Prevalence of Geographic and Fissured Tongue Abnormalities and Factors Associated Among Dental Students of Tabriz Faculty of Dentistry

Document Type : Original article


1 Department of Oral Medicine, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Oral Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran

3 Department of Oral Medicine, Faculty of Dentistry, Tehran University of Medical Sciences, International Campus, Tehran, Iran

4 Dentist, Tehran, Iran

5 Department of Oral and Maxillofacial Disease, Dental Research Center, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran


Background: Geographic Tongue (GT) and Fissured Tongue (FT) are the most common abnormalities of the tongue that etiopathogenesis of them remains to be clarified. This study aims to evaluate the prevalence and the possible factors associated with GT/FT among students of Tabriz Dental School.
Methods: This descriptive-analytic study aims to identify the demographic information and clinical features of the GT/ FT among 132 students that were selected by census method. Data were collected by means of a two-part questionnaire. The collected data were analyzed using SPSS software and chi-square test.
Results: Geographic tongue was found in 10 (7.58%) students (8 females and 2 males). There were no significant differences between gender and the incidence of this condition (p=0.65). Fissured tongue was present in 20 (15.15%) students (9 females and 11 males). No differences between the lesion and the gender distribution was observed (p=0.132). There was a significant correlation between not brushing teeth and fissured tongue (p=0.034).
Conclusion: The results revealed that the oral hygiene may reduce the incidence of FT. The occurrence of GT/FT showed no association with any other systemic conditions and habits.



Tongue is a vital organ in the mouth with important roles in different functions including mastication, speaking, breathing and swallowing. Lesions of tongue are significant part of the oral mucosal lesions 1.

The Geographic Tongue (GT) was first described by Rayer in 1831. Several names for this problem have been mentioned such as immigrant GT, and Benign Migratory Glossitis (BMG) 2. GT is characterized by an erythematous area with atrophy of the filiform papillae of the tongue which give it an irregular texture on the surface with unclear borders that sometimes causes discomfort and burning sensation. The exact etiopathogenesis is still unknown, but the condition is entirely benign. The predisposing factors of this lesion are suggested to be inheritance, allergies, medication, environmental agents, stress and consumption of spicy foods. Also, accompanied by a GT with diseases such as burner syndrome, diabetes and HIV infection is also considered 3. The mean age of patients with GT is reported to be around 30 years by several studies. Nevertheless, GT is not uncommon in children and a study on a primary school in city of Rasht, Iran reported a prevalence of 4.3 and 7.6% for GT and FT, respectively 4. Diagnosis of these lesions is based on oral examination and no treatment is required for asymptomatic lesions 3.

Fissured Tongue (FT) or scrotal tongue is a common variation of a normal tongue which characterized by cracks, grooves, or clefts with varying depth on the dorsal surface of the tongue. Diagnosis is made on the basis of personal history and oral examination 5. FT as a second complication is suggested to be associated with factors such as inheritance, malnutrition, infections such as candidiasis and diabetes, as well as developmental disorders such as Down syndrome and Melkersson Rosenthal syndrome. FT is a benign disorder and no specific intervention is indicated 5.

Several studies believe that FT and GT are related to each other but have different entities of the same inflammatory disease of the tongue 6-8. The prevalence of these abnormalities varies greatly in the literature, so far, many epidemiological studies have been carried out to determine the occurrence of tongue lesions and their association with possible etiologic factors 5,9-11. While FT is the most common tongue disorder in the Swiss population, the GT is the commonest lesion of tongue in Swedish population 12.

The aim of this study was to determine the prevalence of these two lesions among a group of dental students, along with the role of some of the possible factors in the development of lesions. We also recorded the details on age, gender, medical history, history of particular habits such as smoking, usage of smokeless tobacco and alcohol.

Patients and Methods

This descriptive-analytic study was conducted based on observation and interview techniques to obtain information from 132 healthy dental students aged 22-24 years old with no systemic diseases that were selected by census method. Data were collected by a two-part questionnaire; part one included demographic information and part two was for recording the details on seasonal sensitivity, spicy foods consumption, medical history, smoking, allergy to drugs and foods, and brushing of the tongue.

In this study, history taking and examination of the mouth and tongue of all samples were done by a senior dentistry student under the guidance of the specialists in Oral Medicine. All students were examined in the Department of Oral Medicine while they were seated on the dental unit under illumination with dental chair light. Tongues were examined using a mouth mirror, probe, and gauze based on guidelines provided by WHO in 1980 10.

