Fissured tongue in geriatric female patient with diabetes mellitus and schizophrenia: a case report and review of literature
DISCUSSION
Fissured tongue (Lingua Plicata) is as an asymptomatic condition characterized by grooves and fissures of varying depth covering the dorsal surface of the tongue.
Prevalence rate ranges from10-40% across globally.
Though the exact etiology of fissured tongue has not been identified, a polygenic mode of inheritance is proposed, as the condition is seen clustering in families (1).
The condition is usually asymptomatic. Some patients may complain of mild pain.
In some cases, the condition is worsened by entrapment of food particles within the fissures and in patients with poor oral hygiene and nutrition (2).
It can be classified as median and lateral types based on the position of the fissures. Sudarshan R et al., have proposed a novel method of classification based on the pattern of tongue fissures, number of fissures and associated symptoms such as burning sensation and feeling of food lodgement.
In their study, they found that central longitudinal type as the most common type of tongue fissuring which has been discussed in this report (5).
In some cases, tongue fissuring may be associated with other systemic conditions.
Most common conditions are diabetes and hypertension.
Others include asthma, gastritis, trigeminal neuralgia, epilepsy, candidiasis, carcinoma, and Down’s syndrome (4).
Diabetes is a debilitating metabolic disorder with high rate of prevalence worldwide. A study conducted by Balasubramanian S et al., using Panoramic tongue imaging and deep convolutional machine learning model, revealed about 38.80% people had shown fissures on the dorsal surface of the tongue along with coatings (9).
Several studies demonstrated the relationship between diabetes and fissured tongue and the risk factors include inadequate blood glucose control, immunological changes, microcirculatory alternation with decrease of blood flow, xerostomia and alteration in salivary flow and composition (7).
Schizophrenia is a devastating and complex disorder, which impacts normal brain functions, creating mental disarray. While exact origins for this disease remain obscure, it is thought to result from disturbances in brain cell communications due to improper levels of specific neurotransmitters. Trixler et al., found some specific anomalies of the mouth and head, such as fissured tongue, flat occiput along with primitive ears in these patients and hypothesized that they have more relevance to the neurodevelopmental failure (8). In their study Babović SS et al., proposed that higher prevalence of vertical fissure running along the midline and few fissures diffusely distributed cross the dorsal tongue surface in schizophrenic patients, like that of our study case (9).
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