Diagnosis of Glossitis
Glossitis Diagnosis: Book Excerpts
Diagnostic Tests for Glossitis: Online Medical Books
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TONGUE MASS OR SWELLING:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is it painful? Painful swellings of the tongue include trauma, burns, herpes simplex, pemphigus, erythema bullosum, carcinoma, Ludwig's angina, angioneurotic edema, bee stings, and hemorrhage due to coagulation disorders.
- Is the mass or swelling focal or diffuse? Focal masses include trauma, herpes simplex, pemphigus, erythema bullosum, carcinoma, angioma, fibroma, lipoma, mucus cyst, papilloma, or syphilitic gumma. Diffuse masses include Ludwig's angina, angioneurotic edema, bee sting, hemorrhage, myxedema, acromegaly, cretinism, mongolism, primary amyloidosis, diffuse lymphoma, and riboflavin deficiency.
DIAGNOSTIC WORKUP
Focal lesions of the tongue should be referred to an oral surgeon or dermatologist for biopsy or excision. Diffuse enlargement or swellings require a workup including CBC, sedimentation rate, urinalysis, chemistry panel, thyroid panel, VDRL test, and ANA titer. If a coagulation disorder is suspected, a coagulation profile may be done. If a vitamin deficiency is suspected, a therapeutic trial of vitamins is indicated. If amyloidosis is suspected, a biopsy may be done. Other disorders may require biopsy also. A trial of antibiotics or corticosteroids may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
TONGUE PAIN:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Most lesions will respond to conservative treatment and time. In patients with signs of systemic disease and vitamin deficiency, the workup includes serum B12 and folate level, upper GI series, ANA, and
Trichinella
antibody titer. Focal lesions that persist should command a referral to a dentist or oral surgeon.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Oral Lesions:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Aphthous stomatitis
–Idiopathic
–Recurrent, shallow, painful, spontaneously
resolving oral ulcers -
Herpes stomatitis
–Due to a primary outbreak of HSV-1
–Severe gingivostomatitis with pain, redness,
and erosions around the gum line
–Recurrent oral HSV (“cold sores”) often occur at the lip border
–Stress, sun exposure, and many other factors contribute to flare-ups
-
Self-limited viral disease (e.g., herpangina,
hand-foot-mouth disease)
–Most often seen in children
–Prodrome of malaise and fever followed by
a 5–10 day outbreak of oropharyngeal erosions or vesicles is common
-
Chemotherapy drugs (especially 5-FU and methotrexate)
-
Squamous cell carcinoma should always be considered if a nonhealing ulcer or oral erosion is noted
-
Bullous diseases (e.g., pemphigoid,
pemphigus, lichen planus)
–Recurrent painful oral ulcers and erosions
–Evaluate for other skin rashes suggestive of
these disorders
-
Behçet syndrome
–Uncommon but well-known cause of oral ulcers
–Patients must exhibit other symptoms (e.g., uveitis, CNS problems, GI complaints, genital ulcers) before this diagnosis can be made
-
Allergic contact dermatitis to amalgams in dental work may result in buccal tenderness
-
Erythema multiforme (Stevens-Johnson syndrome)
–Characterized by oral ulcers, ocular involvement, and simultaneous targetoid, erythematous, or bullous skin lesions
–May be triggered by HSV infection, Mycoplasma infection, or drugs (e.g., phenytoin, sulfonamides)
-
Primary syphilis
–Painless chancre
-
Agranulocytosis or leukopenia
-
Histoplasmosis (especially in immunosuppressed patients)
Workup and Diagnosis
-
Detailed history and physical examination
–Associated symptoms (e.g., fever, prodrome)
–Review the patient's past medical history and medication
list
–If ulcers occur in the same location with every episode, oral HSV is likely
–Is the patient sexually active (consider HIV, immunosuppression, or syphilis)
–Perform a thorough skin exam to evaluate for rashes or other mucosal lesions (ocular, urethral, or perianal)
–Lacy white plaques on the tongue or buccal mucosa may suggest lichen planus
–Ocular or anogenital complaints can be suggestive of Behçet syndrome, pemphigus, or pemphigoid
-
Initial evaluation includes a viral swab for culture and/or serum for HSV-1 IgG detection to diagnose HSV, and consider an RPR and CBC to rule out syphilis and leukopenia, respectively
-
Consider a punch biopsy of the edge of an ulcer/erosion to determine if there are viral changes or cytologic atypia; or evidence of an autoimmune bullous disease
-
Recurrent aphthous stomatitis is a diagnosis of exclusion, but is also the most common diagnosis of recurrent painful oral ulcers after HSV
