Median Rhomboid Glossitis of the Tongue-Associated Kissing Lesion: A Report of a Rare Case.

A 50-year-old female patient visited the dental outpatient department with the chief complaint of ulceration associated with pain and burning sensation on the anterior and middle parts of the tongue and the posterior portion of the hard palate, which showed contact lesions that were similar in shape and size. The patient gave the history of the following symptoms a week before the patient visited the department. The patient was asymptomatic six months ago when she initially observed yellowish deposits on her tongue that could be scraped off. The patient misjudged these deposits as food debris and did not undergo any treatment for them. It was in the past week that she developed ulceration on the posterior portion of the hard palate.

Median Rhomboid Glossitis: A Case Study.

A smooth, red, oval, or rhomboid patch on the dorsal midline is the classic presentation of median rhomboid glossitis (MRG), a rare and benign lesion of the tongue. MRG is still not fully understood, which presents diagnostic hurdles and calls for additional clinical investigation. It is frequently associated with candidal infections. We describe a case of a 42-year-old man who initially appeared to have either mechanical irritation or thermal injury related to a painless patch on the dorsum surface of the tongue. We document a case of MRG that was consulted for a standard dental examination in this case report. This article also highlights a dentist's need to identify the lesion and provide appropriate education for the patient.

Median Rhomboid Glossitis: A Developmental Disorder Involving the Central Part of the Tongue.

Median rhomboid glossitis (MRG), also known as posterior midline atrophic candidiasis, is a developmental disorder of the oral cavity. It usually involves the central part of the dorsum surface of the tongue. It is a papillary atrophy that is generally well-defined and symmetrical in presentation. It is usually a painless lesion, but some patients may complain of mild itching and irritation in that region. This lesion is more predominant in males than females. It has been widely argued that this lesion is not a developmental disorder but a clinical manifestation of a fungal etiology. This article presents a case report of a 55-year-old woman who reported to the oral medicine department in a tertiary care center in Wardha, India, with the chief complaint of an oval-shaped, discolored area on the dorsum of her tongue since birth. This article also emphasizes the role of a dental practitioner in diagnosing the lesion and appropriate patient education regarding the condition.

Lingual Actinomycosis Clinically Simulating Nodular Median Rhomboid Glossitis: Literature Review and Report of Additional Case.

Actinomycosis is an uncommon, subacute to chronic, suppurative bacterial infection caused by Actinomyces Israelii. About 3% of all actinomycosis cases occur in the tongue, often affecting adult patients (mean age, 50 years). The clinical characteristics of actinomycosis can resemble malignant or benign tumors, and other infectious diseases. A 56-year-old woman was referred presenting an ulcerated lesion on the tongue 1 year ago. Intraoral examination revealed an edematous nodular lesion with an ulcerated surface, slightly symptomatic, on the midline dorsum of posterior tongue, suggesting nodular median rhomboid glossitis. Cytology smear was negative for fungus. After excisional biopsy, histopathological examination showed a chronic inflammatory infiltrate supported by a fibrovascular connective tissue stroma, and at the deepest part, broad basophilic areas surrounded by neutrophils, containing numerous filamentous bacilli, which were highlighted by Gram and Groccott-Gomori staining. The final diagnosis was lingual actinomycosis. Oral amoxicillin treatment (8/8 h for 2 weeks) was started, and after 1-month complete resolution was observed. Lingual actinomycosis is a rare lesion that must be recognized by dentists, because its early diagnosis and correct treatment reduce the possibility of a clinical complication that compromises the patient's quality of life. Noteworthy, when located on the midline dorsum of posterior tongue, actinomycosis can simulate nodular median rhomboid glossitis, expanding its spectrum of clinical differential diagnosis.

A study on oral mucosal changes among tobacco users.

Introduction: Oral malignancies account for about 4% in males and 2% in females among all malignant tumors. Tobacco use in the oral cavity can cause potentially malignant disorders such as oral submucous fibrosis (OSMF), leukoplakia and oral squamous cell carcinoma (OSCC). Factors such as lifestyle changes, habits and limited access to health care increase cancer development and morbidity. Aim and objectives: This study aimed at studying and correlating the oral mucosal changes among the tobacco users with the different forms of tobacco used. Materials and Methods: Four thousand and five hundred individuals were examined and patients with habits were categorized as Group A: only chewing, Group B: only smoking and Group C: smoking and chewing. A preformed case sheet with a detailed recording of the patient's habits was used for each individual. The suspected oral lesions were examined with care and a biopsy was taken (if needed) with patient consent. The collected data were compiled and statistical analysis was done. Results: Among the three groups OSMF, chewer's mucositis, smoker's palate and OSCC were more compared to other lesions. Conclusion: OSCC, OSMF and chewer's mucositis were seen more among A and C Group individuals. Smoker's palate was more in Group B. All the lesions showed a strong correlation with increased usage of tobacco. Lesions were more among males compared to females as there were no females with smoking habits in the study. A future study with larger sample size and equal gender distribution in different population among various locations is to be carried out to get accurate details about the lesions associated with tobacco habits and to correlate between the types, frequency and duration of the habit with the tobacco usage.

Multidisciplinary clinical approach by sharing oral examination information to treat a diabetes patient with dysgeusia.

