Odd Tongues:
The Prevalence of
Lingual Disease
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White papilloma,
syphilitic glossitis and fissured tongue,
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Since the earliest days of medicine the tongue has been considered a good reflection of systemic diseases. Hippocrates, Galen and others considered the tongue to be a barometer of health, emphasizing its diagnostic and prognostic importance. Localized, non-systemic lingual lesions, however, are much more commonly encountered. Incidence investigations of benign lingual lesions are nonexistent, only prevalence data (number of lesions found per every 1,000 persons examined) are available. Several prevalence studies have looks exclusively at tongue lesions, often recording only one or two different entities. Table 1 summarizes the larger studies, representing 384,130 persons examined from 13 countries. Considerable variation in rates is evident, especially for the generalized dorsal abnormalities such as geographic, fissured and hairy tongue. Such variation is probably related more to differing diagnostic criteria than to real differences in disease frequency. Rates from papers reporting all oral lesions, such as those by Bouquot & Gundlach, and Ross & Gross, are lower that many others, probably because of a lower level of clinical suspicion in these general examinations.
Summary of the larger prevalence studies of tongue lesions,
encompassing 424,349 persons examined worldwide,
listed by date of publication.
References
Modified & updated from: Bouquot JE, Gundlach KKH. Odd tongues: the prevalence of common tongue lesions in 23,616 white Americans over 35 years of age. Quintessence Internat 1986; 17:719-730.
| Author(s) | Country | Year | Population Size | # Lesions/1,000 persons * | |||||
| GT | FT | HT | MRG | HLT | Macro | ||||
| Comby J | France | 1912 | 39.0 | ||||||
| Hanhart E | Switzerland | 1934 | 3,260 ** | 67.8 | |||||
| Seiler A | Switzerland | 1936 | 1,625 ** | 99.0 | |||||
| Martin HE, Howe ME | USA | 1938 | 2.0 | ||||||
| Rolleri F | Germany | 1939 | 3,113 ** | 67.8 | |||||
| McCarthy F | USA | 1941 | 2,301 # | 23.9 | 21.7 | 3.9 | 2.2 | 0.4 | |
| Eichenlaub FJ | USA | 1941 | 6,468 # | 3.3 | |||||
| Halperin V, et al | USA | 1953 | 2,478 ## | 13.7 | 52.8 | 3.2 | |||
| Rahaminoff P, Muhsam HV | Israel | 1957 | 8,305 ** | 150.0 | |||||
| Kocsard E, et al | Australia | 1958 | |||||||
| Kaplan BJ | England | 1961 | 1,953 ## | 41.0 | 72.0 | ||||
| Togo T | Japan | 1961 | 1,8503 ** | 83.3 | |||||
| Meskin LH, Redman, Gorlin | USA | 1963 | 3,668 ## | 11.5 | |||||
| Witkop CJ Jr, Barros L | Chile | 1963 | 1,906 ** | 7.0 | 120.7 | 4.0 | 0.5 | ||
| Redman RS, et al | USA | 1966 | 2,094 @ | 2.9 | |||||
| Bhaskar SN | USA | 1968 | |||||||
| Richardson ER | USA | 1968 | 3,319 ^ | 10.8 | 1.5 | ||||
| Luigi G | Italy | 1968 | 3,274 ** | 28.7 | 59.2 | 11.6 | 33.5 | ||
| Schaumann BF, Peagler, FD, Gorlin RJ | USA | 1970 | 956 ^ | 19.9 | 53.4 | 3.1 | 4.2 | 1.0 | |
| Redman RS | USA | 1970 | 3,611 ## | 14.0 | 1.0 | ||||
| Knapp MJ | USA | 1971 | 181,3888 ^^ | 0.3 | |||||
| Aboyans V, Ghaemnaghami | Iraq | 1973 | 4,009 ** | 25.6 | |||||
