B12 deficiency-related glossitis is highly associated with high gastrin-17 and low pepsinogen I.

BACKGROUND: The causes of vitamin B12 (B12) deficiency are varied and mainly related to gastric disorders. Glossitis is a common oral manifestation of B12 deficiency and is often first seen by dentists. This study aimed to investigate the correlation between B12 deficiency-related glossitis (B12-def glossitis) and gastric serum biomarkers [gastrin-17(G17), pepsinogen I (PGI), pepsinogen II (PGII), and anti-Helicobacter pylori (H. pylori) antibodies], and preliminarily discuss the etiology of B12-def glossitis. METHODS: A cross-sectional study was conducted in patients complaining of glossodynia, burning sensation, or severe recurrent oral ulcers, but patients with a history of gastrectomy were excluded. All subjects underwent a uniform oral examination and hematological tests. RESULTS: Of 243 patients, 133 with B12-def glossitis were in the case group, and 110 with other oral mucosal diseases (non-glossitis) and normal B12 levels were in the control group. In the case group, 84.2% (112/133) showed high G17 and low PGI levels (G17hi PGIlow ). Univariate logistic regression showed that G17hi PGIlow was a high-risk factor for B12-def glossitis (OR: 92.44; 95% CI: 35.91, 238.02). Subgroup analyses in the case group showed that the G17hi PGIlow group presented with lower B12 levels and a lower positive rate of anti-H. pylori antibodies compared to the non-G17hi PGIlow group. CONCLUSION: Gastric serum biomarkers in patients with B12-def glossitis generally showed G17hi PGIlow , suggesting possible atrophy of gastric corpus and fundus mucosa. The G17hi PGIlow and non-G17hi PGIlow groups may represent different etiologies of B12 deficiency.

Vitamin B12 deficiency may play an etiological role in atrophic glossitis and its grading: A clinical case-control study.

BACKGROUND: Existing studies have reported the significant association between atrophic glossitis (AG) and hematinic deficiencies, including iron, folate and vitamin B12 deficiency. However, these findings were inconsistent. AG can be graded as partial or complete atrophy. It is still unclear whether hematinic deficiencies are associated with the grading of AG. METHODS: 236 AG patients and 208 sex- and age-matched healthy controls were enrolled in this study. Hematological tests including complete blood count, and serum levels of folate, ferritin and vitamin B12 were performed. The AG group was divided into those with partial AG and those with complete AG according to the extent of papillary atrophy. Statistical analysis was performed to assess whether hematinic deficiencies are risk factors for AG and its grading. RESULTS: Compared with the healthy controls, AG patients had significantly higher frequencies of vitamin B12 deficiency (68.22%), ferritin deficiency (13.98%) and anemia (21.61%). The differences in hematinic deficiencies and anemia between AG patients and healthy controls changed according to gender and age. The frequencies of serum vitamin B12 deficiency and anemia in the complete AG subgroup were significantly higher than those in the partial AG subgroup. Logistic regression analysis revealed that vitamin B12 deficiency and anemia were significantly correlated with AG and its grading. The AG patients with vitamin B12 deficiency responded well to supplement therapy. CONCLUSION: AG could be an important clinical indicator for potential vitamin B12 deficiency, especially when the degree of tongue atrophy more than 50% and complete atrophy. Vitamin B12 deficiency might play an etiological role in the development of AG.

Unusual Case of Painful Glossitis and Xerostomia Following Vaccination with Pfizer-BioNTech SARS-CoV-2 (BNT162b2).

BACKGROUND Adverse events following immunization (AEFIs) remain under recognized, particularly when the symptoms experienced are uncommon and mimic natural disease. In the context of the worldwide effort to provide protection against SARS-CoV-2 using multiple doses of vaccination and with the availability of multiple vaccines, the early recognition and prompt treatment of AEFIs has increased importance, as does the ability to carefully select an alternative after an AEFI occurs. CASE REPORT A 60-year-old woman presented for clinical immunology review with a 9-month history of glossitis and xerostomia. Onset of symptoms occurred following her first vaccination with a COVID-19 vaccine (BNT162b2). After partial interval improvement, her symptoms progressively worsened after a second vaccination and third booster vaccination with BNT162b2. While undergoing reviews from multiple specialists for possible underlying connective tissue disease, and with other causes of her symptoms being excluded, the patient's symptoms progressed, with worsening tongue swelling with new fissuring and xerostomia. The patient experienced an unintentional weight loss of 8 kg due to oral discomfort. It was only after this time that an AEFI was considered the cause of her presentation, after all other diagnostic considerations were considered unlikely. Targeted, symptomatic, localized treatment with topical oral corticosteroids was initiated, followed by a gradual tapering regimen, with excellent response. CONCLUSIONS This case highlights the need to consider AEFIs early in the differential diagnosis of unusual presentations and the importance of considering a trial of targeted symptomatic treatment for patients, even if diagnostic uncertainty remains.