We used written forms to record all required data obtained from examinations. SPSS software (ver, 16) was applied for statistical analysis via chi-square test at significance level of 0.05.


Of the total 132 students, 63 (47.72%) were male and 69 (52.27%) were female (Table 1) and their ages ranged from 22 to 24 years with a mean age of 23.2 years. Ten students (7.58%) had GT including 8 females and 2 males. There was no significant relationship between gender and this condition (p=0.65). Of twenty students (15.15%) with FT, 9 were female and 11 were male. There was also no significant relationship between the incidence of the lesion and the gender (p=0.132).

Table 1. Student distribution according to gender and oral lesions


Fissured tongue


Geographic tongue
























Seasonal susceptibility was recorded for 3 cases with FGT (11.5%) and 5 students (19.2%) with FT. There was no meaningful relationship between this variable and none of the conditions (p=0.310) for GT and p=0.352 for FT. Using spicy foods was not significantly associated with the occurrence of GT or FT (p=0.92) and (p=0.270) for GT and FT, respectively.

None of the people with the GT reported a history of cigarette smoking (p=0.92), while it was reported only in 3 people with FT. Therefore there was statistically no significant correlation between smoking and these two lesions (p= 0.376).

Some students with a history of GT had history of allergy to a drug or certain foods (p=0.089). Also, 2 students with FT had a background of allergy (p=0.287). According to the Fisher test, there was no significant relationship between the sensitivity of the drug and the particular diet with these two complications.

Among students with a GT, only four of them used to brush their tongues. According to the Fisher test, no significant correlation was found between non tongue-brushing and the occurrence of GT (p=0.484). But in people with FT, 3 people used to brush their tongues, and 17 of them did not. Interestingly, there was a significant correlation between not brushing and the prevalence of FT (p=0.034).


It is believed that the lesions of tongue can be a sign of the presence of systemic diseases such as diabetes, hematological disorders and some digestive disorders. However other factors and environmental stimuli such as smoking, general health status and medication etc. can also contribute to the occurrence of tongue lesions 13.

In this investigation, we found no meaningful relationship between the GT and the gender of study subjects (8 females and 2 males). This has also been confirmed by other the studies carried out by Mikkonen 14 Meskin 15 and Redman 16, however studies by dos Santos 17 and Sanei 18, reported that this phenomenon was more common in women than in men 19. Discrepancies in the results from different studies can be attributed to the factors like the role of hormone interference and menstrual cycle. However FT was reported to be more prevalent among men than in women; our study showed 9 females and 11 males had the condition that was in accordance with the findings of Aboyans and Ghaemmaghami 20. Darwezeh and Almelaih 21 and Patil 22 observed that it was slightly more frequent in males, whereas others found a strikingly increased frequency in females as Darwazeh and Almelaih reported 21. Our results were somehow similar to that from studies conducted by of Rabiei 4 and Bhatnagar 23. Avcu 24 reported that men were three times more susceptible than women.

The FT in this study has the highest frequency (15.15%). Many previous studies, such as the Byahatti from Libya 25 reported a figure up to 4.48% and some others like Al-Mobeeriek 26, declared a rate of 1.4%. In the present study, we showed that the frequency of the GT was 7.58% amount study subjects that was consistent with that of Maleki’s 27 report and with the studies conducted by Sanei 18 and Delavarian 28. Though, it is possible to consider and compare it with the cases studied by Yarom 29 and Marks 30. Perhaps the reasons for the different results arise from the methods, type of population and the number of cases used in each study.

There are some studies from Iran using certain age groups that found similar results to ours 4,31. Some other Iranian studies have shown similar male dominance 21,32-34, while some did not 19,35,36. We suggest that differences in sampling method, the study population and factors such as age, ethnicity, and diet can justify the difference between statistical results.

We did not find any association between FT and smoking. The result of our study is in accordance to other studies by Maloth 37 and Koay 33 where they found 81.5% of patients with FT were non-smokers. In researches by Maleki and Sanei 18,27, smoking had a significant relationship with the incidence of FT, however their populations were much larger than ours. 

