What can you do to avoid or get rid of geographic tongue?

Definition: What is geographic tongue?

Geographic tongue (also referred to as "lingua geographica") is not a disease but merely a benign variation in appearance of the top of the tongue. Inflammation spreads in the form of smooth, red irregularly shaped lesions on your tongue, usually with slightly raised edges and white borders that resemble small islands and give the tongue a map-like, or geographic, appearance. In this case, the tiny bumps (papillae) that normally cover the surface of the tongue are missing. The location of the reddish lesions changes every few days.

When it comes to the duration of this condition, individuals affected by it have reported a wide range of experiences: In most cases, geographic tongue resolves after a certain period of time – sometimes several months. Although, it may appear again at a later time. Further, there is no need to be worried about possible transmission. Geographic tongue is neither contagious nor dangerous. The condition is common in children and young people.

The images below show what geographic tongue looks like:

Symptoms of geographic tongue

In addition to the typical map-like appearance, many individuals with this condition complain of a burning sensation and, at times, may also experience pain when eating spicy, hot or acidic food. Since the patches on the surface of the tongue are missing papillae, the taste buds are less protected and therefore particularly sensitive.

The smooth, red and irregularly shaped patches with a white border frequently change their location on the tongue. They can become larger, merge with adjacent lesions and also disappear again. Afterwards, the surface of the tongue recovers fully as the papillae grow back. Geographic tongue always gets better with time, not worse. However, it may appear again at any time, even after it has healed completely. The island-shaped patches, also referred to as lesions, usually grow no bigger than one centimetre in diameter, and sufferers tend to generally have a maximum of five lesions on their tongue.

Geographic tongue does not usually bleed. If the red patches start to bleed, talk to a health care professional.

Course

Geographic tongue raises many questions: Currently, the causes of this condition remain unclear, and its course is unpredictable and varies significantly. To shed light on this mysterious tongue condition, physicists from Israel have studied how the patches move from a mathematical-physical perspective. In doing so, they discovered that geographic tongue can spread in two different ways.

With the first type, the papillae become inflamed and then destroyed when the patches spread like a wave. Once the papillae have been destroyed, the next wave will not appear until they have started to regrow. The physicists compared the spread of the patches to a forest fire, which cannot return to a burnt spot until the vegetation has regrown over time.

In the second type, the patches can develop through the formation of spiral patterns that evolve into regions of the tongue that are still recovering, thus causing that particular region to be excited again. This self-sustaining excitation of recovering regions results in a more acute condition that will linger for a relatively long period of time.

Daily stress

Although doctors and experts generally agree that geographic tongue is harmless and not contagious, those affected often find the variation in appearance to be very unpleasant. They are embarrassed about the unusual appearance of their tongue. The existence of geographic tongue can pose a psychological burden, especially in the context of romantic relationships.

Furthermore, there are situations in which individuals affected by geographic tongue find themselves unable to consume certain foods due to the severe burning and pain it would otherwise cause. As a result, they may feel socially and emotionally isolated, as they do not wish to openly discuss their health condition with everyone.

The good news is that with time you will develop the ability to identify the triggers of your geographic tongue and manage them more effectively. 

Associated problem - fissured tongue

Fissured tongue, which is commonly associated with geographic tongue, is yet another tongue disorder. It causes deep cracks or grooves to develop on top of the tongue. Despite looking unsightly, fissured tongue, just like geographic tongue, is benign and harmless. Fissured tongue can also lead to a burning sensation.

Causes and risk factors

The exact cause of geographic tongue is not yet known. However, it has been noted that the disorder tends to run in families. For example, it is commonly observed that if one parent experiences a variation in appearance of the tongue, their children or siblings are often affected by the same condition. This means that some people definitely have a hereditary predisposition to geographic tongue. Moreover, if you are predisposed to geographic tongue, there are certain factors that make you more likely to develop the condition.

Food

Your diet can determine whether geographic tongue develops and how long it remains. The symptoms may become worse if you eat certain foods. Accordingly, geographic tongue will heal faster if you avoid eating these particular types of food.

