Geographic Tongue

What geographic tongue looks like

The top of a healthy tongue is covered in tiny pink-white bumps called filiform papillae, which give it a velvety texture. In geographic tongue, these papillae are lost in patches, leaving areas that are:

• smooth and red, sometimes slightly shiny
• irregular in shape, like islands on a map
• outlined by a slightly raised white, gray or yellow border
• changing: a patch can heal within days while new ones form nearby, so the pattern shifts from week to week

Patches usually appear on the top, tip and sides of the tongue. Rarely, similar patches appear on the gums, inside of the cheeks or floor of the mouth. This is called geographic stomatitis or erythema migrans.

Many people with geographic tongue also have fissured tongue, in which deep grooves run across the top of the tongue. Food debris can collect in the grooves, so brushing the tongue gently helps.

Symptoms

Most people have no symptoms and the condition is found during a dental visit. When symptoms occur, they include:

• stinging, burning or tenderness, especially with hot, spicy, salty or acidic foods
• sensitivity to toothpaste, mint, cinnamon, alcohol and tobacco
• discomfort that comes in flares, often during stress, illness or hormonal changes

Causes and risk factors

The exact cause is unknown. It appears to be an inflammatory process in the surface layer of the tongue. Factors linked to it include:

• Psoriasis: geographic tongue is more common in people with psoriasis, and the tissue looks similar under the microscope. Some experts see it as an oral form of psoriasis.
• Fissured tongue.
• Family history: it tends to run in families.
• Allergies, eczema and asthma.
• Hormonal factors: some women notice flares around periods, pregnancy or with hormonal contraception.
• Emotional stress.

Smoking may be linked to lower rates, which is not a reason to smoke.

Diagnosis

A dentist or doctor usually recognizes geographic tongue by its appearance and the way patches move over time. No tests are needed in typical cases. Your clinician may:

• ask whether the patches change position and how long they have been present
• check for psoriasis on the skin, scalp or nails
• order blood tests for iron, vitamin B12, folate and zinc if the whole tongue is smooth and sore, because deficiency causes a different condition (atrophic glossitis)
• take a swab if thrush is suspected, or a small biopsy if a patch stays in one place, feels firm or bleeds

Conditions that can look similar

Geographic tongue treatment

There is no cure and no treatment is needed when there are no symptoms. For discomfort:

• Avoid triggers: spicy foods, citrus, tomatoes, vinegar, very hot drinks, salty snacks, alcohol and mint or cinnamon flavors.
• Switch toothpaste: try a mild, unflavored product without sodium lauryl sulfate, whitening agents or tartar-control ingredients.
• Use over-the-counter pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose during flares.
• Rinse with a mild solution: plain water or a baking soda rinse can soothe.
• Prescription options for persistent pain: a numbing mouthwash, an antihistamine rinse, a corticosteroid rinse or gel, or a topical calcineurin inhibitor such as tacrolimus. Evidence for each is limited, so your dentist may try more than one.
• Zinc supplements have been tried, but evidence is weak.

Do not smoke or use tobacco to control it.

Outlook

Geographic tongue can last weeks, months or years. It often comes and goes, with quiet periods without patches. It does not damage the tongue, affect taste long term or raise the risk of oral cancer. Children who have it often grow out of it.

Frequently asked questions

Is geographic tongue serious?

No. Geographic tongue is benign. It is not an infection, cannot spread to other people and does not develop into cancer. Its main effect is mild soreness with certain foods. Any tongue patch that stays fixed, bleeds or feels hard should still be checked, because that is not typical.

What causes geographic tongue to flare up?

Common triggers for flares include stress, illness, hormonal changes such as menstrual periods, and irritating foods: spicy, acidic, salty or very hot foods and drinks. Some people react to mint, cinnamon or certain toothpaste ingredients. Keeping a food and symptom diary helps identify personal triggers.

Is geographic tongue related to psoriasis?

Yes. Geographic tongue is more common in people with psoriasis, especially pustular psoriasis, and both conditions look similar under a microscope. Most people with geographic tongue do not have psoriasis, but your clinician may check your skin, scalp and nails.

Does geographic tongue go away?

It often comes and goes for years. Individual patches heal within days to weeks, and some people have long periods without any. In children it frequently fades with time. There is no treatment that stops it permanently, but symptoms can usually be controlled.

Can vitamin deficiency cause geographic tongue?

Vitamin and mineral deficiency does not usually cause geographic tongue, but low iron, vitamin B12, folate or zinc can cause a smooth, sore tongue that looks similar. Your doctor may test for these if your whole tongue is smooth or if you have other symptoms such as fatigue or pale skin.