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
ORAL OR LINGUAL MASS:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Most of these lesions are referred to the oral surgeon for diagnosis and treatment, so an elaborate discussion of the workup is unnecessary in a text of this scope. Obviously, cultures should be made in cases of suspected infectious granulomas, whereas biopsy or excision is the main diagnostic tool for neoplasms.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
SMOOTH TONGUE AND OTHER CHANGES:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to the diagnosis will depend largely on the clinical picture. A smooth tongue with pallor of the nails and conjunctiva suggests pernicious anemia or iron deficiency anemia. A swollen tongue with cardiovascular abnormalities suggests amyloidosis. A swollen tongue and protruding jaw suggest acromegaly, whereas a swollen tongue and nonpitting edema prompt a diagnosis of myxedema. A dry, furry tongue suggests dehydration.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
SWOLLEN TONGUE:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The diagnosis of macroglossia depends on the presence of other physical findings (almost invariably present) associated with the disorders mentioned above, and, in most cases, the results of a systematic workup. A lingual biopsy is valuable in primary amyloidosis.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
TONGUE PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to the diagnosis includes a CBC, sedimentation rate, serum B12 and folic acid levels, serum ferritin, serology, tuberculin test, and perhaps biopsy of the lesion. A trial of vitamin therapy may be indicated.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Mouth lesions:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin your evaluation with a thorough history. Ask the patient when the lesions appeared and whether he has noticed pain, odor, or drainage. Also ask about associated complaints, particularly skin lesions. Obtain a complete drug history, including drug allergies and antibiotic use, and a complete medical history. Note especially malignancy, sexually transmitted disease, I.V. drug use, recent infection, or trauma. Ask about his dental history, including oral hygiene habits, the frequency of dental examinations, and the date of his most recent dental visit.
Next, perform a complete oral examination, noting lesion sites and character. Examine the patient’s lips for color and texture. Inspect and palpate the buccal mucosa and tongue for color, texture, and contour; note especially painless ulcers on the sides or base of the tongue. Hold the tongue with a piece of gauze, lift it, and examine its underside and the floor of the mouth. Depress the tongue with a tongue blade, and examine the oropharynx. Inspect the teeth and gums, noting missing, broken, or discolored teeth; dental caries; excessive debris; and bleeding, inflamed, swollen, or discolored gums.
Palpate the neck for adenopathy, especially in patients who smoke tobacco or use alcohol excessively.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Stomatitis and other oral infections:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Diagnosis is based on the physical examination; in Vincent’s angina, a smear of ulcer exudate allows for identification of the causative organism.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Mouth lesions:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin your evaluation with a thorough history. Ask the patient when the lesions appeared and whether he has noticed any pain, odor, or drainage. Also ask about associated complaints, particularly skin lesions. Obtain a complete drug history, including drug allergies and antibiotic use, and a complete medical history. Note especially any malignancy, sexually transmitted disease, I.V. drug use, recent infection, or trauma. Ask about his dental history, including oral hygiene habits, frequency of dental examinations, and the date of his most recent dental visit.
Next, perform a complete oral examination, noting lesion sites and character. Examine the patient’s lips for color and texture. Inspect and palpate the buccal mucosa and tongue for color, texture, and contour; note especially any painless ulcers on the sides or base of the tongue. Hold the tongue with a piece of gauze, lift it, and examine its underside and the floor of the mouth. Depress the tongue with a tongue blade, and examine the oropharynx. Inspect the teeth and gums, noting missing, broken, or discolored teeth; dental caries; excessive debris; and bleeding, inflamed, swollen, or discolored gums.