Taste alteration is one of the complications of severe diabetes. It is important in diabetes treatment to assess taste alteration and perform dietary counseling, therapeutic exercise, and oral care. In this case, multidisciplinary clinical approach by medical staff was successful for a severely diabetic patient with dysgeusia.

Application of the novel method in the diagnosis and treatment of median rhomboid glossitis Candida-associated.

The aim of this work is to demonstrate how current molecular techniques should be integrated in the diagnostic process and can have a crucial role in the management of oral fungal infections. A case of median rhomboid glossitis Candida-associated and its resolution will be described step by step. At the time of the first observation, the lesion on the surface of the tongue did not respond to the previous administration of topical antifungal agent, such a nystatin. Firstly, in order to identify the causative agent and confirm Candida albicans infection, a brushing of the lesion was performed and polymerase chain reaction analysis was carried out. In addition, deoxyribonucleic acid sequencing method, known as Pyrosequencing(®), was used in the detection of point mutations commonly associated with fluconazole resistance and consequently, in the prediction of susceptibility to azole agents. According to molecular findings, the administration of fluconazole has therefore led to resolution of the case in 2 weeks. This case highlights how the use of molecular techniques, now-a-days, can assist the clinicians to quickly obtain the report with highly accurate and precise results and appropriately support them in the diagnosis and therapeutic process.

Urban legends series: oral candidosis.

Candida species (spp) are commensal yeast that can only instigate oral infection (oral candidosis - OC) when there is an underlying predisposing condition in the host. We investigated four controversial topics on OC: (i) How can a microbiological determination of OC be made as Candida spp. are commensal yeasts and not all of them form hyphae or pseudohyphae during infection? (ii) Is median rhomboid glossitis (MRG) a manifestation of candidal infection? (iii) Can candidal infection cause palate papillary hyperplasia (PPH)? (iv) What is the best therapeutic treatment for denture-associated erythematous stomatitis (DAES)? Results from extensive literature searches, including a systematic review, suggested the following: (i) the diagnosis of OC merely on the basis of the presence of yeasts is an oversimplification of a complex process. No convincing evidence of a single test or method better able to discriminate the transition from candidal saprophytism to pathogenicity has been reported in the literature; (ii-iii) conclusive evidence of a direct aetiopathogenic relationship between MRG and PPH and candidal infection has not been found; and (iv) only limited evidence is available for any DAES treatment, thus making it impossible to make strong therapeutic recommendations.

Glositis romboidal media: revisión a propósito de un caso clínico / glossitis Rhomboid average: review of a clinical case

La glositis romboidal media (GRM) es una alteración benigna, poco frecuente, que afecta ligeramente más a los varones. Suele localizarse en la línea media del dorso de la lengua por delante de la “V” lingual, en forma de área rojiza, romboidal, de superficie plana, como una mácula o a veces exofítica, mamelonada, que puede sobresalir de 2 a 5 mm y en la que no se observan papilas filiformes. Se presenta el caso clínico de un varón de 50 años de edad que consulta por presentar una lesión en dorso de lengua, situada en la línea media.

Median rhomboid glossitis (MRG) is an uncommon benign abnormality of the tongue, most frequently affecting men. It is typically located around the midline of the dorsum of the tongue, anterior to the lingual “V”, appearing as a reddish, rhomboid area, depapillated, flat maculate or mamillated and raised by2- 5 mm. This paper reports a case of rhomboid glossitis in a 50-year-old man who consulted for a lesion on the dorsum of the tongue, in a medial location.

Median rhomboid glossitis: a clinical and microbiological study.

OBJECTIVES: The purpose of this study was to investigate the relationship between median rhomboid glossitis (MRG) and Candida and bacteria species, prevalence and possible association with age, gender, smoking, denture wearing, and diabetes mellitus. METHODS: Tongue examinations were performed on 4244 consecutive patients. Of all the examined patients, 30 diagnosed with MRG were selected as the study group and another 30 patients were selected as the control group, and these 2 groups were compared in terms of age and gender. Tongue cultures from these 60 patients were subjected to bacterial and mycological examinations. RESULTS: MRG frequency was detected to be 0.7%. In mycological examination, Candida species were determined in 90.0% of the MRG patients and in 46.6% of the control group. This difference was statistically significant. Multivariate logistic regression indicated that diabetes mellitus and 20-39 years of age were significantly related to MRG. However, the association between MRG, gender, smoking, and 40-69 years of age was not statistically significant. CONCLUSIONS: It was determined that although there was a significant association between MRG, Candida and diabetes mellitus, the possible risk factors such as gender, smoking, and denture wearing for oral candidiasis were invalid for MRG.

The prevalence of median rhomboid glossitis in diabetic patients: a case-control study.

BACKGROUND: Diabetes mellitus (DM) is one of the most common disorders of endocrine glands which has a worldwide distribution and is a risk factor for oral pathology so; the purpose of the present study was to investigate the association between median rhomboid glossitis (MRG) and DM. METHODS: We examined 202 Iranian patients with DM aged 10-86 years and 261 healthy subjects aged 10-28 years and the diagnosis of MRG was made based on clinical features. RESULTS: The examination indicated that 13 (6.43%) diabetic patients and 4 (1.53%) of control group had MRG.There was a significant difference in the prevalence of MRG, between patients and control group. MRG showed no association with other variables (age, sex, duration of DM, drugs, FBS, A1C). CONCLUSION: In the present study the prevalence of MRG in diabetics was much higher than that of controls.