Chronic Glossitis Prof. (Dr.) Niranjan Mohanty MD (Hom) Director International Study & Research Center on Homoeopathy, 92, Dharmavihar, Khandagiri, Bhubaneswar Honorary Project Advisor, RRI (H), Puri Honorary President, F.P.A.I. BBSR Branch

Introduction- Glossitis is a condition in which the tongue is swollen and changes color. Finger-like projections on the surface of the tongue (called papillae) are lost, causing the tongue to appear smooth. Glossitis usually responds well to treatment if the cause of inflammation is removed.1

Glossitis is broadly divided into 2 types Glossitis is broadly divided into 2 types. i) Acute glossitis, ii) Chronic glossitis Acute glossitis is characterized by swollen papillae occurs, in eruptions of measles and scarlet fever. 2 Chronic glossitis is characterized by chronic inflammation not of the substance of the tongue, but of the mucous covering of that organ.3

In chronic glossitis, the tongue is raw and red without swollen papillae. It is seen in malnutrition such as in pellagra, Ariboflavinosis and niacin deficiency. In Iron deficiency anemia, Pernicious anemia, and sprue, there is chronic atrophic glossitis characterized by atrophied papillae and smooth raw tongue. 2

Etiology- 4 Chronic disease of the stomach or chronic intestinal disorder. Bacterial or viral infections (including oral herpes simplex). Poor hydration and low saliva in the mouth may allow bacteria to grow more readily. Disorders such as iron deficiency anemia, pernicious anemia and other B-vitamin deficiencies, oral lichen planus, erythema multiforme,aphthous ulcer, pemphigus vulgaris, syphilis, and others.

Mechanical irritation or injury from burns, rough edges of teeth or dental appliances, or other trauma Tongue Piercings Exposure to irritants such as tobacco, alcohol, hot foods, or spices. Allergic reaction to toothpaste, mouthwash, breath fresheners, dyes in confectionery, plastic in dentures or retainers, or certain blood-pressure medications (ACE inhibitors).

Occasionally, glossitis can be inherited. Yeast infection Dry mouth associated with connective tissue disorders, such as Sjogren syndrome Albuterol (bronchodilator medicine) Administration of ganglion blockers (eg. Tubocurarine, Mecamylamine).4

Symptoms 4 Tongue swelling. Sore and tender tongue. Tongue color changes (usually dark "beefy" red), if it becomes Pale, cause must be due to pernicious anemia, and if Fiery red, it is due to deficiency of vitamins B.

Tongue becomes so sensitive, slightly furrowed and cracked, especially at the base, while the tip may show an absence of papillae and be smooth and glossy. Smooth appearance to the tongue due to pernicious anemia (vitamin B12 deficiency). Difficulty with chewing, swallowing, or speaking. 4

Complications 1 Discomfort Airway blockage Difficulties with speaking, chewing, or swallowing 1

Treatment 1 The goal of treatment is to reduce inflammation. Treatment usually does not require hospitalization unless tongue swelling is severe. Good oral hygiene is necessary, including thorough tooth brushing at least twice a day, and flossing at least daily.

Anemia and nutritional deficiencies (such as deficiencies in niacin, riboflavin, iron, or vitamin E) must be treated, often by dietary changes or other supplements. Avoid irritants (such as hot or spicy foods, alcohol, and tobacco) to minimize the discomfort. 1

Prevention 5 Good oral hygiene (thorough tooth brushing and flossing and regular professional cleaning and examination) may be helpful to prevent these disorders. Drinking plenty of water and the production of enough saliva, aid in the reduction of bacterial growth. Minimize irritants or injury in the mouth when possible. Avoid excessive use of any food or substance that irritates the mouth or tongue. 5

Prognosis 5 Glossitis usually responds well to treatment if the cause of inflammation is removed or treated. This disorder may be painless, or it may cause tongue and mouth discomfort. In some cases, glossitis may result in severe tongue swelling that blocks the airway. 5

Prognosis of the disease according to the Homoeopathic Concept After a prescription has been made the physician commences to make observations. The whole future of the patient may depend upon the conclusions that the physician arrives at from these observations, because his action depends very much upon his observations and upon his action depends the good of the patient.

The watching and waiting and observing have to be done by the physicians in order that he may judge by the changes what to do. Dr. Kent has described the following observations with their prognosis after observing the action of the medicine.

A prolonged aggravation with final decline of the patient. First observation A prolonged aggravation with final decline of the patient.

Inference – Antipsoric medicine is too deep. Destruction – established Vital reaction – impossible Case – Incurable Prognosis – Unfavourable

What to do – Antidote the medicine. Remarks – Don’t give a deep remedy when organic disease is present In incurable and doubtful case give no medicine higher than 30th or 200th potency.

Long aggravation but final and slow improvement Second observation Long aggravation but final and slow improvement

Beginning or some very marked tissue change in some organ. Inference – Beginning or some very marked tissue change in some organ.