| Chosack A, Zadik D, Elieger | Israel | 1974 | 70,359 ** | 19.0 | |||||
| Fischman SL | Paraquay | 1974 | 3,118 # | 82.8 | |||||
| Wyk CW, van Dreyer WP, Konviser JV | Malaysia | 1974 | |||||||
| Hume WJ | USA | 1975 | |||||||
| Sedano HO | Argentina | 1975 | 6,180 ** | 15.0 | 1.0 | ||||
| Axell T | Sweden | 1975 | 20,333 ## | 84.5 | 64.8 | 5.8 | 0.5 | ||
| Ghose LJ, Baghdady VS | Iraq | 1982 | 6,090 ** | 43.0 | 26.0 | ||||
| Sawyer DR, Taiwo, Mosadomi | Nigeria | 1984 | 2,203 ** | 3.0 | 8.0 | ||||
| Bouquot JE, Gundlach KKH | USA | 1986 | 23,616 ## | 3.2 | 3.2 | 0.6 | 0.6 | 1.6 | 0.04 |
| Darwazeh, Pillai | Jordan | 1993 | 1,013 | 68.0 | 114.0 | 34.0 | |||
| Kleinman, et al. | USA | 1993 | 39,206 | 6.0 | |||||
| Total: | 424,349 | ||||||||
| Average: | 15,717 | 30.5 | 52.9 | 16.2 | 4.7 | 1.0 | 1.9 | ||
* diagnosis codes: GT = geographic
tongue; FT = fissured tongue; HT = hairy tongue; MRG = median
rhomboid glossitis; HLT =
hyperplastic lingual tonsil; Macro = macroglossia
** children
# patients referred for oral/dental
problems
## adults
@ mentally retarded persons
^ blacks only
^^ army recruits (young males)
Gender-specific prevalence rates (per 1,000 persons) for
mucosal tongue
disorders , ranked by overall frequency.
Modified from: Bouquot JE, Gundlach KKH. Odd tongues: the prevalence of common tongue lesions in 23,616 white Americans over 35 years of age. Quintessence Internat 1986; 17:719-730.
| Rank | Diagnosis | # Lesions/1,000 persons | ||
| Males | Females | Total | ||
| 1 | Lingual varicosities | 3.5 | 3.4 | 3.4 |
| 2 | Fissured tongue | 3.5 | 3.1 | 3.2 |
| 3 | Geographic tongue | 3.4 | 3.0 | 3.1 |
| 4 | Leukoplakia * | 2.4 | 2.8 | 2.6 |
| 5 | Irritation fibroma | 2.6 | 2.3 | 2.4 |
| 6 | Papilloma | 2.7 | 1.7 | 2.1 |
| 7 | Hyperplastic lingual tonsil | 2.4 | 1.2 | 1.6 |
| 8 | Inflammation/Irritation | 0.7 | 1.1 | 0.9 |
| 9 | Hemangioma | 1.1 | 0.6 | 0.8 |
| 10 | Median rhomboid glossitis | 0.8 | 0.5 | 0.6 |
| 11 | Hairy tongue | 1.2 | 1.3 | 0.6 |
| 12 | Smooth red tongue | 0.6 | 0.5 | 0.5 |
| 13 | Inflammatory ulcer ** | 0.8 | 0.3 | 0.5 |
| 14 | Hematoma | 0.2 | 0.3 | 0.3 |
| 15 | Epithelial cyst | 0.5 | 0.1 | 0.3 |
| 16+ | Other # | 0.8 | 0.9 | 0.9 |
| Total | 27.3 | 22.0 | 23.9 | |
* includes 3 men with early invasive squamous cell carcinoma, 3 with severe
epithelial dysplasia, and 56 men and women
with no dysplasia or carcinoma
** includes aphthous ulcers and traumatic ulcers, about evenly divided
# excludes 64 lesions with ambiguous or nonspecific diagnoses
References (Listed Chronologically)
Comby J. La Langue scrotale chez les enfants. Arch Med Enf 1912; 15:161-168.
Hanhart E. Die Faltenzunge (Lingue plicata) als Stigma nervöser Minderwertigkeit. Vorläufige Mitteilung, Schweiz. Naturforsch. Gesllsch. Verhandt. 1934; 115:432-433.
Seiler A. Zur Verbreitung und Vererbung der Faltenzunge (Lingua plicata). Arch J Klaus0Stift 1936; 11:541-569.
Martin HE, Howe ME. Glossitis rhombica mediana. Ann Surg 1938; 107:39-49.
Rolleri F. Über das Vorkommen der Lingua plicata (Faltenzunge). Z Menschl Vererb- u Konstitutionst 1939; 23:587-593.
McCarthy F. A clinical and pathological study of oral disease. J Am Med Assoc 1941; 116:16-21.
