Geographic tongue, also known as benign migratory glossitis, is a non-cancerous and clinically benign inflammatory disorder that affects the surface of the tongue—usually the dorsal (top) surface. The condition gets its name from the map-like appearance of the lesions. The lesions appear as distinctly red, smooth patches surrounded by white or pale colored slightly raised borders. The patch shape is irregular, can resemble islands or continents (the lesions have been referred to as a “geographic tongue”), and often change in size, shape and location, giving the impression of “migratory.” The patches are due to the loss of filiform papillae (the small projections that cover the tongue and give the tongue its rough appearance)—the lesions appear smooth and reddish. The white borders around the red patches represent developing papillae. The appearance of geographic tongue can be alarming, but it is benign and typically asymptomatic. But some people might experience burning, irritation, or sensitivity, especially to spicy, acidic or salty foods, or to oral hygiene products.

Although the appearance can be alarming, geographic tongue is in no way associated with an infection, disease systemically or any form of cancer. Geographic tongue may develop at any age, but is more common in young to middle-age individuals. It occurs slightly more often in females. The condition will often appear sporadically, and you may have flares and then remissions.

Geographic tongue doesn’t generally require treatment. However, you should see a healthcare provider for persistent patches, pain or other symptoms to rule out other issues.

The precise etiology of geographic tongue is unknown, but this is typically considered a multifactorial condition, meaning many factors involving genetics, immune function, the environment and lifestyle may all play a role in its development. Although geographic tongue is often harmless in a previous sense, understanding potential causes may help manage acute exacerbations and possibly associated discomfort. 
Key Factors:

1. Genetics: Evidence suggests that geographic tongue has a genetic component that may run in families, indicating that those who have a family history will have a strong likelihood of developing the condition based off inherited factors. 
2. Autoimmune and/or Inflammatory Conditions: Various autoimmune and/or inflammatory diseases have existed in association with geographic tongue. A particularly striking association is that of psoriasis and geographic tongue in patients (especially pustule psoriasis). Other conditions, including lichen planus, Reiter’s syndrome and eczema have also shown associative factors with geographic tongue. These observations lend credence to the theory that immune dysfunction plays a key role.
3. Hormonal Influences: Hormonal changes seem to affect the condition. Hormonal changes may trigger or worsen flare-ups associated with menstruation, pregnancy and menopause. Many women notice a fluctuation in symptoms during different times of the menstrual cycle when an association could be made and give a degree of support for a hormonal role.
4. Nutritional Deficiencies: Geographic tongue has been associated with deficiencies in iron, zinc, vitamin B12, vitamin B6 and folic acid. Correcting the deficiency does not always remediate the condition but some improvements may result when signing of these deficiencies.
5. Stress and Psychosocial Factors: Emotional stress, anxiety and psychosocial stressors are often identified as a trigger. We do not understand the exact mechanism by which stress works, but it does seem to affect immune response and seem to affect the frequency and severity of flare-ups. Stress reduction methods may benefit those who identify that stress causes their symptoms. 
6. Food Triggers or Irritants: Some foods and things we use are often noted to irritate symptoms to worsening. Some common irritants noted are: 
   • Spicy foods, acidic foods, salty foods, or sugary foods.
   • Alcohol and tobacco.
   • Any flavored toothpaste or mouthwash that has additives or stronger flavors.

     Some of these items have a different reaction depending upon the individual, and in most cases will need to be determined by observation.

7. Other Systemic Conditions: Geographic tongue has been reported to be more frequent in individuals with systemic health conditions such as diabetes, asthma and allergies. These conditions have been noted, but they have not yet been reliably shown as linked to geographic tongue—at least, as is the basis of current research.
8. Fissured Tongue: Geographic tongue has been often reported together with fissured tongue, a condition characterized by grooves and/or cracks on the surface of the tongue. Fissured tongue is more common in older adults and both conditions may occur together. The reason for the associations (the doctor will sometimes say “concurrent”) is not known.

Geographic tongue cannot be transferred from one person to another by contact, saliva or sharing of utensils because it is not contagious. Additionally, it is not brought on by diseases, injuries to the tongue, or poor dental hygiene.

Rather, a combination of environmental stressors and genetic predisposition may cause an individual to develop the illness.

Risk factors consist of:

• Geographic tongue or psoriasis in the family
• Autoimmune diseases
• Stressful way of living
• Deficits in nutrition
• The increased predominance of female sex
• History of allergies or atopic
• Tongue cracks
• Hormonal birth control
• Allergies

While the illness may manifest suddenly and go away on its own, some people may develop chronic symptoms that repeat over months or even years.

Geographic tongue may go unnoticed for months or years and will typically remain asymptomatic for most people. Often a dentist or doctor will bring it to the individual’s attention upon performing a routine examination of the mouth.

The primary clinical finding is irregular areas of red with smooth surfaces on the top and sides of the tongue. Locations of red patches appear smooth and lack taste buds due to the loss of the filiform papillae. The lesions are usually bordered by a white or yellowish raised border. Lesions appear to modify shape, size, and location over time—that is, they possess a “migratory,” feature.

Common Signs:

• Red, map-like patches on the tongue surface
• The affected area has a smooth texture
• Usually white or gray raised borders around the edges of the patches
• The lesions change in shape and size and location.
• The lesions heal in one place and they reappear in another.

