| Median rhomboid glossitis | Smooth, shiny, erythematous, sharply circumscribed, rhomboid shaped plaque; usually asymptomatic, but burning or itching possible; dorsal midline location | Topical antifungals | Often associated with candidal infection |
| Atrophic glossitis | Smooth, glossy appearance with red or pink background | Treat nutritional deficiency or other underlying condition | Caused by underlying disease, medication use, or nutritional deficiencies (e.g., iron, folic acid, vitamin B12, riboflavin, niacin) |
| Fissured tongue | Deep grooves, malodor and discoloration may occur with inflammation or trapping of food | Usually no treatment; gentle brushing of tongue if symptomatic inflammation occurs | Associated with Down syndrome, psoriasis, Sjögren syndrome, Melkersson-Rosenthal syndrome, geographic tongue |
| Geographic tongue | Bare patches on dorsal tongue surrounded by serpiginous, raised, slightly discolored border | No treatment necessary, but topical steroid gels or antihistamine rinses can reduce tongue sensitivity | Associated with fissured tongue, inversely associated with tobacco use |
| Hairy tongue | Hypertrophy of filiform papillae, tongue discoloration (white, tan, black) | No treatment necessary, but gentle brushing or scraping of tongue may be helpful | Associated with tobacco use, poor oral hygiene, antibiotic use |
| Oral hairy leukoplakia | White, hairy appearing lesions on lateral border of tongue | Antiviral medications | Epstein-Barr virus super infection; associated with immunocompromise, human immunodeficiency virus infection |
| Lichen planus | Manifests as reticular, white, lacy pattern on dorsal tongue or as shallow, scattered, erythematous ulcerations | No treatment if asymptomatic, topical steroid for symptomatic ulcerative lesions | Consider evaluation and treatment for coexisting candidal infection; biopsy needed for definitive diagnosis of lichen planus |
| Linea alba | Thin white line of thickened epithelium on lateral borders of tongue | No treatment necessary | Caused by chewing trauma to lateral tongue |
| Leukoplakia | White adherent patch or plaque | Close observation, biopsy to rule out malignancy | Strongly associated with tobacco use, but higher malignant potential when occurring in never smokers |
| Squamous cell carcinoma | Thickened white or red patch or plaque, may develop nodularity or ulceration, usually on lateral tongue | Surgical excision, radiation | Associated with tobacco use, alcohol use, older age |
| Papilloma | Single, isolated pedunculated lesion with finger-like projections | Surgical excision or laser ablation | Associated with human papillomavirus type 6 or 11 infection |
| Burning tongue | Daily pain that worsens throughout the day, tongue has normal appearance | Alpha-lipoic acid, clonazepam (Klonopin), cognitive behavior therapy; treatment of any underlying condition | Underlying systemic or local disorders (e.g., nutritional deficiency, endocrine, hyposalivation, infection, allergic reaction) should be excluded |
| Tongue-tie (ankyloglossia) | Shortened frenulum limiting tongue protrusion, breastfeeding difficulties | Surgical division in infants having difficulty breastfeeding | Associated with poor breastfeeding, including nipple pain |
| Macroglossia | Enlarged tongue with scalloping of lateral margin | Treat underlying condition | Associated with various underlying conditions |