Geographic Tongue

Dr. Greene’s HouseCalls have been a great help to me. Just finding out more about things I have questions about is informative and helpful to me with a 6-year-old, a 10-month-old, and a baby on the way. The information on ear infections has answered lots of questions and eased concerns. Now, Dr. Greene, my daughter has geographic tongue. What is that exactly and what causes it?
Cheryl Farrell – Clyde, North Carolina

Geographic Tongue

Dr. Greene’s Answer:

Cheryl, you certainly have your hands full. What an exciting (and busy) time lies ahead! Two in diapers is always a challenge – especially when they are numbers two and three. Be sure to ask for the help you need.

Geographic tongue is a marvelous, descriptive name for one of the most common medical conditions of the tongue. Parents usually are the ones to notice several large, red, slightly depressed, unusually smooth patches on the surface of their child’s tongue — when nothing was there hours before. Often the red areas are bordered with distinct white bands. The sharp borders of these irregularly shaped lesions give the surface of the tongue the appearance of a map, perhaps a map of a group of uncharted islands. The rather dramatic appearance of geographic tongue looks to many like a burn, or like some kind of nasty infection.

How many parents must puzzle over geographic tongue? The exact prevalence varies widely from study to study, but at any given time, somewhere between 0.1 percent and 14.3 percent of otherwise healthy people have it. It has been found to be present in about 0.6 percent of Americans (Community Dental and Oral Epidemiology Aug 1994), about four percent of healthy Iraqi schoolchildren (Community Dental and Oral Epidemiology Aug 1982), and about 2 percent of young Finns (Oral Surgery, Oral Medicine, and Oral Pathology, Feb 1982).

The healthy tongue is a mass of muscle fibers covered by a mucous membrane. On the underside of the tongue, the mucous membrane is smooth. On the upper side, the tongue is covered with many tiny protrusions called papillae. These papillae come in four types with different shapes. Three of these types contain taste buds; the fourth does not. This fourth type are called filiform papillae, and they are packed tightly together over the entire upper surface of the tongue.

For some reason, medical conditions of the tongue often have picturesque names (such as “black hairy tongue” or “scrotal tongue”). Most of these conditions are abnormalities of the papillae, of one type or another. In geographic tongue, the filiform papillae are missing in the reddish areas and are overcrowded in the gray-white borders.

We still do not know exactly what causes geographic tongue, but we do know that it strongly tends to run in families (Oral Surgery, Oral Medicine, and Oral Pathology, Nov 1976). Geographic tongue has polygenic inheritance — it is associated with several different genes. We also know that it is associated with a number of other genetic medical conditions.

It has been most closely linked to psoriasis, and is notably more common in those who have psoriasis (British Journal of Dermatology, Sep 1996). The two conditions have been linked to the same gene and are probably produced in the same manner; nevertheless the great majority of those with geographic tongue do not go on to develop psoriasis.

Geographic tongue is also significantly more common in people who are sensitive to the environment — those with allergies, eczema, and/or asthma (Oral Surgery, Oral Medicine, and Oral Pathology, Aug 1984).

It is also four times more common in those with diabetes (Oral Surgery, Oral Medicine, and Oral Pathology, Jan 1987). But a great many conditions are more common in those with diabetes, and geographic tongue has never been noted as an early warning of diabetes.

In young women with geographic tongue who are also taking oral contraceptives, the geographic tongue is worst on day 17 of the cycle (British Dental Journal, Aug 1991). This suggests that hormone levels probably play a role. Perhaps there is even some truth to the unproven belief that stress can trigger geographic tongue.

Weaker links have been reported to anemia, seborrhea, and eating spicy foods.

Most people with geographic tongue are otherwise healthy. The condition is usually entirely painless. While it can produce a burning sensation in the mouth, this is very rare in children. If there is any pain or burning, this usually can be successfully controlled with antihistamines (Pediatric Dentistry, Nov 1992).

There is no loss of the sense of taste (hurrah for the glorious sense of taste!), nor is there any loss of the dexterity of the tongue. There is, however, a measurable decrease in the tongue’s sense of touch. This was studied by carefully assessing response to mechanical vibration (Journal of Laryngology and Otology, Mar 1984).

