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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5989
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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I have a red painful spot on my tongue. What can it be?

Resolved Question:

I have a large red spot on my tongue that is painful, but not raised up. It is actually lower than the rest of my tongue. Absence of white band around the area. Daily meds include Celexa, Amitriptryptaline, Lithium, Multi Vitamin. Just finished a 7-day course of provera for lack of menstrual period. 30-years-old, non-smoker. Last oral cancer screen in Dec. 2009 was negative. History of migraines, sinus infections, lumbar fusion, fibromyalgia.

Submitted: 5 years ago.
Category: Dental
Expert:  Mark Bornfeld, DDS replied 5 years ago.

Welcome to JustAnswer, and thank you for putting your trust in me!

Would it be possible for you to provide a photograph of the affected area? Use the "tree" icon on the text entry form toolbar to upload your graphics file. An alternative would be to upload you photo to an online photo hosting site, such as Flickr or Photobucket.

This will allow me to provide a more accurate and relevant response.

Customer: replied 5 years ago.

The only area affected is on the left side in the photo - right side in actual - It is just as bad this morning as it was last night. My dentist can't see me until the end of Feb, so I'm trying to determine if this is more urgent and needs immediate attention.

Expert:  replied 5 years ago.
Although appearance alone is sometimes insufficient to conclusively identify these types of oral lesions, your photo is strongly suggestive of a condition known technically as "benign migratory glossitis", and in the vernacular as "geographic tongue". It manifests as areas where the many white papillae that stud the upper surface of the tongue become atrophic. Although this does not qualify as an ulcer (the surface layers of mucous membrane are actually intact), it gives the appearance of an ulcer, because the "bald" spot on the tongue looks redder and more depressed than the surrounding areas that are still covered by the papillae.

As the name indicates, it is considered a benign condition. The "migratory" part of the name implies that the affected areas sometimes move around and change shape. It's called "geographic tongue" because the sharply-demarcated areas give the tongue an appearance that resembles a map.

The cause of benign migratory glossitis is unknown, but some clinicians believe that oral yeast (candida albicans) is implicated. For this reason, some dentists will prescribe anti-fungal medications, such as nystatin or fluconazole, but this would normally be reserved for cases where there is bothersome soreness, which is not always the case.

What may be complicating your situation is your regimen of medications, which may cause significant drying of the mouth (the Celexa and amitriptyline are especially problematic here). Even if your dentist chooses to do nothing, you may benefit from using any of the dry-mouth products-- toothpastes and mouthwashes-- specially marketed for sore mouth. Most pharmacies carry these products under the Biotene and Oasis brands.

This condition is not serious, and usually does not merit a special dental appointment unless you find it particularly bothersome. You can read more about it on the Mayo Clinic web site.

Hope this helps...
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