex and the clinical presentation of geographic tongue, simple frequency and percentages were determined. Bivariate analysis such as t-test, Fisher’s exalt and chi-square statistics or their non-parametric equivalents were used as appropriate to compare between two variables as may require. Statistical significance was inferred at p<0.05 and confidence interval was set at 95% for all the analysis.