Desquamative glossitis

Inflammation of the tongue, accompanied by keratinization and rejection of the papillae of the mucosa( desquamation), is called desquamative glossitis. The diagnosis is not difficult, because the language has a characteristic appearance.

But, in order to effectively treat the disease, it is necessary to identify its main cause. It was found out that pathologies are more vulnerable to women and children. In adulthood, desquamative glossitis is rare.

What language changes characterize the disease?

The normal form of the tongue has a pale pink color and a velvety surface on the back and edges. This is explained by the formation of numerous papillae from the cells of the mucosa. They are outgrowths, covered with multilayered flat epithelium, differ in shape, size and functional purpose. Vessels, sensitive nerve endings are suitable for them.

Filiform papillae are the most numerous. Occupy the entire front surface of the tongue and the marginal part. The height of protrusions of cells of keratinizing type in the range of 0.6-2.5 mm( closer to the tip they are longer).On the surface of the cells scraping flakes are formed. They also give the language a whitish color. The process goes on constantly.

In case of violations, the rejection of keratinized cells is delayed, which is manifested by a white bloom( doctors say "lipped tongue").Filiform papillae do not have taste buds and do not participate in the determination of food taste. Their main function is to touch and hold food in the tongue so that other papillae can evaluate.

Desquamative glossitis is associated with dystrophic changes in the filiform papillae. The process of keratinization and rejection of the epithelium is disturbed. The type of language is characteristic: on the background of the usual mucous there appear foci of desquamation of different shapes and sizes. They resemble a geographical atlas or map. Thus, the name of the feature - the "geographical" language was formed.

Causes of the disease

The search for desquamative glossitis has been conducted to date. Most authors agree that dystrophic changes are caused by vascular disorders. There is a decrease in cell nutrition. Pathology can arise as a primary( independent disease), and as a result of another disease( secondary).

Changes do not cover the whole shell, but some areas, foci appear and disappear quickly, it seems that they migrate from one zone to another

Primary desquamative glossitis cause:

• traumatizing the tongue with the sharp edge of the destroyed teeth;
• in children improper eruption of infant teeth;
• uncomfortable denture or filling;
• burns with hot food or chemical.

Secondary glossitis appears due to increased sensitivity of the tongue's mucosa to any abnormalities in the body, pathological processes. Desquamation of the epithelium is impaired:

• in chronic gastrointestinal diseases;
• pathology of the liver and gallbladder;
• eating disorders, hunger;
• changes in the vitamin-mineral composition of tissues( with a lack of vitamins B3, B1, B6, folic and pantothenic acid, broken iron balance);
• diseases of the blood and blood-forming organs;
• autoimmune systemic pathology( lupus erythematosus, scleroderma, rheumatism);
• endocrine disorders and functional imbalance of hormones during pregnancy;
• disorders of the vegetative part of the nervous system;
• chronic skin diseases( psoriasis, exudative diathesis).

Less frequently cases of desquamative glossitis are found in acute infectious diseases( scarlet fever, flu, typhoid fever), helminthic invasion in children, expressed dysbiosis, as a negative effect of drugs( antibiotics).

The baby has a root tooth in the second row, this creates problems for the

Classification

Depending on the relief of the mucous membrane of the tongue and the degree of lesion of the papillary layer, dentists identify 3 forms of desquamative glossitis. Superficial - the language shows a clear pattern of smooth bright red stripes and spots, around a healthy mucosa. Patients experience mild burning and itching.

Hyperplastic - characterized by foci of compaction, formed by hypertrophied filiform papillae, in the language of a dense coating of gray-white or yellow. Patients experience a foreign body sensation in the oral cavity, discomfort.

Lichenoid - desquamation foci are characterized by migration, an increase in mushroom papillae in the desquamation zone, they are surrounded by a cluster of filamentous forms. Every day the "geographical" picture changes. People feel burning. It is more common in prosthetics of teeth due to the increased sensitivity of the tongue mucous to metals that are used in dentistry.