Our results show a significant relationship between non tongue-brushing and FT (p<0.05). We, however, believe that brushing habits cannot be a reason for the FT and it needs more investigation. Seasonal sensitivity, spicy food and special drug also did not show a significant relationship with the GT/FT in our study, which was similar to that in Shulman’s study 38. However, other studies by Voros-Balog 19 and Marks 30 confirmed such a relationship.

It is often difficult to detect the association between the occurrence of a GT and seasonal allergies as it is not possible to accurately determine the time interval between the consumption of the food and the generation or exacerbation of the condition. So we suggested that larger studies on families with asthma, eczema, serum IgE levels, and similar immunological conditions are required to be done.

None of the cases with the GT reported a history of smoking, which did not reveal a meaningful relationship between these two variables. Shulman and coworkers showed that the prevalence of the GT was low among smokers, while there was a statistically significant relationship with non-smokers 38.

Of the total number of people with a GT, six did not have the habit of brushing their tongues, so according to the Fisher test, no significant correlation was found between non tongue-brushing and the incidence of GT (p=0.484).


The results of this study indicate that the prevalence of GT and FT lesions in our study subjects from a small population of dental students at Tabriz Dentistry Faculty is not much different from other similar studies from Iran. Although from the literature we found that there are different results from non-Iranian epidemiological studies that might be attributable to factors such as sample size, geographical area, special diet and habits, etc.


