Approach
Fissured tongue, hairy tongue, and geographic tongue are all benign clinical conditions and, hence, reassurance is often all that is required.
Geographic tongue
No treatment is generally required. If the symptoms are significant, barrier agents such as topical hyaluronic acid-based preparations (e.g., Gelclair®), or over-the-counter topical analgesic/anti-inflammatory agents (e.g., benzydamine), may be helpful in providing short-term symptomatic relief. Some clinicians prescribe topical corticosteroid preparations or topical calcineurin inhibitors (e.g., tacrolimus) in an attempt to treat symptomatic geographic tongue; however, their efficacy is not supported by high quality evidence.[26]
Fissured tongue
No medication or definitive treatment is required. Patients can be reassured that this is a benign clinical condition. If the debris that becomes lodged in the fissures and grooves acts as an irritant then patients may be advised to brush the dorsal surface of the tongue gently.[27] If the symptoms are significant, barrier agents such as topical hyaluronic acid-based preparations (e.g., Gelclair®), or over-the-counter topical analgesic/anti-inflammatory agents (e.g., benzydamine), may be helpful in providing short-term symptomatic relief.
Hairy tongue
In general, hairy tongue is a benign condition requiring no treatment. Patients who dislike the aesthetic appearance, or who complain of halitosis, can be advised to use a tongue scraper or toothbrush regularly to debride the dorsal midline tongue. If possible, risk factors such as poor oral hygiene should be modified.[28]
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