Fissured Tongue

  • Akanksha SuryvanshiBachelor of Dental Surgery- BDS, Ahmedabad Dental, College and Hospital, India

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Introduction

A fissured tongue is a non-cancerous disorder that affects the tongue's upper surface. Small furrows or cracks across the surface may also be present, giving the tongue a wrinkled look.1 One or more cracks of differing diameters and depths may exist.2

The precise aetiology of a fissured tongue is unknown but approximately 10-30% of people are affected worldwide.1 It may be present at birth or develop later in life and individuals of all ages, ethnicities, and genders can be affected by a fissured tongue.3 According to some research, the illness may be more frequent among elderly people.2,4 Fissured tongue may also be more common in some ethnic groups than others.

While a fissured tongue is generally considered a harmless symptom, it may be linked to certain systemic disorders or hereditary factors. Individuals with a family history of fissured tongues are more likely to acquire the disorder. It may also occur alongside another syndrome or disease, such as child malnutrition or Down syndrome.1

Fissured tongue characteristics

Fissured tongue, also known as “lingua plicata” is characterised by grooves or furrows on the dorsal (top) surface of the tongue. These furrows can differ in depth, quantity, and pattern, giving them a unique look. The fissures or grooves frequently run from the midline of the tongue to the borders, giving the tongue a split or "fissured" look. Key features include:1,3

Furrow pattern and depth

The depth of the fissures can vary from modest to deep, and the pattern might differ greatly across individuals. Some cracks are small and invisible, while others are longer and more noticeable.

Location

Fissures are commonly present on the tongue's dorsal surface and extend from the tip to the back. They frequently extend outward from the midline, giving the skin a furrowed appearance.

Possible symptoms

To rule out underlying illnesses, a healthcare expert should check any changes in the look of the tongue or if symptoms emerge. Importantly, a fissured tongue is generally regarded as a benign ailment that does not often necessitate treatment. 

Asymptomatic characteristics

Fissured tongue is frequently asymptomatic, causing no pain or discomfort. Many people are unaware of the illness until it is discovered by chance during a normal oral examination.3

Sensations that might occur

Individuals may experience a burning or tingling feeling in rare circumstances, especially if food particles gather within the cracks.3 

Causes

Genetic factors

Fissured tongue has been discovered to have a familial propensity, implying a hereditary component. Individuals with a family history of fissured tongue may be more likely to acquire the disorder. Ongoing genetic investigations are attempting to identify particular genes or markers linked to fissured tongue, offering information on the interaction of hereditary and environmental variables.2

Ageing 

Ageing is associated with an increase in the prevalence of fissured tongue. Changes in the structure and function of the tongue as people age may lead to the formation of fissures. Changes in connective tissue, which occur naturally as we age, may affect the tongue's elasticity and resilience, perhaps rendering it more prone to fissuring.5

Environmental variables

Certain environmental variables might contribute to the development of a fissured tongue. Oral hygiene activities, such as tongue cleansing and regular dental care, may have an impact on tongue health. Furthermore, dietary variables such as nutritional inadequacies or food irritants may contribute to the formation or worsening of fissures.3 

Underlying medical conditions

Doctors have no clue as to why tongue cracks arise. It is thought to be inherited. A fissured tongue is occasionally found alongside:3 

Diagnosis

Clinical examination

Visual examination

A fissured tongue is frequently diagnosed by visually inspecting the dorsal surface of the tongue. Healthcare specialists examine the presence, depth, and pattern of fissures on the tongue.1

Physical examination

Palpation may be used to check tongue texture and detect any related indications or symptoms. The clinical examination aids in determining the extent and kind of fissures.6

Medical background

Interviews with patients

A thorough medical history, including family history, aids in the understanding of potential hereditary variables. Questions on dental hygiene, food habits, and lifestyle variables give useful information.

Symptom evaluation

Inquiring about sensations like burning or pain can help distinguish a fissured tongue from other oral disorders. Understanding the onset and length of symptoms aids in diagnosis.

