Cracks in Tongue, Fissured, Causes & how to get rid

Cracks in or on your tongue is for sure a scary condition. Quite a number of individuals suffer from this condition. The cracks mostly occur in the middle of the tongue and they may come in various sizes-small and large/big. Read on to learn what these cracks mean, how they look in pictures, causes including vitamin deficiency plus gluten intolerance, diagnosis and treatment or cures.

Fissured Tongue-Cracks on, in Middle Tongue, Small & Large Meaning

Cracked tongue, also referred to as fissured tongue is common according to Medical Practitioners during diagnosis. In fact you will mostly only notice signs of a cracked tongue during your regular dental check-up.

According to the American Academy of Oral Medicine[i], fissure tongue occurs in about 5% of the population in US. It is more prevalent in aged individuals where its severity is also know to increase. Prevalence is also predominant in men than in women.

Fissure tongue describes a tongue with multiple furrows or grooves on the surface. It may occur as a sign of an underlying condition and also as a comorbidity (with another disease). Fissure tongue may occur in combination with geographic tongue.

Signs & Symptoms-Painful, Hurting & Burning

Features common in cracked tongue may include:

• Tongue that is increasingly sensitive to spicy foods
• Halitosis (bad breathe) especially due to entry of food into these cracks
• Bacteria or fungal infection in the mouth is common as the fissures do not allow proper cleaning and therefore harbor pathogens.

Cracks on the tongue may develop as early as when you are a child but may not manifest as a big deal until you are adult.

Cracks in my Tongue that Hurt and Burn

In addition to the above signs, a cracked tongue can come with, a burning sensation, grooves, irritation, mouth sores or pain

What does their size (Small, Large or Big) say?

Cracks on the tongue commonly appear on the center. The sides are laden with smaller ones. The appearance of the fissures will however also vary with the underlying condition, the depth and development of the grooves. The cracks may connect in a grooved pattern and this makes the tongue look segmented being as deep as 6 mLs.

The cracks should only appear on your tongue with no cheek or gum involvement in fissured tongue disease. It is also expected that the cracks are not painful and this explains the difficulty in noticing their presence. Any irritants such as hot, acidic or spicy foods may cause a needles sensation (Med-Health.net).

As cracks on the tongue begin at the center, there lies the epicenter, prominent fissure and spread shallowly or deeply, singly or multiple around it. They may spread on the middle 1/3 of the tongue.

The size of the cracks determines the severity and cause (underlying condition).

Cracks in Tongue Pictures

How do to cracks in the tongue look like? Below are pictures illustrating fissured tongue.

Fissured Tongue -Chinese medicine

Chinese medicine considers the tongue to be the window to total body health. The effectiveness of this has led to an integrative approach in the diagnosis of a condition. A Chinese medicine practitioner, with an integrative approach, will first take a lifestyle and medical history leaving no stone unturned (thorough). Afterwards, the first element of the body that will be examined is the tongue. This approach enables the practitioner link the tongue’s wellbeing with the rest of the body. The tongue is believed to be linked to the heart, bladder, liver, spleen and the intestines[ii].

Total health can be determined by checking the coating of the tongue, status of the color, shape and its thickness. Alyse Shockey, a naturopathic practitioner, states in the Registered Dental Hygienist Magazine that with Chinese medicine and integrative approaches, possible health issues that may need monitoring can be derived from the tongue’s status.

Cracked Tongue Vitamin Deficiency

Biotin deficiency[iii] is one cause of cracked tongue. Biotin is a vitamin B commonly utilized by the body in metabolism and fat synthesis. It is rare to be deficient in biotin but since it is a B vitamin, its water solubility means the body does not store it. Biotin is recommended for strengthening the nails, hair and skin and this is why it is found in many cosmetics.

According to Better Health Channel website, biotin deficiency manifests on the skin and muscles as graying, pale and dry skin, muscles get fatigued due to low metabolism rates. The deficiency extends to the tongue manifesting as cracks on the tongue. The tongue occurs as painful and magenta in color, inflamed (glossitis). Vitamin H deficiency mostly occurs in those taking anti-seizure medications, taking long-term antibiotics and absorption difficulties such as in Crohn’s disease.

Cracks on Tongue Gluten Intolerance

Gluten intolerance occurs as one of the collection of symptoms of Celiac Syndrome. It is mostly congenital. Gluten is found in many grains including wheat, rye, oats and barley. Gluten is not only found in foods but also in some medications. It begins as a digestive disorder, damaging the intestinal epithelium and causing malfunction in the absorption of nutrients. It also results in the ‘leaky gut’ leading to loss of more nutrients.  Upon ingestion of food with gluten by those who have an allergic to this protein, the immune system is triggered and attacks the small intestine. This makes the villi unable to absorb nutrients including vitamin B. Signs of celiac include cracked lips, tongue and corners of the mouth (angular chelosis), shiny tongue and sores in the mouth (aphthous ulcers).