Common Symptoms:

• Burning or tingling sensation
• Sensitivity to spicy, hot, acidic or salty foods
• Mild pain or discomfort while eating or brushing
• Altered taste in some cases
• Discomfort with certain toothpastes or mouthwashes (especially those with strong flavoring)

While many individuals are asymptomatic and only notice the condition due to its appearance, others may experience flare-ups that cause noticeable discomfort. These symptomatic periods may last for days or weeks, followed by intervals of remission. In some cases, individuals may also observe swollen lymph nodes under the jaw, though this is less common.

Geographic tongue is usually diagnosed with a clinical examination and patient history. In most cases, dentists and physicians can accurately diagnose the condition because of its recognizable appearance and often migratory lesions. 

Preliminary steps in the diagnosis of geographic tongue:

1. Medical and Dental History: Your healthcare data provider may ask about the following history: 
   • Family history of geographic tongue or other related conditions
   • Recent illness
   • Stress levels
   • Allergies
   • Hormonal/other changes
   • Patient history of diet and which foods may trigger the lesions condition
2. Physical Exam: Most conditions can be diagnosed with the distinct signs of red, smooth patches with white borders, which change shape and location over time. 
3. Signs of Infection: Your provider may look for fever or swollen lymph nodes in the neck to rule out infections or other systemic related issues.
4. Differential Diagnosis: To rule out the possibility that the symptoms are caused by a different disease, your provider will rule out:
   • Oral candidiasis (yeast infection)
   • Lichen planus
   • Erythroplakia
   • Glossitis from vitamin B deficiency
   • Leukoplakia
   • Oral cancer (rare)
5. Biopsy (rarely required): After ruling out other conditions, if the diagnosis remains unclear or if the lesion does not respond to treatment, a biopsy can be indicated. Tissue samples are taken and examined using a microscope to rule out more serious diagnoses.
6. Lab tests: Blood or lab tests are usually normal and not needed unless an underlying disease or nutritional deficiency is suspected.

Geographic tongue is an innocent and usually self-limiting condition that may even resolve on its own without medical treatment. However, if there are symptoms of burning or sensitivity or pain, there are many options that may relieve irritation and mitigate episodes of geographic tongue. 

Lifestyle and Home Remedies

1. Avoid Trigger Foods: Minimize or remove from eating habits any foods that irritate the tongue. Examples include:
   • Spicy dishes (e.g. chili, hot sauces, etc.)
   • Acidic fruits (e.g, orange, and pineapple)
   • Tomatoes, vinegar and citrus juices
   • Tobacco and alcohol
2. Change Oral Care Products: Use a toothpaste that does not contain sodium lauryl sulfate (SLS), or whiteners, or intense flavor. A toothpaste made for sensitive teeth is often a good choice. Avoid mouthwash with alcohol or high levels of menthol, as these can exacerbate symptoms.
3. Maintain Good Oral Hygiene:
   • Use warm saltwater to soothe irritation.
   • Brush gently and lightly with a soft toothbrush to avoid irritating sensitive spots.
   • Drink plenty of water to ensure oral cavity is kept lubricated and balanced.
4. Minimize Stress: Use slow deep breathing or yoga or meditation to relax. Improve mental, social, and emotional health, as stress can be a trigger for flare-ups.
5. Medical Management: If patients continue to experience troublesome or lingering symptoms, the following medications may be prescribed by a healthcare professional: 
   • Topical corticosteroids (i.e., triamcinolone dental paste) to reduce inflammation
   • Antihistamine mouth rinses (i.e., diphenhydramine) to reduce burning or irritation 
   • Topical anesthetics or pain relief gels (i.e., benzocaine) for short term pain relief
   • Antiseptic or anti-inflammatory mouth rinses prescribed by a dentist
   • Vitamin or mineral supplements if deficiencies (including B12, zinc, or iron) are determined 
   • Antifungal medication may be prescribed if there is a suspicion of concurrent oral conditions, although it is rarely required.

Follow-Up and Monitoring

Regular dental visits are important in monitoring the condition and ensuring there are no other oral health concerns. 

Geographic tongue rarely causes any complications; however, if you experience ongoing or increasing symptoms, you should discuss these issues with your doctor to ensure proper assessment.

Geographic tongue is a comparatively common and completely harmless condition that affects the top surface of the tongue. Even though the lesions it can show can seem alarming—especially when they keep changing—it causes no health risks, is not contagious, and does not pose long-term health risks. The causes are not fully understood, but a mix of genetics, how the immune system works, and environmental stressors likely all serve as contributing factors. Symptoms are usually mild, controlled by changing factors, and sometimes topical creams.

The hardest part of living with geographic tongue is accepting the condition’s nature. It is usually best to just trust your instincts, avoid triggers where possible, and only seek medical attention when necessary, such as when your discomfort intensifies. Most by following proper medical advice can live with geographic tongue easily and comfortably.

While you might observe changes in your tongue, go to your medical provider when you observe changes that are unusual to you to determine the cause, and rule out any other condition.

• Mayo Clinic. (2023). Geographic tongue. Mayo Foundation for Medical Education and Research. 
• American Academy of Oral Medicine. (n.d.). Geographic tongue (benign migratory glossitis). 
• Cleveland Clinic. (2023). Geographic tongue: Symptoms, causes, treatment & more.
• MedlinePlus. (2022). Geographic tongue. U.S. National Library of Medicine.