The clinical types of desquamative glossitis have been identified according to the morphological changes in tissues with the calculation of the keratinization index( the percentage of cornified epithelium), biochemical changes and immunological tests, and the readiness of cells for apoptosis( a normal process of destruction of dying cells by phagocytes of tissues).

Microbial

Another name - dysbiotic( caused by a change in conditionally pathogenic flora) - is detected in persons with infectious diseases of the respiratory and digestive system. Morphology shows a decrease in the keratinization index by 20%, an increase in the number of cells ready to be killed 5 times.

Bacteriological studies from the oral cavity reveal pathogenic microorganisms( Staphylococcus aureus, β-hemolytic streptococcus) and conditionally pathogenic( Clostridia, Staphylococcus, Corynebacteria).Immunological analysis indicates a lowered level of immunoglobulin A( IgA), providing local immunity, and lysozyme activity in saliva.

Biochemical tests provide information on the decrease in the hormone norepinephrine. The study of blood flow with the help of a doppler ultrasound diagnosis shows a decrease in the volume of blood passage through the capillaries of the tongue at 20-30% of the normal level.

Candidiasis

Usually considered a concomitant symptom of inflammation of the oral cavity, pharynx, ears, intestinal dysbiosis. The plaque and desquamation sites do not migrate, the epithelium grows in a hyperplastic type, it reveals blast forms of fungi, pseudomycelia, exceeding the norm by almost 9 times.

The morphology of the tissue shows a decrease in the keratin index by 30%( this is attributed to the toxic effect of fungi), the number of epithelial cells prepared for lysis is increased 1.5 times.
The immunoglobulin A decreased 3-fold, with the decrease in lysozyme activity.

Neurogenic

Glossitis of a neurogenic type is distinguished by the patient's neurological symptoms or mental disorders. Usually a person is observed about:

• asthenoneurotic or hypochondriac syndrome;
• neurasthenia;
• various phobias( fears).

Phobias in an apparently healthy person are not advertised, but they cause an unexpected reaction.

In such patients, the content of noradrenaline is increased 7 times in such blood. The study of the blood flow of the tongue shows spasms of the capillaries and foci of dystrophy. The conclusion causes in patients carcinogenesis( fear of cancer).The index of keratinization is halved, and the mass of epithelial cells prepared for apoptosis is increased 3-fold. Usually there is a decrease in saliva production.

Allergic

According to the name, the pathology accompanies chronic allergic diseases:

• urticaria;
• diathesis;
• vasomotor rhinitis;
• drug and food allergies;
• a pronounced reaction to pollen from plants and flowers.

In this case, the content of histamine in the oral cavity is increased 2-fold. The index of hornfelsion is reduced slightly. The number of cells ready for apoptosis was doubled.

Mixed

It is expressed in a combination of signs of candidal and allergic desquamative glossitis.

How does the disease manifest itself?

Symptoms of desquamative glossitis are more common without clear causes. Less often a person first experiences unclear pain in the tongue( glossalgia), numbness in the mouth. Almost 50% of patients have a combination with folding of the tongue. Complaints do not arise at all. In most cases, the desquamative process is detected accidentally at a dentist or an otolaryngologist.

Sometimes patients notice uncomfortable sensations especially during meals, some have problems with pronouncing words and breaking taste. Usually disturbed is the abnormal kind of language. First, small areas of irregular shape appear on the surface, covered with a whitish-gray coating.

Penetration of the infection into the deep layers can cause abscessing, as seen in the photo

Then the top layer swells and flakes, and in its place remains a smooth bright spot of pink or red. It stands out sharply against the background of the surrounding white-pink hue. The process of disappearance of epithelial cells begins at the periphery of the focus. Due to this in the central part, the filiform papillae atrophy, an inflammatory zone is seen along the edges, and the focus itself increases in size.

Recovery takes 2-3 days. Desquamation foci are of multiple character and are located on the back and sides of the tongue. The picture of the mucosa is constantly changing due to non-simultaneous transformations in different foci. The disease is characterized by a long, chronic course. The "geographic" drawing may temporarily disappear, then appear again in the same place or nearby.