Third observation Aggravation is quick, short and strong with rapid improvement of the patient In Acute disease – 1st hour after the remedy In chronic disease – during the first few days

Inference – Remedy correct Reaction – vigorous Improvement will be long and marked No tendency to any structural change in the vital organs. Any structural change in the vital organs Prognosis very good.

No aggravation whatever, with recovery of the patient. Fourth observation No aggravation whatever, with recovery of the patient.

Inference – Remedy and potency are exactly correct. There is no organic disease or no tendency to organic disease. The disease is not of great depth, and belongs to functions of nerves. Prognosis – In acute case – good, In chronic case – Doubtful

Remarks – Highest order of cure in acute affections. Yet the physician sometimes will be more satisfied if in the beginning of his prescribing he notices a slight aggravation of the symptom.

Amelioration comes first and aggravation comes afterwards. Fifth observation Amelioration comes first and aggravation comes afterwards.

Inference – Either the remedy was superficial remedy and could only act as a palliative or the Patient was incurable and the remedy was somewhat suitable. Prognosis – Unfavorable

Too short relief of the symptoms Sixth observation Too short relief of the symptoms

Inference – Has the patient done something to spoil the action of this medicine.If not, the Physician may suspect the following: In acute cases – Presence of high grade inflammatory condition of organs which are threatened by the processes going on. In Chronic cases - It means that there is a structural change and organs are destroyed or being destroyed or in a very precarious condition. Prognosis - Bad

A full time amelioration of symptoms yet no special relief of patient. Seventh observation A full time amelioration of symptoms yet no special relief of patient.

Inference – Presence of latent condition or latent existing organic condition which prevents improvements beyond all the certain stages. The remedies acts favorably but the patient is not cured and never be cured. The patient is palliated in this instance.

Prognosis – good Remarks – The patient can never be cured. It is a suitable palliation for homoeopathic remedies

New symptoms appearing after the remedy. Tenth observation New symptoms appearing after the remedy.

Inference – Medicine given is given is an unfavorable one. The greater the array of new symptoms coming out after the administration of a remedy, the more doubt there is thrown upon the prescription. After these new symptoms have passed away, if the patient will settle down to the original state and no improvement take place, it indicates that the medicine did not sustain a true homoeopathic relation. Prognosis - Bad What to do – The medicine should be antidoted.

When old symptoms are observed to reappear. Eleventh observation When old symptoms are observed to reappear.

Inference – In proportion as old symptoms that have long been away return just in that proportion the disease is curable. Symptoms are disappearing in the reverse order of their coming. The patient is on the road to discovery. It indicates that the medicines must be left alone. Prognosis – Good, because the prescription is correct one.

What to do - Old symptoms often come back and go off without any change of medicines if the old symptoms come back to stay then the repetition of dose is often necessary. Remark – It is well to say that patient that this is encouraging that disease gets well from above downwards etc.

Symptoms take the wrong directions. Twelfth observation Symptoms take the wrong directions.

Inference – Medicine given is wrong. What to do – The remedy must be antidote at once otherwise the structural change will place in that new side. Remark – There is a great danger in selecting a remedy on external symptoms alone ignoring all the symptoms that the patient may have ignoring the whole economy and general state of the patients.

Homoeopathic concept of Chronic Glossitis Homoeopathy got a generalized concept of disease irrespective of name and organ involved. According to Dr. Kent, it is the man that is sick and to be restored to health, not his body, not the tissue. Chronic glossitis is not a disease itself rather it is product of some internal disease.

Chronic glossitis is true natural chronic disease with definite involvement of Miasm. On the basis of symptoms produced by Chronic glossitis is mixed miasmatic disease. i.e. Psora-syphillitic, it can be Tubercular miasm also. 6

Symptoms of Chronic Glossitis found in different Repertories are

Complete Repertory (Version 2003) 7 MOUTH - SWELLING - general - tongue MOUTH - SWELLING - general - tongue - base MOUTH - SWELLING - general - tongue - center MOUTH - SWELLING - general - tongue - one-sided MOUTH - SWELLING - general - tongue - right MOUTH - SWELLING - general - tongue - tip MOUTH - SWELLING - general - tongue - under MOUTH - SWELLING - sensation of - tongue MOUTH - PAIN - sore, bruised - tongue MOUTH - PAIN - sore, bruised - tongue - spots MOUTH - PAIN - sore, bruised - tongue - base MOUTH - PAIN - sore, bruised - tongue - center

MOUTH - PAIN - sore, bruised - tongue - edges MOUTH - PAIN - sore, bruised - tongue - tip MOUTH - DISCOLORATION - redness - tongue MOUTH - DISCOLORATION - redness - tongue - center MOUTH - DISCOLORATION - redness - tongue - edges MOUTH - DISCOLORATION - redness - tongue - tip MOUTH - DISCOLORATION - redness - fiery-red, tongue MOUTH - DISCOLORATION - redness - glistening, tongue MOUTH - DISCOLORATION - redness - raw, tongue MOUTH - ULCERS - tongue MOUTH - ULCERS - tongue - base

