Have you ever checked the color and texture of your tongue in the mirror? Well, if you haven’t, then do it right now.

If you notice any discoloration and patches on the surface of the tongue, it’s time to consult a dental professional for help.

Median rhomboid glossitis is a rare tongue disorder which develops as a pink or smooth red patch on the dorsum of the tongue. Often, the location can vary from center to the back of the tongue.

The occurrence of median rhomboid glossitis is more among the men above 30 years of age as compared to women.

About 1% of the population gets affected by the median rhomboid glossitis.

Smokers and steroid inhalers are the people who develop median rhomboid glossitis more frequently in life.

There is no treatment necessary for median rhomboid glossitis. However, a symptomatic approach is used to heal the effects of this condition in the mouth.

This article focuses on the cause and symptoms of median rhomboid glossitis. We will also look upon some common symptomatic treatments done to relieve the effects of median rhomboid glossitis in the oral cavity.

What is median rhomboid glossitis?

Median rhomboid glossitis is commonly known as –

  • Central papillary atrophy
  • Glossal central papillary atrophy

As the name suggests, median means the center of the tongue; rhomboid implies the shape of the lesion and glossitis indicates inflammation of the tongue.

It is an oral condition which is characterized by a typical red or smooth pink patch that develops on the center or the back of the tongue dorsum. The lesion measures around 2-3 centimeters in length along its longest dimension.  (1)

Often the affected area lacks the coating of filiform papillae. This is why the spot is also referred to as the bald spot of the tongue.

 Usually, men aged 30 – 50 years are affected by median rhomboid glossitis.

Median rhomboid glossitis is a painless inflammation of the tongue is commonly detected on routine dental examinations. Often the only symptom that a person with this oral condition may experience is burning sensation in the mouth.

Sometimes a kissing lesion forms at the back of the tongue. This is thought to happen due to the transfer of fungal organisms from the tongue to the palate while swallowing.

History of median rhomboid glossitis

Historically, median rhomboid glossitis was believed to be a developmental defect of the tongue. This defect was thought to be caused by the failure of tuberculum impar to fuse with the lateral processes of the tongue.

However, this theory was disproved by a study done on 10,000 children who showed no signs of median rhomboid glossitis. Recent studies have shown a correlation between Candida albicans and median rhomboid glossitis. (2)

What causes median rhomboid glossitis?

Predisposing factors of median rhomboid glossitis include –

  • Diabetes
  • Smoking
  • Immune-compromising diseases
  • Patients undergoing antibiotic, steroid and chemotherapy
  • Denture wearers who do not remove denture in the night
  • Dry mouth
  • Nutritional deficiency like iron, B12 and folate deficiencies
  • People who have a high sugar-diet

What are its clinical signs and symptoms?

The clinical sign is the appearance of the lesion on the surface of the tongue. An oval or rhomboid red patch that may be flat or slightly raised on the center of the tongue dorsum. Usually, the lesion is present in the midline just in front of sulcus terminalis.

The margins of the lesion are often well demarcated, erythematous and depapillated giving it a shiny appearance. In rare instances, the lesion may be hyperplastic and nodular.

Median rhomboid glossitis is thought to represent a chronic fungal infection on the tongue. In this case, the condition is also called as chronic multifocal oral candidiasis.

Median rhomboid glossitis rarely shows any symptoms. Soreness and burning sensation of the mouth maybe some of the typical symptoms of this oral condition.

Sometimes, a white patch may be seen on the palate. Frequent contact of the tongue with the palate during swallowing transfers the fungal organisms to the surface of the palate.

How is median rhomboid glossitis diagnosed?

The diagnosis is based on the clinical appearance of the oral lesion. Biopsy of the tissue is usually not required. However, if a biopsy is taken, the histology may show superficial candida hyphal infiltration which is typical for median rhomboid glossitis. (3)

What is the available treatment for median rhomboid glossitis?

Median rhomboid glossitis has no treatment as such.

A dentist prescribes certain medications to treat fungal infections. Additionally, an antifungal mouth rinse like nystatin can be used to reduce the symptoms of oral disease and decrease the number of bacteria in the mouth. (4)

Median rhomboid glossitis has a high rate of recurrence.

Good oral hygiene can help to minimize the risk of microorganisms in the mouth. Brush regularly at least twice a day followed by interdental cleaning with floss or an interdental brush.

An antifungal mouth wash can help to maintain the health of the tissues and reduce the symptoms of candida infection.

Follow regular dental appointments to keep a check on the progress of the lesion. A dentist can guide you to look after your oral health. 

Take away message

Median rhomboid glossitis is the most unpredictable lesions of the mouth that rarely occurs among men aged 30 – 50 years.

It presents as a red or pink, rhomboid-shaped patch on the center of the tongue usually in the midline just in front of sulcus terminalis.

This oral lesion has minimal to no symptoms, and its clinical sign is limited to its appearance. The diagnosis of median rhomboid glossitis is made based on the clinical manifestations with an additional biopsy only if necessary.

There is no treatment for median rhomboid glossitis. However, symptomatic therapies can help to relieve the fungal infection and subside the lesion.

If you notice a similar type of patch on your tongue, consult a dentist to know more about this lesion and treat appropriately.

In median rhomboid glossitis, a typical red or smooth pink patch that develops on the center or the back of the tongue dorsum.