Median Rhomboid Glossitis: Causes, Symptoms, and Treatments

Imagine spotting an abnormally smooth, red, flat area in the middle of your tongue when you look in the mirror one day. It is most likely a condition called median rhomboid glossitis (MRG). While the name sounds complex, it is an oral problem that occurs to many. Though it often does not feature pain or discomfort, this condition can indicate underlying health conditions.

Read on to learn what MRG is, the potential causes, risk factors, and symptoms to watch out for. Understand when to see a dentist, the treatment options available, and the various measures to prevent this condition.

Median rhomboid glossitis (MRG) is a benign condition that occurs as a smooth, red, rhomboid-shaped patch on the tongue. It usually appears at the midline on the top part (dorsum of the tongue) and rarely off-centre. The prevalence is more significant in males than females and often goes unidentified until middle age. Though MRG is generally asymptomatic, mild discomforts are likely.

Papillae are the tiny bumps responsible for the tongue’s texture and overall function. The filiform papillae, covering two-thirds of the tongue’s front, do not have taste buds. They are responsible for texture and sensation of touch. The large, circumvallate papillae at the back of the tongue contain taste buds and help detect flavours. MRG typically appears in front of the circumvallate papillae. The smooth patch indicates missing filiform papillae.

As the exact reason is largely unknown, research on median rhomboid glossitis causes is ongoing. Traditionally, MRG is seen as a developmental anomaly of the tongue. However, today, the medical community is studying the connection of MRG with various health conditions. MRG is often associated with chronic fungal infections (oral candidiasis) caused by candida albicans.

Healthy individuals have a low count of fungi in the oral cavity and the digestive system. A fungal infection occurs when these fungi multiply. Here are some other risk factors and possible causes of glossitis to look for:

• Diabetes mellitus and immunocompromising diseases

• Allergies to foods, oral care products, or medicines

• Dry mouth

• Bacterial, yeast or viral infections

• Nutritional deficiencies and hormonal factors

• Trauma or injuries from rough teeth, burns or poorly-fitting dentures

• Skin problems affecting the mouth

• Irritation from smoking, alcohol, tobacco use, or other irritants

Median rhomboid glossitis often does not show any symptoms. It is mostly painless and gets detected by a dental professional during a routine oral checkup. For most individuals, the condition goes undetected until their middle ages. For some people, MRG can cause discomfort, like itching and burning sensations. Some glossitis symptoms can appear quickly or over time. They include:

• Smooth, red patch: The primary symptom is a smooth, red or dark pink, rhomboid-shaped patch in the middle of the dorsal surface of the tongue. It is usually flat or slightly raised, irregular, and nodular.

• Depapillation: The affected portion lacks the normal papillae. Hence, it shows up as an abnormally smooth, flat area on the tongue. It can cause difficulty while chewing, swallowing, and speaking.

• Mild discomfort: Mild irritation or a burning tongue sensation when eating spicy or hot foods is likely. 

• Soreness: In some individuals, MRG can result in a sore tongue, tenderness, or swelling in the affected area. 

Most occurrences of MRG are painless. In some individuals, MRG may cause inflammation of the palatal mucosa that comes in contact with the affected area. This condition is known as a “kissing lesion” and can result in soreness or irritation in the palate.

Median rhomboid glossitis can be treated. The treatment is usually necessary when it is associated with infections or creates discomfort. They are intended to reduce the soreness and swelling by treating the infection. If MRG has resulted from other health conditions, addressing them is essential. The various median rhomboid glossitis treatment options include:

• Antifungal therapy: Oral medicines may be suggested to treat candidal infections. They aim to reduce the fungal growth and clear the tongue lesion.

• Topical medicines: They help relieve pain or soreness in case of discomfort.

• Biopsy and monitoring: For lesions that do not respond to treatment, biopsy helps rule out other conditions. Regular monitoring and follow-up help detect any changes early.

• Treating underlying conditions: This is vital to help manage MRG. This calls for treating diabetes and other systemic disorders.

• Nutrition: An optimal supply of nutrients helps avoid deficiencies that can cause MRG.

Preventive steps aim to minimise the risk factors and avoid the potential causes. Managing health issues linked to MRG is vital. Dentistry recommends ensuring good oral hygiene to avoid oral infections from bacteria and fungi. You may consider the following tips to prevent median rhomboid glossitis:

• Brush twice, floss once, and clean your tongue every day.

• A fluoride toothpaste with antibacterial properties can help prevent infections.

• If you are wearing dentures, keep them clean. Avoid wearing them overnight.

• Limit the use of alcohol and highly spicy foods that can irritate the tongue.

• Quit smoking and tobacco use. It prevents MRG and various other oral problems.

• Monitor and manage underlying health issues.

• Ensure regular dental checkups to detect and treat oral problems early on.

Consult a dental professional if the red, smooth patch in the middle of your tongue persists. Do not delay the visit, especially if you experience pain or discomfort. Seek evaluation if you have difficulty chewing, speaking, or swallowing. If the symptoms do not respond to the basic treatment, visit your dentist immediately.

Median rhomboid glossitis (MRG) is a typically benign, red, smooth patch on the tongue. It usually shows no symptoms and is often detected during dental checkups. Most MRG occurrences are linked to fungal infections. Other risk factors include underlying health conditions and habits like smoking. Various treatment options are available to ease discomfort. Good oral hygiene and managing health concerns help to prevent the condition. 

1. What is the difference between geographic tongue and median rhomboid glossitis?

Both are benign tongue conditions and differ in their appearances and causes. Median rhomboid glossitis appears as a smooth, red, rhomboid-shaped patch on top of the tongue. It is often linked to fungal infections or other health conditions. Geographic tongue appears as irregular, map-shaped red patches with white borders. It is usually caused by irritation from spicy foods and alcohol.

2. What is the main cause of median rhomboid glossitis?

Fungal infection is the common cause of median rhomboid glossitis. It is also linked to factors that promote fungi. These include smoking, diabetes, deficiencies, and poor immunity. Irritation from spicy foods and injuries are other causes.

3. What virus causes glossitis?

Glossitis is often related to factors like fungal infections or irritants. It can sometimes be caused by viruses, like the herpes simplex virus (HSV). HSV can cause swelling and sores on the tongue. Other viruses include human papillomavirus (HPV).

4. Can a dentist treat glossitis?

Yes, a dentist can treat glossitis. They can identify the cause, like infection or irritation. Oral or topical medicines may be provided to treat fungal infections. To manage underlying health problems, you may consult a healthcare provider.