Ask the doctors: Adding zinc to diet may help geographic tongue
Q: I have had geographic tongue for almost two years. It's unsightly and sometimes quite painful, but my ENT assures me it's not related to infection or cancer. A prescription for nystatin oral hasn't made a difference. Is there anything else that might help?
A: Geographic tongue is a chronic inflammatory condition that affects the surface of the tongue. It is marked by areas of irregular tissue that develop on the top or sides of the tongue. These occur less often on the underside of the tongue.
They typically appear as patches of smooth, reddish tissue surrounded by a light-colored border. The appearance suggests landforms on a map — probably how the condition got its common name. The medical term is benign migratory glossitis.
As your doctor has assured you, and as the word “benign” in the medical name states, geographic tongue is not a health risk. Glossitis refers to inflammation or swelling of the tongue. This inflammation can cause tenderness, pain or a burning sensation like you described. The irregular patches can move over time, hence why it's called a migratory condition.
The changes to the appearance of the tongue are due to a temporary loss of papillae. These are tiny projections that, in addition to giving the surface of the tongue its textured appearance, house taste buds and provide sensory information.
In a healthy tongue, papillae regenerate about every 14 days. The regeneration causes some bald spots to heal. As the regeneration progresses, the spots may migrate to a new cluster of papillae.
The cause of geographic tongue is not yet understood. Family history appears to play a role, and there may be a link to certain inflammatory conditions, including psoriasis. As a benign condition, it does not require treatment. However, many people find it embarrassing and sometimes painful.
Depending on the case, medications to address inflammation or to suppress immune response may be recommended. The antifungal medication you were prescribed can be helpful when geographic tongue is accompanied by oral candidiasis, also known as thrush.
People living with geographic tongue may benefit from avoiding spicy and acidic foods. Be vigilant about oral hygiene, including regular dental checkups. Some toothpastes can be irritants, particularly those with a whitening component. Try a product formulated for sensitive teeth.
Some researchers suspect a connection to nutritional deficiencies. Gut health may also play a role in the condition. Several clinical trials are currently exploring zinc deficiency as a possible factor as well.
A diet rich in zinc, sometimes accompanied by zinc supplementation, may promote healing. A deficiency in B vitamins, particularly niacin, folate and B12, may also be a factor. And, as with zinc, adding B vitamins in the form of food as well as supplements is the optimal approach.
It is important to note that too much zinc can be harmful. If you decide to pursue supplementation, seek medical guidance.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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