The following food and drinks can act as triggers for geographic tongue:

• Red wine and other alcoholic drinks
• Cooked meats
• Nuts
• Garlic
• Acidic fruit (e.g. lemons, oranges, pineapple, kiwis)
• Bananas
• Melons
• Tomatoes
• Vinegar
• Onions
• Ginger
• Cayenne pepper
• Feta cheese
• Parmesan cheese
• Mature cheese
• Spicy food
• Hot food and drinks

Several of the listed foods are also not suitable for individuals with histamine intolerance.

Stress and psyche

Emotional stress and psychological issues exacerbate the symptoms and prolong the duration or cause the recurrence of geographic tongue.

Age

Geographic tongue is more common in young people than in adults. Firstly, this is because the surface of the tongue gets thicker with age. And, secondly, over time individuals affected by this condition acquire strategies to manage the symptoms and steer clear of obvious triggers.

Hormonal changes

If you have a predisposition to geographic tongue, it may also develop during pregnancy or menopause – when your hormones are going haywire. In general, the condition is more likely to affect women than men.

Medications

A study carried out in Sweden identified an association between geographic tongue and anti-hypertensive medications. 

Smoking

Smoking can also exacerbate the symptoms of geographic tongue. Further, tobacco dries out your mouth, making it easier for bacteria to spread. And this can lead to a variety of problems, including bad breath.

Diseases

Geographic tongue can present itself in connection with the following diseases

• Gastrointestinal conditions (affecting the digestive system)
• Psoriasis
• Allergies
• Diabetes
• Asthma
• Hormonal imbalances
• Down's syndrome
• Lichen planus
• Reactive arthritis
• Coeliac disease (gluten intolerance)

Causes according to traditional Chinese medicine

In traditional Chinese medicine (TCM), conditions affecting the digestive system or hormonal imbalances are considered to be the cause of geographic tongue. A TCM therapist examines the tongue coating to establish a diagnosis and to monitor the progress of the respective therapy. 

Geographic tongue in children

Parents are usually quite shocked upon discovering geographic tongue in their child's mouth – particularly if they have never experienced this harmless variation in appearance of the tongue themselves. This is evidenced by the multitude of posts in online forums where parents seek advice and support.

Do you need to worry if your child or baby develops reddish patches with white borders on their tongue? No, because geographic tongue is not a disease but merely a variation in appearance of the top of the tongue, which is often triggered by certain foods. If you remove the foods listed above from your child's diet for a while, the peculiar appearance will usually resolve itself.

However, if your child has white patches on their tongue and on the insides of their cheeks and lips, they may be suffering from oral thrush. Should your child present these symptoms, always consult a paediatrician. And if you are still uncertain, it is always a good idea to visit a doctor with your child for a check-up.

Babies rarely suffer from geographic tongue. Nevertheless, there have been instances where patients as young as six months old have been affected by this condition.

Treatment: How to get rid of geographic tongue

Geographic tongue often goes away on its own without treatment. But there are, however, a number of things you can do if you experience discomfort, pain or burning sensation. If you are not sure whether you are suffering from geographic tongue or another condition, it is best to consult a health care professional.

Which health care professional should you see about geographic tongue?

Now you might be asking which health care professional is the right person to visit about geographic tongue: Dentist? General practitioner? ENT specialist? Ideally, a dermatologist is the best person to see about geographic tongue. There are, in fact, several other diseases that look very similar to geographic tongue. A medical check-up helps to ensure that the condition is indeed geographic tongue, thus eliminating any uncertainties.

The following health conditions present similar symptoms to those of geographic tongue:

• Oral thrush (fungal infection of the tongue and oral cavity)
• Leukoplakia (hairy white patches after weakening of the immune system, e.g. due to a HIV infection)
• Scarlet fever (red patches on the tongue and a sore throat)
• Coated tongue with cold, flu or COVID-19 symptoms
• Herpes simplex infection
• Minor tongue injuries
• Anaemia
• Iron deficiency
• Folic acid deficiency
• Vitamin B12 deficiency

After being diagnosed with geographic tongue, there are various measures you can take to alleviate the symptoms and to get over them faster.

