OVERVIEW

What are lingual papillae?

On the dorsal surface of the tongue, there are small nipple-like projections called lingual papillae, which mainly include the following four types:

• Filiform papillae: The most numerous and smallest in size, they cover the entire dorsal tongue surface. Shaped like cones, their superficial cells continuously keratinize and shed, mixing with food debris and saliva to form the familiar tongue coating.

• Fungiform papillae: Slightly larger than filiform papillae, they are mostly found at the tip and edges of the tongue, interspersed among filiform papillae. Fewer in number, they contain taste buds responsible for taste sensation.

• Circumvallate papillae: Typically 7–9 in number, arranged in front of the sulcus terminalis. They are the largest, with a circular shape surrounded by deep grooves containing taste buds, also responsible for taste.

• Foliate papillae: Located on the lateral edges near the base of the tongue, each side has 5–8 vertical folds that are red in color, contain taste buds, and have lymphoid tissue beneath the mucosa.

What is papillitis?

Papillitis generally refers to inflammation occurring in the lingual papillae.

• Filiform papillitis manifests as atrophic glossitis, also known as smooth tongue or mirror tongue.

• Fungiform papillitis, circumvallate papillitis, and foliate papillitis all present as nonspecific inflammation.

Are papillitis and geographic tongue the same condition?

No, they are different conditions.

Geographic tongue, also known as migratory stomatitis, marginal exfoliative glossitis, pityriasis linguae, or erythema migrans, has an unclear etiology. It may be related to psychological factors, fungal infections, nutritional deficiencies, or genetics. Geographic tongue is more common in children aged 6 months to 3 years but can also occur in adults. It appears as red patches where filiform papillae have shed, with white raised borders or alternating with red exfoliated areas, changing location daily in a map-like pattern. Patients may experience pain due to inflammation, affecting eating.

SYMPTOMS

What are the manifestations of lingual papillitis?

• Filiform papillitis: Presents as atrophic glossitis, commonly seen in middle-aged and elderly women with systemic diseases. The filiform papillae on the dorsal tongue atrophy first, accompanied by dry mouth and burning discomfort. Subsequently, the fungiform papillae atrophy, leaving the dorsal tongue smooth and devoid of coating. Other mucosal areas may also show atrophy with pronounced burning sensations. In severe cases, the tongue may become dry and emaciated, even affecting the esophagus. Abnormal or loss of taste may occur.

• Fungiform papillitis: The fungiform papillae become congested, swollen, and enlarged, appearing as shiny red granules distinctly protruding above the surrounding filiform papillae. Symptoms often include stinging, burning sensations, or pain triggered by eating.

• Foliate papillitis: The foliate papillae become congested, swollen, and hyperplastic, with more pronounced grooves between the papillae and tenderness. Patients may experience spontaneous dull pain on one or both sides of the tongue base. The pain can range from mild and intermittent to severe, affecting sleep, speech, and eating. The condition tends to be chronic.

• Circumvallate papillitis: The circumvallate papillae become congested and enlarged, leading to swallowing discomfort and a foreign body sensation at the tongue base. Local pressure may cause mild pain, often discovered incidentally. A few cases may exhibit dulled taste. This condition is relatively rare.

What complications can lingual papillitis cause?

Generally, lingual papillitis does not present significant complications.

• If caused by anemia, symptoms such as dizziness, tinnitus, pale skin and mucous membranes, loss of appetite, chills, and fatigue may occur.

• Atrophic glossitis due to niacin deficiency may resemble herpetiform aphthous ulcers, accompanied by diarrhea, rough skin, memory impairment, and limb paresthesia.

What conditions should lingual papillitis be differentiated from?

• It should be distinguished from geographic tongue, atrophic glossitis, median rhomboid glossitis, hairy tongue, and amyloidosis of the tongue.

• Atrophic glossitis requires differentiation from lichen planus of the tongue, erythema, and chronic atrophic candidiasis.

• Foliate papillitis should be distinguished from tongue or nasopharyngeal tumors, glossodynia, and lingual tonsil hypertrophy.

• Circumvallate papillitis should be differentiated from chronic pharyngitis, glossodynia, and lingual tonsil hypertrophy.

• Additionally, systemic diseases with lingual papillitis-like symptoms must be ruled out, such as scarlet fever glossitis and Kawasaki disease.

CAUSES

What are the causes of lingual papillitis?

Atrophic glossitis:

• Anemia, iron deficiency, vitamin B₁₂, vitamin B₆, or folate deficiency may lead to anemia.

• Niacin deficiency, Sjögren's syndrome, and Candida infection can also cause atrophic glossitis.

• Some patients have no obvious cause.

Fungiform papillitis: There are many causes, mostly related to systemic diseases or local irritation, and sometimes the specific causative factor is difficult to identify.

• Local factors often include sharp tooth edges, consumption of spicy or excessively hot foods.

