Odd Tongues: The Prevalence of Lingual Disease
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White papilloma, syphilitic glossitis and fissured tongue, all present in the same patient, in a 1915 paper by Bloodgood.

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Introduction

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. 

Table 1: Summary of the larger prevalence studies of tongue lesions, encompassing 424,349 persons examined worldwide, listed by date of publication.  References are at end of this page.

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.

    * 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)

Table 2: 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.

  * 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)

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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.

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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.

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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.