Association of Severe Tongue Edema With Prone Positioning in Patients Intubated for COVID-19.

OBJECTIVES/HYPOTHESIS: Prone positioning is frequently used in patients intubated for COVID-19-related lung injury to improve oxygenation. At our institution, we observed severe tongue edema develop in some of these patients. Hence, we sought to determine the incidence of tongue edema in this cohort and whether prone positioning was a risk factor associated with this complication. STUDY DESIGN: Retrospective cohort study. METHODS: A single-system retrospective cohort study of patients intubated for respiratory failure secondary to COVID-19 who subsequently developed clinically notable tongue edema from March 13 to July 5, 2020. RESULTS: 260 patients were intubated for COVID-19-related respiratory failure during the study period. 158 patients (60.8%) underwent at least one episode of proning. Twelve patients in total (4.6%) developed clinically significant tongue edema. Eleven of the twelve patients (91.7%) who developed tongue edema underwent proning prior to the development of edema. Prone positioning was associated with an increased incidence of tongue edema (odds ratio [OR] 7.56, 95% confidence interval [CI] 0.96-59.46, P = .027). In all proned patients who developed edema, this complication was noted during proning or shortly after supination (range, 0-4 days). Tongue edema was primarily managed with conservative measures; one patient required tracheostomy for definitive management. CONCLUSIONS: Tongue edema appears to develop in a subset of patients with COVID-19 who are intubated. It appears to be associated with prone positioning but is likely multifactorial in nature. Further investigation into its incidence and pathophysiology is warranted. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:287-289, 2022.

Investigation of oral atopic diseases: Correlation between geographic tongue and fungiform papillary glossitis.

INTRODUCTION: The correlation between oral lesions and atopy is not new, but few studies have investigated the prevalence of mucosal changes in diseases within the atopic spectrum, leading to conflicting data. Some studies found a possible relationship between geographic tongue, transient lingual papillitis and atopic diseases. AIM: To investigate the frequency of geographic tongue and fungiform papillary glossitis in patients with atopic diseases, and its correlation with serum IgE levels and skin test results. MATERIAL AND METHODS: The sample was comprised of participants with atopic diseases paired with participants who received negative puncture skin tests. All were submitted to stomatological and medical evaluations, prick test and oral cytopathological. RESULTS: The female sex was more numerous in both groups. Mean age was 21 years. A total of 60 diagnoses of atopic diseases were obtained, with allergic rhinitis being the most prevalent. Fungiform papillary glossitis was the most frequent oral lesion in both groups, while geographic tongue was present in 2 cases (2%) in the test group and 2 (2%) in the control group. Atopic patients with fungiform papillary glossitis presented high serum IgE levels. In atopic patients with geographic tongue, the prick test positively identified extracts of Dermatophagoides pteronyssinus (100%) and Dermatophagoides farinae (100%). CONCLUSION: Due to the low frequency of geographic tongue lesions found in the study, it is no possible to conclude if that could be an oral manifestation of atopy. However fungiform papillary glossitis is a common alteration in atopic and non-atopic patients and has a relationship with high IgE serum levels. However, the consolidation of this result requires a larger sample size.

Atrophic glossitis: Etiology, serum autoantibodies, anemia, hematinic deficiencies, hyperhomocysteinemia, and management.

Atrophic glossitis (AG) is characterized by the partial or complete absence of filiform papillae on the dorsal surface of the tongue. AG may reflect the significant deficiencies of some major nutrients including riboflavin, niacin, pyridoxine, vitamin B12, folic acid, iron, zinc, and vitamin E. Moreover, protein-calorie malnutrition, candidiasis, Helicobacter pylori colonization, xerostomia, and diabetes mellitus are also the etiologies of AG. Our previous study found the serum gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA) positivities in 26.7%, 28.4%, and 29.8% of 1064 AG patients, respectively. We also found anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia in 19.0%, 16.9%, 5.3%, 2.3%, and 11.9% of 1064 AG patients, respectively. Moreover, GPCA-positive AG patients tended to have relatively higher frequencies of hemoglobin, iron, and vitamin B12 deficiencies and hyperhomocysteinemia than GPCA-negative AG patients. Supplementations with vitamin BC capsules plus corresponding deficient hematinics for those AG patients with hematinic deficiencies can achieve complete remission of oral symptoms and AG in some AG patients. Therefore, it is very important to examine the complete blood count, serum hematinic, homocysteine, and autoantibody levels in AG patients before we start to offer treatments for AG patients.