• Systemic factors may be associated with gastrointestinal disorders, insomnia, high stress, or malnutrition.

Foliate papillitis: The cause is unclear but often related to local irritation or psychosomatic factors:

• Local irritants: Tooth remnants, sharp cusps, poorly fitted dentures, smoking, or alcohol abuse.

• Bacterial or fungal infections.

• Lymphoid hyperplasia: Lymphoid tissue proliferation beneath the foliate papillae, oral tonsils, or pharyngeal ring.

• Psychosomatic factors: Cancerophobia or other psychological issues.

Circumvallate papillitis: Rarely inflamed, but often caused by pharyngeal lymphadenitis or reactive lymphoid hyperplasia of the lingual tonsils.

DIAGNOSIS

How to Diagnose Lingual Papillitis?

In most cases, diagnosis can be made based on clinical manifestations:

• Atrophy of lingual papillae may cause the dorsum of the tongue to appear smooth and dark red, resembling a mirror surface. Diagnosis can be made based on clinical symptoms.

• Fungiform papillitis typically presents with congestion and edema. If no systemic disease is present, local irritants may be identified.

• To diagnose foliate papillitis, tumors of the tongue or nasopharynx must first be ruled out. Symptoms usually include localized redness, swelling, and hyperplasia of the foliate papillae, with tenderness and localized pain. Due to their location, eating or speaking may aggravate the pain.

• Circumvallate papillitis: Congestion and tenderness in the circumvallate papillae at the base of the tongue.

What Tests Are Needed for Patients with Lingual Papillitis? Why Are These Tests Performed?

Diagnosis is usually confirmed through clinical presentation and identification of local irritants. If necessary, tests such as trace element analysis, serum iron concentration, total iron-binding capacity, autoantibody testing, and Candida detection may be performed.

TREATMENT

Which department should I visit for lingual papillitis?

Dental department. If the dental department has subspecialties, you should visit the oral mucosa department.

Does lingual papillitis require hospitalization?

No.

How is lingual papillitis treated?

Atrophic glossitis:

• Symptomatic treatment: Avoid oral medications that cause dry mouth. Artificial saliva can be used for significant dryness.
• Etiological treatment: Iron deficiency can be treated with oral iron supplements like ferrous sulfate. Niacin deficiency may require nicotinamide tablets. Antifungal treatment is needed for Candida infections.

Fungiform papillitis: Remove irritants and provide local symptomatic treatment. If conditions like gastric disease or insomnia exist, corresponding treatments should be administered.

Foliate papillitis:

• Address the underlying cause and remove local irritants.
• For significant inflammation, oral anti-inflammatory drugs like tinidazole or cefalexin (if no allergy history) may be used. Topical antibiotics like 5% aureomycin glycerin paste can be applied.
• Use chlorhexidine mouthwash.
• Provide emotional support to alleviate "cancer phobia" and avoid excessive tongue movements that cause irritation.

Circumvallate papillitis:

• Anti-inflammatory treatment is needed. Due to its location near the tongue base and frequent throat discomfort, patients may suspect tumors. Psychological counseling is essential to discourage excessive self-examination.
• Correct anemia or vitamin deficiencies if identified as underlying causes.

DIET & LIFESTYLE

What should patients with lingual papillitis pay attention to in their diet?

Maintain a balanced diet and regularly consume nutrients rich in protein, vitamins A, D, C, as well as calcium, phosphorus, and iron. Avoid spicy, irritating foods and overly hot foods.

What should patients with lingual papillitis pay attention to in daily life?

• Promptly treat nasopharyngeal and oral diseases, as well as anemia;

• Quit smoking and alcohol, relax, divert attention, avoid "cancer phobia," and refrain from frequently sticking out the tongue for self-examination;

• Maintain good oral hygiene daily, brush teeth effectively twice a day (morning and night), and learn to use special cleaning tools such as dental floss and interdental brushes.

• Reduce intake of spicy and irritating foods.

Does lingual papillitis require follow-up? How is it done?

Regular follow-up is generally unnecessary. However, if nodules or ulcers appear in the foliate papillae area, prompt re-examination is required. If symptoms are caused by anemia, follow-up should be scheduled as advised by a hematologist.

PREVENTION

Can lingual papillitis be prevented?

Yes, it can.

• Prevention is key. Maintain good oral hygiene habits, including effective brushing twice daily (morning and night), and learn to use special cleaning tools like dental floss and interdental brushes.

• Promptly treat issues such as residual roots, sharp tooth edges, and poorly fitted dental restorations.

• Maintain a balanced diet to avoid deficiencies in niacin, vitamins, and trace elements, as well as conditions like anemia.

• Limit consumption of spicy, irritating, or excessively hot foods.

How to avoid complications from lingual papillitis?

Promptly address conditions such as anemia, niacin deficiency, and Sjögren's syndrome.