Eichenlaub FJ. Discussion. J Am Med Assoc 1941; 116:22.
Halperin V, et al. Occurrences of Fordyce spots, benign migratory glossitis, median rhomboid glossitis and fissured tongue in 2,478 dental patients. Oral Surg Oral Med Oral Pathol 1953; 6:1072-1077.
Rahaminoff P, Muhsam HV. Some observations on 1,246 cases of geographic tongue. Am J Dis Child 1957; 93:519-525.
Kocsard E, et al. Senile changes in the skin and visible mucous membranes of the Australian male. Aust J Dermatol 1957/58; 4:216-223.
Kaplan BJ. The clinical tongue. Lancet 1961; (1):1094-1097.
Togo T. Clinical study on the geographic tongue. J Kurume Med Assoc 1961; 24:1156-1172.
Meskin LH, Redman RS, Gorlin RJ. Incidence of geographic tongue among 3,668 students at the University of Minnesota. J Dent Res 1963; 42:895-902.
Witkop CJ Jr, Barros L. Oral and genetic studies of Chileans, 1960. I. Oral anomalies. Am J Phys Anthropol 1963; 21:15-24.
Redman RS, et al. Psychological components in the etiology of geographic tongue. J Dent Res 1966; 45:1403-1408.
Bhaskar SN. Oral lesions in the aged population. A survey of 785 cases. Geriatrics 1968; 23:137-149.
Richardson ER. Incidence of geographic tongue and median rhomboid glossitis in 3,319 Negro college students. Oral Surg Oral Med Oral Pathol 1968; 26:623-625.
Luigi G. Indagine clinico-statistica sulla frequenze della lingua scrotale, della lingua geografica, della lingua nera villosa, della glossite rombica mediana, della anchiloglossia e del torus palatinus in 3,274 stomatopazienti. Rass Int Stomatol Prat 1968; 19:261-268.
Schaumann BF, Peagler FD, Gorlin RJ. Minor craniofacial anomalies among a negro population. II. Prevalence of tongue anomalies. Oral Surg Oral Med Oral Pathol 1970; 29:729-734.
Redman RS. Prevalence of geographic tongue, fissured tongue, median rhomboid glossitis, and hairy tongue among 3,611 Minnesota schoolchildren. Oral Surg Oral Med Oral Pathol 1970; 30:390-395.
Knapp MJ. Oral disease in 181,338 consecutive oral examinations. J Am Dent Assoc 1971; 83:1288-1293.
Aboyans V, Ghaemnaghami A. The incidence of fissured tongue among 4,009 Iranian dental outpatients. Oral Surg Oral Med Oral Pathol 1973; 36: 34-38.
Chosack A, Zadik D, Elieger E. The prevalence of scrotal tongue and geographic tongue in 70,359. Epidemiol 1974; 2:253-257.
Fischman SL. Oral health in the Republic of Paraguay. Comm Dent Oral Epidemiol 1974; 2:176-181.
Hume WJ. Geographic stomatitis: a critical review. J Dent 1975; 3:25-43.
Sedano HO. Congenital oral anomalies in Argentinean children. Comm Dent Oral Epidemiol 1975; 3:61-63.
Axéll T. A prevalence study of oral mucosal lesions in an adult Swedish population. Odont Revy 1976; 27 (suppl 26):1-103.
Ghose LJ, Baghdady VS. Prevalence of geographic and plicated tongue in 6,090 Iraqi schoolchildren. Comm Dent Oral Epidemiol 1982; 10:214-216.
Sawyer DR, Taiwo EO, Mosadomi A. Oral anomalies in Nigerian children. Comm Dent Oral Epidemiol 1984; 12:269-273.
Bouquot JE. Common oral lesions found during a mass screening examination. J Amer Dent Assoc 1986; 112:50-57.
Bouquot JE, Gundlach KKH. Odd tongues: the prevalence of common tongue lesions in 23,616 white Americans over 35 years of age. Quintessence Internat 1986; 17:719-730.
Darwazeh AMG, Pillai K. Prevalence of tongue lesions in 1013 Jordanian dental outpatients. Community Dent Oral Epidemiol 1993; 21:323-324.
Kleinman DV, Swango PA, Pindborg JJ. Epidemiology of oral mucosal lesions in United States schoolchildren: 1986-87. Community Dent Oral Epidemiol 1994; 22:243-253.