Tongue manifestations of anemia

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Tongue Manifestations of Anemia: Key Clinical Signs

Pallor of the Tongue and Oral Mucosa in Anemia

Pallor of the tongue and oral mucosa is one of the most common and early signs of anemia, especially iron deficiency anemia (IDA) and hemolytic anemia. Studies consistently report a high prevalence of mucosal and tongue pallor among anemic patients, with rates as high as 74–97% in different populations 346789. This pallor results from reduced hemoglobin levels, leading to decreased blood flow and oxygenation in the oral tissues.

Glossitis and Atrophic Glossitis in Anemia

Glossitis, characterized by inflammation, redness, and swelling of the tongue, is a frequent manifestation in various types of anemia, particularly IDA. Atrophic glossitis, where the tongue appears smooth and shiny due to loss of papillae, is also commonly observed. Prevalence rates for glossitis and atrophic glossitis range from 11% to 36% in anemic patients 35678910. Patients may report a burning sensation, pain, or discomfort, especially when eating spicy or hot foods 5910.

Fissured Tongue and Geographic Tongue

Fissured tongue, marked by grooves or cracks on the tongue surface, is less common but still reported in some cases of anemia, with prevalence rates around 6–24% 1367. Geographic tongue, characterized by irregular, map-like patches on the tongue, is rare but has been documented in both IDA and thalassemia patients 37.

Burning Sensation and Glossodynia

A burning sensation of the tongue (burning mouth syndrome) and glossodynia (painful tongue) are notable symptoms in anemic individuals. These symptoms are reported in 2–10% of patients and are often associated with glossitis or atrophic changes 23567910.

Candidiasis and Other Lesions

Candidiasis, a fungal infection presenting as white patches or soreness on the tongue, is frequently seen in anemic patients, particularly those with compromised immunity such as HIV/AIDS. Other less common tongue and oral lesions include angular cheilitis (cracking at the mouth corners), recurrent aphthous ulcers, and oral pigmentation 23678910.

Clinical Relevance and Early Detection

Tongue and oral manifestations can be among the first signs of anemia, sometimes appearing before systemic symptoms. Dentists and healthcare providers should be vigilant for these changes, as early recognition can prompt further investigation and timely management of underlying hematological disorders 1489.

Conclusion

Anemia, especially iron deficiency anemia, often presents with distinct tongue manifestations such as pallor, glossitis, atrophic glossitis, fissured tongue, burning sensations, and, less commonly, candidiasis and geographic tongue. These oral signs are valuable clinical indicators and can aid in the early detection and management of anemia.

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Most relevant research papers on this topic

Importance of Tongue Manifestations in Iron Deficiency Anemia - A Case Report

Tongue manifestations, such as fissured tongue and glossitis, can help diagnose iron deficiency anemia, a common cause of anemia in developing countries like India.

Case Report

2024·

0citations

·P. Balamanikandan et al.

Oral manifestations of anemia in HIV/AIDS patients without ARV treatment

Oral manifestations of anemia in non-ARV HIV/AIDS patients include candidiasis, glossodynia, glossitis, and angular cheilitis.

Observational Study

2017·

1citation

·W. Hidayat et al.

Prevalence of Oral Manifestations of Iron Deficiency Anemia in a Sample of Egyptian Population, Hospital-Based Cross-Sectional Study

Iron deficiency anemia patients have a high prevalence of oral manifestations, with recurrent aphthous ulcers being significantly associated with anemia duration.

Observational Study

2019·

7citations

·Eman Alsheikh et al.

Oral manifestations of hemolytic anemia: A case report

Dentists often recognize oral conditions as early signs of systemic conditions, and proper diagnosis and treatment planning require a complete examination.

Case Report

2016·

0citations

·I. Yusuf et al.

Laporan Kasus: Glossitis pada Penderita Anemia Defisiensi Besi

Glossitis is an oral manifestation of iron deficiency anemia, and consuming iron-rich foods can help reduce the inflammation and pain in the tongue area.

Case Report

2022·

1citation

·Agus Surachman et al.

Oral and perioral manifestations of iron deficiency anemia in Hiwa Hospital in Sulaimani city

Oral and perioral manifestations of iron deficiency anemia are more common in patients than in control groups, with no significant difference in frequency between anemia degrees except for pallor of lip and oral mucosa.

2025·

0citations

·Kamal Amin et al.

Prevalence of Oral Manifestation of Thalassemic Patients in Sulaymaniyah Thalassemia Center

Thalassemia patients have a higher frequency of oral manifestations, which can negatively affect their oral health, highlighting the need for dentists to understand and manage these complications.

2023·

1citation

·Dastan Rahim Abdulkarim et al.

Oral Manifestations of Haematological Disorders (RBC Disorders)

Oral manifestations of haematological disorders, particularly anaemias, can often serve as the initial sign of an underlying disease and should be recognized for early detection.

Literature Review

2020·

0citations

·Shoborose Tantray et al.

Manifestações orofaciais associadas aos diferentes tipos de anemias

Oral manifestations of anemias, such as iron deficiency, megaloblastic, fanconis, sickle cell, thalassemia, and aplastic anemia, can be the first signs of anemia, requiring early diagnosis and proper dental treatment management.

Systematic Review

2020·

0citations

·Alessandra Laís Pinho Valente Pires et al.

Effect of anemia on oral cavity and hematological assessments

Anemia leads to decreased white blood cell counts and various oral manifestations, such as atrophic glossitis, burning mouth syndrome, angular cheilitis, and recurrent aphthous stomatitis.

2024·

0citations

·Hayder Mahdi Idan et al.

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