It is important that in the outbreaks there is no normal mucosa. This means that through them the infection gets much faster, a local reaction appears in the form of cracks, painful inflammation. It is possible to increase submandibular lymph nodes and general malaise.

How is the diagnosis carried out?

Suspicion of the diagnosis occurs after questioning the patient about the sensations in the mouth and examining the appearance of the tongue. For reliable confirmation, dentists use laboratory methods and study of morphological structure, blood circulation, local immunity. To establish the type of desquamative glossitis, the index of keratinization( keratinization) is counted. When the disease is reduced by 20-50%.

According to the morphological composition of cells, the mass of epithelial cells ready for apoptosis is important. Immunity characterizes the drop in serum IgA and lysozyme saliva levels. The content of norepinephrine in saliva is determined biochemically. Elevated levels indicate a spastic reduction in capillaries and a malnutrition of the papillae with cell degeneration.

Visual inspection - the first stage of diagnosis

Another important biochemical indicator is the level of histamine. Excess of the norm speaks about the allergic origin of glossitis. Bacteriological analysis by the method of sowing a smear from the surface of the tongue makes it possible to identify the pathogenic flora that has evoked or joined. For an accurate determination, an enzyme-linked immunosorbent assay is used, a polymerase chain reaction procedure.

It is important to identify the fungal, bacterial and viral nature of inflammation, the treatment depends on this. To establish the connection with a specific infection, scrapes are analyzed for pale treponemia, an RPR test for syphilis, feces for helminth eggs and the presence of parasites. Check the capillary blood flow allows ultrasound dopplerography.

Desquamative glossitis must be differentiated:

• with secondary changes in syphilis;
• red lichen planus in lichenoid form;
• is a flat form of leukoplakia;
• scleroderma;
• by Addison-Birmer disease;
• exudative erythema;
• deficiency of vitamin A;
• galvanized.

With the difficulties in diagnosis, it is necessary to involve specialists of different profiles: dentist, gastroenterologist, otolaryngologist, infectious disease specialist, dermatologist, neurologist, psychiatrist.

What is the treatment for desquamative form of glossitis?

The treatment of desquamative glossitis necessarily includes general and local activities. Therapy of exacerbations of chronic diseases of the stomach and intestines, liver and gallbladder.

Gentle diet is associated with the restriction of fatty and fried foods, smoking, spices and pickles, acidic foods. Food should exclude fast food, canned food, hard crackers, nuts.

Children need a course of dehelmmentation with special preparations. Mandatory vitamin and mineral complexes are prescribed to eliminate hypovitaminosis, probiotics and prebiotics to restore the balance of the intestinal microflora. You may need antihistamines, soothing. To stimulate immunity, immunomodulators( aloe, extract zamaniha, magnolia vine, transfer factor) are shown.

Rosehip oil strengthens healing, possesses bactericidal property

Local procedures begin with complete sanitation of teeth, replacement of irritating prostheses. To relieve the sensations of pain and burning, we recommend:

• rinsing with solutions of antiseptics( soda, chlorhexidine, furacilin);
• imposition of applications on foci with oil solutions Retinol, dog rose, glycerol solution of Anestesin Pyromecaine;
• if the pain does not disappear, make a Novocain blockade of the lingual nerve.

In therapy, antibacterial and antifungal agents may be needed. Effectively, physiotherapeutic treatment by methods of drug electrophoresis, ultraphonophoresis, ultrasound therapy.

Desquamative glossitis usually does not cause trouble to patients, it is safe for health. There is practically no transformation into a cancerous tumor of the tongue. For the prevention it is necessary to normalize the food, to stop smoking and alcohol, to eliminate in a timely manner inconvenient factors of traumatization after tooth filling, installation of crowns.

The condition of the tongue depends on the general functioning of the digestive system. Therefore, in addition to daily hygienic local procedures, patients with chronic diseases of the digestive tract should follow all the recommendations of the gastroenterologist and treat the underlying disease.