Other Causes of Cracks in Tongue

Common tongue conditions mentioned in the study of Primary health care (Reamy BV, Derby R, Bunt CW)[iv] and NetWellness Consumer Health Information[v] include:

Oral Thrush

An oral yeast infection caused by Candida albicans may result in cracks on the tongue. This occurs when the candida accumulates in the lining of your mouth. Other signs and symptoms that may accompany cracks include pain, lesions on the tongue and loss of taste. Fungal infections are more prevalent in people with weak immune systems such as HIV/AIDS patients, diabetes and cancer (MayoClinic.com).

Sjögren’s syndrome

This is a disorder in which your body immune system attacks moisture-producing glands. These glands can either be the tear or the salivary glands. The cause of this condition is not definite but its development may be genetically related triggered by environmental factors as well as bacteria or viral infections. This autoimmunity disorder results in cracked tongue, dry mouth, fatigue, itching of the eyes and joint pain.

Melkersson-Rosenthal Syndrome

It is quite rare but has been associated with fissured tongue. It however shows with swelling of lips, face and Bell’s palsy which is the paralysis of the face)

Geographic tongue (Benign Migratory Glossitis)

According Dr. Burkhat N.[vi], Erythema migrans (geographic tongue) is often associated with fissured tongue as well.

The filiform papillae of the tongue disappears in this condition. Bald patches resulting from this increases the chances of getting a cracked tongue. It is the opposite of hairy tongue in which the filiform papillae overgrows and keratinizes and the tongue becomes stained.

According to Mayo Clinic, geographic tongue manifests as cracks and lesions red in color but smooth. The location and size vary and the pain is evident upon consuming spicy or acidic foods.

Injury or Trauma

Brushing the lateral borders or dorsal surface of the tongue frequently increases the risk of having fissures on it. Friction caused by foods you ear or a broken and inclined tooth is also a cause. Constantly eating spicy food, stress exposure or grinding your teeth can lead to cracking of the tongue.

Hereditary Causes

Though not backed up by adequate studies, practitioners argue that there are people who are prone to fissuring of the tongue. In Down’s syndrome, studies show that almost 8 out of 10 children with this chromosomal disorder have fissure tongue.

Cracks in Tongue Diagnosis

On rare occasions will you consult a doctor on seeing cracks on the tongue. Most people assume it does not require treatment and that it will resolve. It normally occurs incidentally during a routine dental examination. It may also be observed to be of abnormal status if the diagnosis of the underlying disease requires tongue examination.

A biopsy is usually not indicated for the diagnosis of the fissured tongue but in some rare cases, it may be required to check for any tissue malignancy.

For differential diagnosis purposes, Down’s and Melkersson-Rosenthal Syndromes may also be an indicator of the presence of fissures on the tongue.

How to get rid of Fissured  Tongue-Cracks Treatment/Fix

Fissured tongue can be treated by:

1. Encouraging good oral hygiene. This involves brushing the top surface and eliminating any bacteria and debris from the cracks. This will also reduce any form of irritation and halitosis. If you are uncomfortable with the toothbrush you are using, you could consult a pharmacist or dentist in making informed choices regarding tongue cleansing devices.
2. Treating the causative factor. Infections are treated with antibiotics. Your physician may recommend antifungal medications and other treatments based on the cause of your condition. Topical soothing creams with antiseptic properties may also be recommended.
3. Hydration of the tongue. Take plenty of plain water to hydrate your oral cavity. You could also chew some gum to stimulate the production of saliva.
4. If you are suffering from biotic deficiency, include cauliflower, chicken, mushrooms and egg yolks in your diet. Consult your doctor before altering your diet.
5. Saliva and tear stimulants are normally helpful in Sjögren’s Syndrome since it cannot be cured.
6. Geographic tongue may be treated by ointments and mouth rinses.

Sources and References

[i] American Academy of Oral Medicine; http://www.aaom.com/fissured-tongue

[ii] Eisen D, Lynch D. The Mouth: Diagnosis and Treatment. Mosby St. Louis, 1998.

[iii] Shulman JD, Beach MM, Rivera-Hidalgo F. The prevalence of oral mucosal lesions in U.S. adults: data from the Third National Health and Nutrition Examination Survey, 1988-1994. J Am Dent Assoc. 2004; 135(9):1279-1286.

[iv] Reamy BV, Derby R, Bunt CW. Common Tongue Conditions in Primary Care. Am Fam Physician 2010; Mar 1; 81(5):627-34.

[v] NetWellness Consumer Health Information: “Common Mouth and Tongue Conditions.”

[vi] Burkhart N. Geographic tongue. RDH, 2008; Oct 28:10: 54-58.