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CASE REPORT
Atrophic glossitis; an indicator of iron deficiency anemia : report of three cases
Veena Raju, Anjana Arora, Shweta Saddu
ABSTRACT
Atropic glossitis of tongue is considered as one of the signs of nutritional deficiency anemias. Tongue de-papillation
can be present with or without other clinical manifestations of iron deficiency anemia leading to diagnostic dilemma.
This paper report three cases of atrophic glossitis associated with iron defieciency anemia.
Keywords: Anemia; Atrophic; Glossitis; Iron Deficiencey Anemia
Introduction margins was present over anterior 1/3 of dorsum and right lat-
eral margin of tongue (Figure 2). Filliform papillae were absent
Atrophic glossitis (AG) is an inflammatory disorder of the with inter-dispersed prominent fungiform papillae. Based on
tongue mucosa that shows a smooth, glossy appearance with these findings, a provisional diagnosis of dentinal hypersensi-
a red or pink background.1,2 Atrophy of the papillae, muco- tivity in relation to 11, 21, 22 due to erosion and atrophic glos-
2014 Volume 6 Issue 3
sa, and dorsum of the tongue are considered classical signs sitis was made. Gastric disease involvement was ruled out due
of nutritional deficiencies.3 Absence of filiform or fungiform to absence of any history of regurgitation of food or dental
papillae involving more than 50% surface area of dorsum of erosion on palatal surfaces of upper anterior teeth. Differential
tongue gives rise to a soft aspect, known as atrophic glossitis diagnosis of nutritional deficiency anemia, median rhomboid
or smooth tongue.3 Clinically, iron deficiency anemia progress- glossitis, geographic tongue were considered. Following this,
es slowly, and symptoms include fatigue, light-headedness, the patient was enquired about history of lethargy, weight
cramps in legs weakness and spoon-shaped nails. Oral signs loss or weight gain, polydypsia, polyphagia, polyuria and in-
and symptoms, including pale oral mucosa, glossitis, angular take of drugs like antibiotics to rule out other systemic causes
cheilitis, and recurrent oral ulcerations offer the dentist an op- of atrophic glossitis. Patient was advised to undergo haema-
portunity to participate in the diagnosis of this condition.4 This tological investigations including complete haemogram with
paper report three cases of atrophic glossitis associated with peripheral smear. Her haemoglobin level was found to be 6.4
iron defieciency anemia. gm%. Peripheral smear showed presence of hypochromic,
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E-ISSN :0975-8437 P-ISSN: 2231-2285
I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
tors of the atrophic glossitis is mainly didvided into local and Clinics. 2014;6(3):30-31.
systemic. Local causes includes trauma to oral mucosa due to
excessive use of tobacco spices, geographic tongue, medi-
an rhomboid glossitis, chronic atrophic candidiasis, fissured
tongue, erosive lichen planus etc. Systemic causes are defi- Address for Correspondence
ciency of Vit B12 or iron or folate leading to anemia, drugs like Dr. Anjana Arora, BDS,
ACE inhibitors, protease inhibitors, antibiotics, aspirin, immu- Post Graduate Student,
no-supressive drug, corticosteroid inhalers, post-menopausal
Department Of Oral Medicine And Radiology,
state in females, diabetes, irritable bowel disease, gastic dis-
turbances leading to hyperacidity, hypothyroidism, loss of The Oxford Dental College,
papillae secondary to epidermolysis bullosa, dyskeratosis con- Bommanahalli, Bangalore,
genita, endocrine candidosis, hyalinosis cutis et mucosae syn- Karnataka,India.
dromes, radiation induced mucositis etc. Dentist can rule out Email: dr.anjanaarora2909@gmail.com
various systemic diseases associated with atrophic glossitis by
the classical clinical signs and symptoms and refer patient to
concerned for management. In cases reported here, atrophic
glossitis was the main clinical manifestation which helped us
in suspecting iron deficiency anemia and which was support-
ed by the results of hemogram and peripheral smear. Confir-
mation of diagnosis of iron deficiency anemia is done by es-
timation of decreased serum iron and ferritin level, increased
serum iron binding capacity and transferrin level. However, for
case 2 and case 3 confirmatory tests were not performed due
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to economical reasons.
References
1. Erriu M, Canargiu F, Orr G, Garau V, Montaldo C. Idiopath- Source of Support: Nil
ic atrophic glossitis as the only clinical sign for celiac disease Conflict of Interest: None Declared
diagnosis: a case report. Journal of medical case reports.
2012;6(1):185.
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