Dental and oropharyngeal lesions in rats with chronic acid reflux esophagitis.

OBJECTIVE: In this study, we evaluated pathological changes in the tooth and pharynx of GERD rats to elucidate the association between gastric acid reflux and oral and pharyngeal diseases. METHODS: An experimental rat model of chronic acid reflux esophagitis was surgically created. The oral cavities were observed histologically every 2 weeks until 20 weeks after surgery. RESULTS: At 10 weeks after surgery, molar crown heights in GERD rats were shorter than that in control rats, and inflammatory cell infiltration by gastric acid reflux was found in the periodontal mucosa of GERD rats. Furthermore, dental erosion progressed in GERD rats at 20 weeks after surgery, and enamel erosion and dentin exposure were observed. During the same period, inflammatory cell infiltration was observed in the mucosa of the posterior part of the tongue. These findings suggest that gastric acid reflux may be one of the exacerbating factors of dental erosion, periodontitis and glossitis. CONCLUSION: We investigated oral changes in an experimental rat model of GERD and observed development of dental erosion, periodontitis and glossitis. Our findings suggested chronic gastric acid reflux may be involved in the pathogenesis of oral disease.

Goodness, gracious, great balls of fire: A case of transient lingual papillitis following consumption of an Atomic Fireball.

Transient lingual papillitis is a benign condition characterized by the inflammation of one or more fungiform papillae on the dorsolateral tongue. Although it is a common condition that affects more than half of the population, few cases have been reported in the dermatological literature. Therefore, it is a condition uncommonly recognized by dermatologists though it has a distinct clinical presentation that may be easily diagnosed by clinicians familiar with the entity. We report an interesting case of transient lingual papillitis in a 27 year-old healthy woman following the consumption of the hard candy, Atomic Fireball. We describe treatment and resolution of the condition, and its recurrence following re-exposure to the identified culprit. This report further reviews the literature to illustrate the clinical manifestations, etiology, differential diagnosis, course, and treatment of this condition.

Factors associated with the presence of atrophic tongue in patients with dry mouth.

PURPOSE: This study aimed to identify factors associated with atrophic tongue in patients with dry mouth. METHODS: Discriminant analysis was performed in 1265 patients with dry mouth to identify factors that might influence the risk of developing atrophic tongue. The dependent variable was the presence of atrophic tongue, while patient age, resting saliva flow rate, stimulated saliva flow rate and Candida colony-forming units (CFU) were used as the independent variables. RESULTS: The standardised linear discriminant coefficients showed that Candida CFU, stimulated saliva flow rate and age were significantly associated with the presence of atrophic tongue. The following linear discriminant function was obtained: z = 0.024 × age - 0.63 × (resting saliva flow rate) - 0.81 × (stimulated saliva flow rate) + 0.002 × Candida CFU - 0.611. CONCLUSION: High Candida CFU, low stimulated saliva flow rate and advanced age were identified as closely associated factors for the risk of development of atrophic tongue.

Bone Marrow-derived Cell Therapy for Oral Mucosal Repair after Irradiation.

Oral mucositis (ulcer) is a serious and painful side effect for patients with head and neck cancer following radiation therapy. However, current clinical strategies cannot efficiently prevent the occurrence of oral mucositis. In this study, we investigated whether bone marrow-derived cells (BMDCs) prevented the occurrence and/or decreased the severity of radiation-induced oral mucositis. Fresh concentrated BMDCs from male C3H mice were transplanted intravenously into female mice after tongue irradiation. For 14 days postirradiation, the changes of body weight and the time courses of ulceration were observed. Until the ulcer reached maximum size (7 days postirradiation), macroscopic and histologic analyses of harvested tongues were performed to detect the behavior of donor BMDCs. Between 2 and 5 days postirradiation, BMDCs-transplanted mice showed more expression of stem cell markers (c-Kit, Sca-1) and EGFR and fewer apoptotic cells when compared with nontransplanted control mice (irradiation group). On day 7, there were fewer and smaller ulcers observed in the BMDCs-transplanted group. Tongues of these mice had preserved their epithelial thickness, and regenerative activities (blood vessels formation, cell proliferation) were higher than they were in the irradiation group. Fluorescently labeled BMDCs were not detected in tongue epithelium but rather in connective tissue (dermis) just below the basal cell layer. These findings suggest that exogenous BMDCs behave to reduce radiogenic oral mucositis in a paracrine manner.