Diagnostic procedures and tests

Biopsy 

A biopsy may be conducted in some circumstances to rule out other underlying diseases.7

Associated conditions

Correlation with geographic tongue 

A fissured tongue commonly occurs alongside geographic tongue (benign migratory glossitis).1

Relationship to certain systemic diseases

Psoriasis and down syndrome

Fissured tongue has been associated with systemic illnesses such as psoriasis and Down syndrome.1 

Treatment and management

Topical therapies

To relieve pain or burning sensations, mouthwashes or gels may be advised. Maintaining appropriate oral hygiene habits aids in symptom management.4

Education in oral hygiene

Educating people about good oral hygiene techniques, such as tongue washing, can help prevent fissures from worsening.1 

Prognosis

The long-term prospects for people with fissured tongues are typically positive. As a benign disorder, a fissured tongue seldom leads to more significant health issues. While the appearance of the tongue may alter with time, particularly with ageing, the disorder itself normally does not represent a hazard to overall health.1

Complications

Individuals with fissured tongues should have routine monitoring and follow-up treatment, especially if there are underlying conditions or concerns about complications. Regular dental checkups enable healthcare specialists to assess the state of the tongue, intervene as needed, and provide advice on correct oral care.6

FAQs

Is a fissured tongue a concern?

A fissured tongue is a very harmless and widespread variation in tongue morphology. On its own, it is usually not a reason for worry. Individuals who suffer pain, and burning sensations or have concerns about linked disorders should seek professional examination for a more precise diagnosis.

Is it possible to avoid a fissured tongue?

While fissured tongue is generally a natural variation that cannot be completely avoided, certain lifestyle adjustments can help to improve overall tongue health. Regular tongue cleansing, a balanced diet, and avoiding excessive consumption of irritants can all assist in minimising difficulties connected with a fissured tongue. Furthermore, genetic counselling may give insights into possible hazards and preventive strategies for those with a family history.

Is treatment necessary for a fissured tongue?

A fissured tongue does not always necessitate treatment, especially if it is asymptomatic. However, if individuals feel pain, burning sensations, or underlying issues connected with a fissured tongue, healthcare practitioners may offer symptomatic relief treatments, address underlying causes, and provide lifestyle change advice. It is critical to get individualised counsel from a healthcare expert based on specific circumstances.

Summary

Individuals and healthcare professionals alike must comprehend the nature, diagnosis, and management of a fissured tongue. This is a benign and asymptomatic ailment presented by grooves or furrows on the tongue's top surface. Individuals with fissured tongues may not feel any severe health consequences or discomfort in the majority of cases.

Diagnosis includes clinical examination, an assessment of medical history, and, if necessary, specialised testing. The fissured tongue may co-occur and/or be related to other dental and systemic disorders. Symptomatic alleviation, and making lifestyle changes are all important components of dealing with a fissured tongue.

Seeking expert advice is critical for diagnosis, prognosis and personalised care. Promoting dental health and well-being requires both individual efforts and collaboration with healthcare experts. Individuals may traverse the subtleties of a fissured tongue through this collaboration, guaranteeing excellent dental health and overall quality of life.

References

  1. What Is a Fissured Tongue? Cleveland Clinic [Internet]. [cited 2024 Jun 11]. Available from: https://my.clevelandclinic.org/health/diseases/fissured-tongue.
  2. Bakshi SS. Fissured tongue. CCJM [Internet]. 2019 [cited 2024 Jun 11]; 86(11):714–714. Available from: https://www.ccjm.org/content/86/11/714.
  3. Sudarshan R, Sree Vijayabala G, Samata Y, Ravikiran A. Newer Classification System for Fissured Tongue: An Epidemiological Approach. J Trop Med [Internet]. 2015 [cited 2024 Jun 11]; 2015:262079. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592719/.
  4. Mangold AR, Torgerson RR, Rogers RS. Diseases of the tongue. Clinics in Dermatology [Internet]. 2016 [cited 2024 Jun 11]; 34(4):458–69. Available from: https://www.sciencedirect.com/science/article/pii/S0738081X16300505.
  5. CHAKRABORTY SK. FISSURED AND BURNING TONGUE. Med J Armed Forces India [Internet]. 2000 [cited 2024 Jun 11]; 56(1):89. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5531982/
  6. Fissured Tongue Clinical Presentation: History, Physical Examination, Complications [Internet]. [cited 2024 Jun 11]. Available from: https://emedicine.medscape.com/article/1078536-clinical#b1
  7. Rathee M, Hooda A, Kumar A. Fissured Tongue: A Case Report and Review of Literature. The Internet Journal of Nutrition and Wellness [Internet]. 2009 [cited 2024 Jun 11]; 10(1). Available from: https://ispub.com/IJNW/10/1/3217.

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Akanksha Suryvanshi

Bachelor of Dental Surgery- BDS, Ahmedabad Dental, College and Hospital, India

Dr. Akanksha is a general dentist with over 1 year of experience children and adults to promote healthy dental habits. She is going to start her Master of Science in Clinical Epidemiology from Kent State University, Ohio, USA. She also has research experience. And currently also work as medical writer for Klarity to write medical articles for spreading awareness and also for providing health benefit knowledge to the community.

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