1. Kayalioglu M, Shcherbatyy V, Seifi A, Liu Z. Roles of intrinsic and extrinsic tongue muscles in feeding. Arch Oral Biol 2007;52(8):786-796.
2. Prinz H. Wandering rash of the tongue (geographic tongue). Dent Cosmos 1927;69:272-275.
3. Picciani BL, Domingos TA, Teixeira-Souza T, Santos Vde C, Gonzaga HF, Cardoso-Oliveira J, et al. Geographic tongue and psoriasis: clinical, histopathological, immunohistochemical and genetic correlation - a literature review. An Bras Dermatol 2016 Jul-Aug;91(4):410-421.
4. Rabiei M, Mohtashamamiri Z, Amigh S, Ghotbirad SF, Ahsani Tehrani S. Prevalence of geographic tongue, fissure tongue and partial ankyloglossia among students of three stages of school in Rasht in 2003. J Islamic Dent Assoc Iran 2006;18(1):30-36.
5. Al-Maweri SA, Tarakji B, Al-Sufyani GA, Al-Shamiri HM, Gazal G. Lip and oral lesions in children with Down syndrome. A controlled study. J Clin Exp Dent 2015 Apr 1;7(2):e284-8.
6. Musaad AY, Abuaffan AH, Khier E. Prevalence of fissured and geographic tongue abnormalities among university students in Khartoum State, Sudan. Enz Eng 2015;5:137.
7. Goswami M, Verma A, Verma M. Benign migratory glossitis with fissured tongue. J Indian Soc Pedod Prev Dent 2012 Apr-Jun;30(2):173-175.
8. Kumar D, Das A, Gharami RC. Benign migratory glossitis. Indian Pediatr 2013 Dec;50(12):1178.
9. Mathew AL, Cherian SA, Daniel MP, Abraham T, Mathew R. Prevalence of fissured tongue in a South Indian population - A cross-sectional study. J Oral Med 2017;1(1):9.
10. Feil ND, Filippi A. Frequency of fissured tongue (lingua plicata) as a function of age. Swiss Dent J 2016;126(10):886-897.
11. Rezaei F, Safarzadeh M, Mozafari H, Tavakoli P. Prevalence of geographic tongue and related predisposing factors in 7-18 year-old students in Kermanshah, Iran 2014. Glob J Health Sci 2015 Feb 24;7(5):91-95.
12. Sudarshan R, Sree Vijayabala G, Samata Y, Ravikiran A. Newer classification system for fissured tongue: an epidemiological approach. J Tropical Medicine 2015;5 pages.
13. Mistretta CM, Kumari A. Tongue and taste organ biology and function. Annu Rev Physiol 2017 Feb 10;79:335-356.
14.Kullaa-Mikkonen A. A familial study of fissured tongue. Scand J Dent Res 1988;96(4):366-375.
15. 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.
16. Redman RS, Shapiro BL, Gorlin RJ. Hereditary component in the etiology of benign migratory glossitis. Am J Hum Genet 1972;24(2):124-133.
17. dos Santos PJ, Bessa CF, de Aguiar MC, do Carmo MA. Cross-sectional study of oral mucosal conditions among a central Amazonian Indian community, Brazil. J Oral Pathol Med 2004;33(1):7-12.
18. Sanei AS. Epidemiologic study of geographic tongue in population of Tehran. Beheshti Univ Dent J,2000;16(2):210-215.
19. Voros-Balog T, Vincze N, Banoczy J. Prevalence of tongue lesions in Hungrian children. Oral Dis 2003;9(2):84-87.
20. Aboyans V, Ghaemmaghami A. The incidence of fissured tongue among 4,009 Iranian dental outpatients. Oral Surg Oral Med Oral Pathol 1973;36(1):34-38.
21. Darwazeh AM, Almelaih AA. Tongue lesions in a Jordanian population. Prevalence, symptoms, subject’s knowledge and treatment provided. Med Oral Patol Oral Cir Buccal 2011;16(6):e745-749.
22.Patil S, Kaswan S, Rahman F, Doni B. Prevalence of tongue lesions in the Indian population. J Clin Exp Dent 2013;5(3):e128-132.
23.Bhatnagar P, RaiSh, Bhatnagar G, Kaur M, Goel S, Prabhat M. Prevalence study of oral mucosal lesions, mucosal variants, and treatment required for patients reporting to a dental school in North India: In accordance with WHO guidelines. J Family Commu Med 2013;20(1):41-48.
24. Avcu N, Kanli A. The prevalence of tongue lesions in 5150 Turkish dental outpatients. Oral Dis 2003;2509(4):188-195.
25. Byahatti SM, Ingafou MS. The prevalence of tongue lesions in Libyan adult patients. J Clin Exp Dent 2010;2(4):e163-168.
26.Al-Mobeeriek A, AlDosari AM. Prevalence of oral lesions among Saudi dental patients. Ann Saudi Med 2009;29(5):365-368.
27. Maleki Z, Sanei A, Darvishi Tafvizi M, Naseri F, An epidemiological study of fissured tongue in the population of Tehran Province in 1995. J Dental School Shahid Beheshti Univ Med Sci 2004;2(4):578-583.
28. Delavarian Z, Zavar SV. Prevalence of oral lesions and awareness of their presence in patients attending to oral medicine center of Mashhad dental school. J Dental School Shahid Beheshti Univ Med Sci 2004;22(3):425-436.
29. Yarom N, Cantony U, Gorsky M. Prevalence of fissured tongue, geographic tongue and median rhomboid glossitis among Israeli adults of different ethnic origins. Dermatology 2004;209:88-94.
30. Marks R, Simons MJ. Geographic tongue-a manifestation of atopy. Br J Dermatol 1979;101(2):159-162.
31. Mojarrad F, Bakianian Vaziri P. Prevalence of tongue anomalies in Hamadan, Iran. Iranian J Public Health 2008;37(2):101-105.
32.Motallebnejad M, Babaee N, Sakhdari S, Tavasoli M. An epidemiological study of tongue lesions in 1901 Iranian dental outpatients. J Contemp Dent Pract 2008 Nov 1;9(7):73-80.
33. Koay CL, Lim JA, Siar CH. The prevalence of tongue lesions in Malaysian dental outpatients from the Klang Valley area. Oral Dis 2011 Mar;17(2):210-216.
34. Sedano HO, Freyre CI, Garza ML, Gomar Franco CM, Hernandez CG. Hernandez Montoya ME, et al. Clinical orodental abnormalities in Mexican children. Oral Surg Oral Med Oral 1989;68(3):300-311.
35. HalperinV, Kolas S, Jefferis KR, Huddleston SO, Robinson HB. The occurrence 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(9):1072-1077.
36. Milo─člu O, Göregen M, Akgül HM, Acemo─člu H. The prevalence and risk factors associated with benign migratory glossitis lesions in 7619 Turkish dental outpatients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107(2):e29-33.
37. Maloth S, Padmashree S, Shilpa PS, Sultana N. The prevalence of fissured tongue in 2050 Indian patients: A cross sectional study. Int J Dental Res Dev (IJDRD) 2005;5(4):5-14.
38. Shulman JD, Carpenter WM. Prevalence and risk factors associated with geographic tongue among US adults. Oral Dis 2006 Jul;12(4):381-386.