MOUTH - ULCERS - tongue - center MOUTH - ULCERS - tongue - edges MOUTH - ULCERS - tongue - tip MOUTH - ULCERS - tongue - under MOUTH - ULCERS - deep - tongue MOUTH - ULCERS - irregular - tongue MOUTH - PAIN - burning, raw, smarting - tongue - base MOUTH - PAIN - burning, raw, smarting - tongue - center MOUTH - PAIN - burning, raw, smarting - tongue - edges MOUTH - PAIN - burning, raw, smarting - tongue - tip MOUTH - PAIN - burning, raw, smarting - tongue - under MOUTH - EXCORIATION - general - tongue

Kents Repertory 8 [Kent ] [Mouth] Pain: Tongue: [Kent ] [Mouth] Pain: Burning, raw and smarting: Tongue: [Kent ] [Mouth] Pain: Sore: Tongue: [Kent ] [Mouth]Pain:Sore:Tongue:Tip: [Kent ] [Mouth]Mucous membrane: Tongue, excoriation: [Kent ] [Mouth]Swelling:Tongue: [Kent ] [Mouth]Swelling:Tongue:Centre: [Kent ] [Mouth]Swelling:Tongue:Root of: [Kent ] [Mouth]Swelling:Tongue:Tip: [Kent ] [Mouth]Swelling:Tongue:Under:

[Kent ] [Mouth]Swelling:Tongue:Painful when touched: [Kent ] [Mouth]Swelling:Tongue:One sided: [Kent ] [Mouth]Discoloration:Tongue:Red: [Kent ] [Mouth]Discoloration:Tongue:Red:Fiery-red: [Kent ] [Mouth]Discoloration:Tongue:Red:Glistening (see smooth): [Kent ] [Mouth]Discoloration:Tongue:Red:Spots: [Kent ] [Mouth]Discoloration:Tongue:Red:Stripe down centre: [Kent ] [Mouth]Discoloration:Tongue:Red:Centre: [Kent ] [Mouth]Discoloration:Tongue:Red:Edges: [Kent ] [Mouth]Discoloration:Tongue:Red:Tip: [Kent ] [Mouth]Discoloration:Tongue:Pale:

The Important Homoeopathic drugs indicated for Chronic Glossitis are 9 Aconite Apis mel. Lachesis Merc. cor. Mur. ac. Ars. Alb. Belladona Cantharis Crotalus hor. Mercurious

Aconite Nap. Tongue swollen, tip tingles. Teeth sensitive to cold, Constantly moves lower jaw as if chewing, Gums hot and inflamed. Tongue coated white. Mouth numb, dry and tingling. Great fear, anxiety, worry and restlessness. Pains are intolerable. 9

Apis mel. Tongue fiery red, swollen, sore and raw, with vesicles. Scalding in mouth and throat. Tongue feels scalded, red hot trembling. Gums swollen, Cancer of the tongue. Awkwardness, drops things from hands

Lachesis Tongue swollen, burns, trembles, red, dry and cracked at tips, catches on teeth. Apthous and denuded spots with burning and rawness. Nauseous taste, Teeth aches, pain extends into ears. Great loquacious, Jealous and suspicious. 9

Merc. cor. Tongue swollen and inflamed, salivation, Ptyalism, Taste salty and bitter, Pyorrhoea 9

Muriatic acid Tongue pale, swollen, dry, leathery, paralyzed. Deep ulcers on tongue. Hard lumps on tongue. Apthous mouth. Gums and gland swollen. Sordes on teeth. 9

Ars. Alb. Tongue dry, clean, clean and red; Stitching and burning pain in the tongue, ulcerated with blue colour. Bloody saliva. Neuralgia of teeth; feel long and very sore; < after midnight, > Warmth, Metallic taste. Gulping up of burning water. Great anguish and restlessness. Fear of death, of being left alone. 9

Belladona Tongue red on edges, Strawberry tongue. Tongue swollen and painful, Grinding of teeth, Mouth dry, throbbing pain in teeth. 9

Cantharis Tongue covered with vesicles; Deeply furred; edges red. Burning in mouth, pharynx, and throat. Vesicles in mouth. Great difficulty in swallowing liquids. Inflammation of throats; feels on fire. 9

Crotalus hor. Tongue red and small, but feels swollen. Tongue fiery red, dry in centre, smooth and polished. Mouldy smell of breath. Tongue when protruding, goes to right. Cancer of tongue with hemorrhage. Great disorganization of the blood 9

Mercurious Furrow in upper surface of tongue lengthwise. Tongue heavy, thick, moist coating, yellow, flabby, teeth-indented, Tongue feels as if burnt with ulcer. 9

Other Rare drugs indicated for Chronic Glossitis 9 Phytolacca Ranunculus sceleratus Ox. ac. Sul. ac. Vipera

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