Gentle toothpaste and mouthwash

Individuals suffering from geographic tongue often find that their symptoms worsen when using an aggressive toothpaste or mouthwash. The affected area of the tongue is painful and burns. To enable regular tooth brushing despite the painful variation in appearance of the tongue, we recommend using a particularly gentle toothpaste. This helps prevent unnecessary irritation of the inflamed tongue. 

Identifying and avoiding triggers

Given that the symptoms can worsen with certain foods, such as acidic, very spicy or hot dishes, it is advisable to carefully monitor the occurrences of geographic tongue and to identify potential triggers. Not everyone suffers from the same food sensitivity reactions. Once you have determined the specific foods that trigger your geographic tongue, you can remove them from your diet, resulting in a reduced frequency of symptoms.

If you are currently experiencing symptoms of geographic tongue and your tongue is highly sensitive, it is advisable to avoid consuming acidic fruits and hot spices in general. 

Fasting

Many individuals believe in the efficacy of fasting as a way to accelerate the natural healing of the body when suffering from geographic tongue. By preventing any contact between the tongue and food, notable improvements in symptoms can be expected within just a few days. However, to date, there is no scientific evidence to confirm that fasting actually helps to heal geographic tongue. Again, it is best to consult a health care professional for advice about whether it is safe for you to fast.

Relaxation exercises

Emotional stress and psychological suffering have a negative effect on geographic tongue. Having said that, active stress management has a positive effect. Various relaxation exercises, such as meditation and yoga, can help significantly. Health insurance companies frequently cover the costs for training programmes, health apps and yoga courses.

Home remedies

If your tongue is burning, you can relieve the discomfort and pain by consuming tannin-containing and anti-inflammatory infusions, e.g. sage tea. Drink several cups of sage or black tea slowly throughout the day or rinse your mouth with lukewarm tea.

Plants with medicinal properties that contain soothing mucilage, such as marshmallow roots, lime blossom and mallow leaves, can also provide relief. And they can also be used to make infusions.

Vitamins

Geographic tongue is sometimes confused with vitamin deficiency. A lack of vitamin B12 can also lead to red patches on the tongue and burning and tingling sensations. If the appearance of your tongue does not distinctly indicate geographic tongue, it is probably wise to see a doctor and have a blood test done to determine if you are suffering from a lack of vitamin B12. This deficiency is frequently observed in older individuals, vegetarians, vegans, pregnant women and people with kidney or digestive disorders. Vitamin B12 deficiency is also more common in people with gluten intolerance (coeliac disease) and during menopause.

Medications

As yet, no medication exists that targets and alleviates the symptoms of geographic tongue. And this is the reason why patients with geographic tongue typically do not resort to medicinal treatment. Despite the limited options, there are a few medications that can be used to aid the healing process:

• Antihistamines: To help the taste buds heal faster, you can apply an antihistamine gel to the affected areas.
• Mouthwash with chlorhexidine: Chlorhexidine, if its use is recommended by a dentist, serves as the gold standard for oral cavity inflammation, effectively ensuring well balanced oral flora.
• Probiotic lozenges: Probiotic lozenges help to repopulate 'good' bacteria in the oral cavity.

Naturopathy

When it comes to homoeopathic remedies, alternative health practitioners use various globules to treat geographic tongue. The best idea is to consult an alternative health practitioner for advice on the right dosage and the exact name. But always bear in mind that there is no scientific evidence that homoeopathic treatments actually work. If symptoms improve through homoeopathic remedies or practices, the cause is, according to the current state of research, most likely down to a 'placebo effect'. This judgement has been discussed in various publications of Helmholtz-Gemeinschaft Deutscher Forschungszentren.

Summary: Five tips to combat geographic tongue

Geographic tongue is not curable since it can reappear at any time. However, the symptoms usually go away on their own without treatment. To help you get rid of your geographic tongue as quickly as possible, here are five key tips for you to consider:

1. Avoid acidic and very spicy dishes.
2. Rinse your mouth thoroughly with water after eating.
3. Drink several cups of sage or black tea throughout the day (or use it to rinse your mouth).
4. Try to relax (e.g. with relaxation exercises such as yoga or meditation).
5. Use a gentle toothpaste.