Applicability of the Geographic Tongue Area and Severity Index among Healthcare Professionals: A Cross-Sectional Clinical Validation of a Newly Developed Geographic Tongue Scoring System

Abstract

Geographic tongue (GT) is a chronic condition of unknown aetiology, with no defined parameters to establish the protocol for evidence-based management. Validation of a newly developed and proposed clinical index to assess the severity of GT could assist in its diagnosis, especially in cases associated with systemic dermatological diseases in the form of psoriasis. Objective: To verify the applicability of the geographic tongue area and severity index (GTASI). This involved healthcare professionals from different specialties to evaluate the usefulness of the GTASI in supporting GT classification, as well as the follow-up process. Methods: One hundred cases of previously diagnosed GT were initially evaluated by three independent, experienced researchers/clinicians to obtain a standardised classification baseline. Subsequently, nine cases of GT were selected, three cases for each category—mild, moderate and severe. These stages were professionally evaluated by 51 healthcare professionals from three groups: 17 dentists (33%), 22 oral medicine specialists (43%) and 12 specialist dermatologists (24%) during a cross-sectional survey. Results: The quantitative and qualitative assessment based on experts’ opinions in the cross-sectional survey demonstrated an acceptable, similar level of GT clinical diagnosis (p > 0.05), with coherence between the various groups of professionals critically appraising the GTASI. An apparent divergence was observed for the moderate GT category, as well as in the group of less experienced evaluators. Conclusion: Whilst the validation of GTASI applicability was successfully executed, the general dental practitioners, specialists in oral medicine and dermatologists were equally capable of correct GT diagnosis and appropriately rating its severity. These coherent results were especially replicated among the experienced clinicians. The validation of the newly proposed index confirmed its reliability as a feasible instrument in oral medicine, with the prospect of its wider implementation in clinical practice.

Clinical atrophy patterns of filiform papillae of the tongue and their relationship with the serum levels of iron, vitamin B12 and folic acid in patients with systemic diseases

“…Benign migratory glossitis is an oral condition that courses with circinated whitish and atrophic plaques on the tongue of unknown etiology. Several factors have been associated with this condition, including hormonal disorders, the use of oral contraceptives, juvenile diabetes mellitus, psoriasis, allergic conditions, fissured tongue, lichen planus, Down syndrome, mental factors, lithium consumption, family history, and nutritional deficiencies, 28,49,50 although their role as potential predisposing or etiological factors has not been well dilucidated. In this study, this entity was more frequent in subjects with systemic lupus erythematosus.…”

“…We recorded separately other entities associated with FP atrophy according to their clinical features 7,26,27 . Clinical diagnosis of benign migratory glossitis was specially considered based on previously published descriptions 28,29 . The criteria used to classify benign migratory glossitis were the lingual presence of a central atrophic area surrounded by an erythematous halo circumscribed by a slightly elevated white circinate line (Figure 1h).…”

“…7,26,27 Clinical diagnosis of benign migratory glossitis was specially considered based on previously published descriptions. 28,29 The criteria used to classify benign migratory glossitis were the lingual presence of a central atrophic area surrounded by an erythematous halo circumscribed by a slightly elevated white circinate line (Figure 1h). Clinical diagnosis of oral candidiasis was also evaluated and confirmed by cytology (Figure 1i,j).…”

A tongue with a map on it

“…Benign migratory glossitis, also known as geographic tongue, 1 is a chronic inflammatory condition for which there is no specific treatment. It is characterized by epithelial atrophy of the filiform papillae 2 and frequently seen in association with psoriasis. 3 , 4 It typically begins in childhood 5 and has a prevalence of 2% in the US population.…”

Worldwide prevalence of geographic tongue in adults: A systematic review and meta‐analysis

“…Geographic tongue, also known as benign migratory glossitis, erythema migrans, and annulus migrans, is a benign disorder of the tongue characterized by multiple, well‐demarcated, erythematous, and depapillated patches surrounded by a slightly elevated yellowish‐white border, and usually restricted to the dorsum of the tongue, which regresses spontaneously, recurring and coalescing in varying proportions (Oyetola et al, 2018; Picciani et al, 2021; Shulman & Carpenter, 2006).…”