Geographic Tongue Young Patient

Hi Sandra,   I have a 2 year old, foster child that was referred for speech/language evaluation. According to the parent, the child has a geographical tongue. She reported that the dentist showed her some pictures of these types of tongues. When I completed his oral motor examination, the spots look as if he bit his tongue or the spots looks like he burned his tongue. The child has difficulty with tongue elevation and limited lateral movement. It does not appear that the tongue was restricted. However, the parent reported that she is not able to look under his tongue. She has consulted with the ECI SLP and she said her child had a geographical tongue and it was nothing to be concerned about. What are your thoughts and opinons on a “geographical tongue”. I have done some research on it.   Thank you,   Kim

Hi Kim, Regarding the child’s ability to demonstrate various movements/excursions with his tongue, a child of that age can rarely, if ever, separate the lateral or horizontal lingual movements from the mandible.  He’s typical in that regard.  Also, they usually cannot elevate the tongue to show you beneath it.  To check out the lingual frenum you will have to put your gloved hand/index finger into his mouth and under the tongue to feel the size, length, and texture of the l. frenum.     From all that is written about geographical tongue, there doesn’t seem to be any information suggesting that it is an abnormality to be concerned with.  At least to this point in time, most professionals don’t seem to be concerned about it.  There is some suspicion that there could be a connection to psoriasis, but it is as yet unproven.  I think keeping the “indentations” as clean as possible is probably the best option.  If certain foods cause burning sensation, they should of course be eliminated.   If you haven’t read the article in Dent Clin N Am 49 (2005) 1–14 on “Variations of structure and appearance of the oral mucosa” by Thomas J. Canaan, DDSa, Sean C. Meehan, DMDb, I think you will find it interesting and informative.  We have a short write up about it in our Orofacial Myology News  (October Edition). Thank you for your excellent question and I hope I have helped to ease your mind about your concerns for your young patient, Kim.