Geographic tongue’s rather spectacular appearance in the mouth has frequently caused parents to worry. In the years since 1955, when the condition was first described (Journal of the American Dental Association, Sep 1987), several treatments have been tried for geographic tongue. Topical Retin-A was the most successful (Cutis Aug 1979). No treatment is currently recommended, however, for this benign, self-limited condition.

Geographic tongue heals spontaneously. The individual lesions often heal at the same time new ones are forming, changing the appearance of the tongue over hours or days. This gives rise to the appearance that the map is migrating across the face of the tongue. Thus, geographic tongue is also called benign migratory glossitis. Although benign, this condition may last for months — or even longer — and often recurs.

The same pattern holds true for the rare, but real, variation — geographic lip.

In the future we may know more about geographic tongue, what causes it, and why it recurs. In the meantime, Cheryl, you can rest assured knowing that even though geographic tongue is spectacular in appearance, it will not harm your precious daughter.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

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  1. Shirley W

    Hi there, I developed a sudden onset of geographic tongue in Sept last 2014, so its been almost 6 months now. I never suffered with this before and have tried numerous things in the last number of months to get it diagnosed and see what will help it. I’ve been told theres no cure for it and have no idea if or when it will go away. From what I’ve read, it mostly isn’t sore or bothersome, but mine is sore nearly all the time, even when I’m not eating! The borders move around my tongue but its mainly the sides of my tongue that are the most irritated. I’ve tried all sorts, gluten-free, herbalists, antibiotics, anti-fungal medications, acupuncture, taken Vitamin B complex, zinc tablets, but all to no avail. My diet is so bland, its boring. I normally would eat everything but its literally impossible now. I’ve cut out sugar (definitely makes it worse!), salt, spicy foods, coffee, you name it! I don’t know what else I can do, any ideas would be greatly appreciated….. Thanks.

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  2. Stefanie

    Hello, I have had Geographic tongue for years. I am about to be 23. It never occurred to me what it was, and I never said anything to anyone because it never bothered me, however after I had my two children (first one I had at 18, second I had at 21) my tongue started hurting. I noticed at about 18 years old, that my tongue started hurting when eating. My Doctor diagnosed me with it. I can’t eat salty foods, like crackers, or BBQ. I can’t eat beef jerky, or pineapple, strawberries, smoothies… it all hurts!!

    I have taken YEARS of medical assisting, in college and technical schools. I have learned a lot, and I know my body more than anyone and I honestly think it is hormones.

    I have been on birth control (orthro evra patch) on and off for years at a time. When I am not on it, I realized it starts to hurt again, but when I start taking my birth control it goes away!!!

    Another thing I would take that I noticed would help, is COMPLEX B vitamins. The B2 is what I believe helped…. I haven’t been on birth control in 5 months and lately my tongue has been hurting so bad, its hard to eat! Its so painful. Come to think of it, I think I actually started getting geographic tongue when I hit puberty because I don’t remember having it as a kid.. but as a teenager I remember it.

    I wish there were some sort of treatment though. I scheduled an appointment to get back on my birth control and get my hormones because they seem to be the only thing that helps!

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  3. Donna Kirkland

    My 6 month old granddaughter was just diagnosed with geographical tongue. She has GERD and is taking Ranitidine twice daily. Could GERD be a possible reason for her geographical tongue?

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    • Stefanie

      I don’t think so. I have geographical tongue, have had it for years and I don’t have any acid reflux issues at all. I honestly think personally in my experiences with birth control and all, that it is possibly hormones and vitamin B. I started to take complex B vitamins and it helped.

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  4. Kayla

    I am 14 years of age and i have had a geographic tounge since birth and i don’t think it is going away anytime soon because i still have it!.

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  5. Teresa Reaves

    I have geographic tongue and spices seem to be the worst for me…even regular black pepper tastes super hot to me…also lemons and limes will make my tongue swell up…is in the geographic tongue or a separate
    issue?

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  6. CW

    I have had what I believe to be geographic tongue 3 times in the past year. All 3 episodes happened while on Cipro. Do you know if there is a relationship between the condition and taking antibiotics?

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    • Stefanie

      You might be thinking of thrush. Thrush can be caused through medications, and it is similar to geographic tongue. The only way to know for sure is go to a doctor, let them scrape your tongue and see if it is thrush or not. Then you will get a certain diagnosis.

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  7. Aidan O'Reilly

    Hello I have geographic tongue as a question how many people out of a 100 have it?

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