Palpate the neck for adenopathy, especially in patients who smoke tobacco or use alcohol excessively.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Oral Lesions:
Differential Overview
(Field Guide to Bedside Diagnosis)
Ulceration
❑ Aphthous ulcers
❑ Angular cheilitis
❑ Herpes simplex
❑ Traumatic ulcers
❑ Impetigo
❑ Erythema multiforme
❑ Mucositis
❑ Lichen planus
❑ Squamous cell cancer
❑ Syphilis
❑ Coxsackievirus A
❑ Herpes zoster
❑ Primary HIV
❑ Crohn disease
❑ Behçet syndrome
❑ Acute leukemia
❑ Pemphigoid
Glossitis
❑ Vitamin B12 deficiency
❑ Folate deficiency
❑ Niacin deficiency
❑ Riboflavin deficiency
❑ Leukoplakia
❑ Candida
❑ Geographic tongue
❑ Black hairy tongue
❑ Scarlet fever
❑ Kwashiorkor
❑ Polyarteritis nodosa
Macroglossia
❑ Myxedema
❑ Angioedema
❑ Acromegaly
❑ Amyloidosis
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Stomatitis and other oral infections:
Diagnosis
(Handbook of Diseases)
Physical examination allows diagnosis. A smear of ulcer exudate allows identification of the causative organism.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Mouth lesions:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin your evaluation with a thorough history. Ask the patient when the lesions appeared and whether he has noticed any pain, odor, or drainage. Also ask about associated complaints, particularly skin lesions. Obtain a complete drug history, including drug allergies and antibiotic use, and a complete medical history. Note especially any malignancy, sexually transmitted disease, I.V. drug use, recent infection, or trauma. Ask about his dental history, including oral hygiene habits, frequency of dental examinations, and the date of his most recent dental visit.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Mouth lesions:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin your evaluation with a thorough history. Ask the patient when the lesions appeared and whether he has noticed odor or drainage or experienced pain. Also ask about associated complaints, particularly skin lesions. Obtain a complete drug history, including drug allergies and antibiotic use, and a complete medical history. Note especially malignancy, sexually transmitted disease, I.V. drug use, recent infection, or trauma. Ask about his dental history, including oral hygiene habits, the frequency of dental examinations, and the date of his most recent dental visit.
Next, perform a complete oral examination, noting lesion sites and character. Examine the patient's lips for color and texture. Inspect and palpate the buccal mucosa and tongue for color, texture, and contour; note especially painless ulcers on the sides or base of the tongue. Hold the tongue with a piece of gauze, lift it, and examine its underside and the floor of the mouth. Depress the tongue with a tongue blade, and examine the oropharynx. Inspect the teeth and gums, noting missing, broken, or discolored teeth; dental caries; excessive debris; and bleeding, inflamed, swollen, or discolored gums. Note any odor.
Palpate the neck for adenopathy, especially in patients who use tobacco or ingest alcohol excessively.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
ORAL OR LINGUAL MASS:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Most of these lesions are referred to the oral surgeon for diagnosis
and treatment, so an elaborate discussion of the workup is unnecessary in a
text of this scope. Obviously, cultures should be made in cases of suspected
infectious granulomas, whereas biopsy or excision is the main diagnostic
tool for neoplasms.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
SMOOTH TONGUE AND OTHER CHANGES:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to the diagnosis will depend largely on the clinical
picture. A smooth tongue with pallor of the nails and conjunctiva suggests
pernicious anemia or iron deficiency anemia. A swollen tongue with
cardiovascular abnormalities suggests amyloidosis. A swollen tongue and
protruding jaw suggest acromegaly, whereas a swollen tongue and nonpitting
edema prompt a diagnosis of myxedema. A dry, furry tongue suggests
dehydration.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
SWOLLEN TONGUE:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The diagnosis of macroglossia depends on the presence of other physical
findings (almost invariably present) associated with the disorders mentioned
above, and, in
most cases, the results of a systematic workup. A lingual
biopsy is valuable in primary amyloidosis.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
TONGUE PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to the diagnosis includes a CBC, sedimentation rate, serum
B12 and folic acid levels, serum ferritin, serology, tuberculin test,
and perhaps biopsy of the lesion. A trial of vitamin therapy may be
indicated.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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