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| CASE REPORT |
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| Year : 2016 | Volume
: 7
| Issue : 1 | Page : 48-50 |
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Ozone as healing touch in a case of benign migratory glossitis
Tarun Kumar1, Neha Arora2, Ajaypal Singh Kataria3, Dheeraj Sharma3
1 Department of Oral Medicine and Radiology, Yamuna Institute of Dental Science and Research, Yamunanagar, Haryana, India
2 Department of Prosthodontics, Yamuna Institute of Dental Science and Research, Yamunanagar, Haryana, India
3 Department of Oral Medicine and Radiology, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, India
| Date of Web Publication | 16-Feb-2016 |
Correspondence Address:
Tarun Kumar
Department of Oral Medicine and Radiology, Yamuna Institute of Dental Science and Research, Yamunanagar, Haryana
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0976-433X.176475
Benign migratory glossitis also known as the geographical tongue is a recurrent condition of unknown etiology characterized by loss of epithelium particularly of the filiform papillae on the dorsum of the tongue. Clinically the appearance is of multifocal, circinate, irregular erythematous patches bounded by slightly elevated, white colored keratotic bands. The condition is very common in adults and older age groups. The present article describes a rare case of geographic tongue in a 2.5-year-old child. Keywords: Benign migratory glossitis, burning, cancer, child, geographic tongue
How to cite this article:
Kumar T, Arora N, Kataria AS, Sharma D. Ozone as healing touch in a case of benign migratory glossitis. SRM J Res Dent Sci 2016;7:48-50 |
How to cite this URL:
Kumar T, Arora N, Kataria AS, Sharma D. Ozone as healing touch in a case of benign migratory glossitis. SRM J Res Dent Sci [serial online] 2016 [cited 2023 May 31];7:48-50. Available from: https://www.srmjrds.in/text.asp?2016/7/1/48/176475 |
| Introduction | |  |
Benign migratory glossitis is common benign disorder of unknown etiology. The epithelium of the tongue is affected with loss of filiform papillae leading to smooth ulcer like lesions that rapidly change the color and size. The lesions commonly occur on the tip, lateral borders, dorsum of the tongue and sometimes extend to the ventral portion of the tongue.[1] The prevalence rate is between 1.0% and 2.5%.[2] According to Jainkttivong and Langlais the highest incidence of geographic tongue is in the 20-29 age group.[3] A higher female preponderance is reported.[3] Jainkittivong and Langlais observed higher rates in females (1.5:1) between ages 9 and 79 in a population in Thiland.[3] The present case was of a female patient with only 2.5 years of age. The condition is very rare in this age group.
| Case Report | | |
A 2.5 years old female child reported to the department of Oral Medicine and Radiology of the dental college, with white patches on the tongue since last 6 months. Her mother gave history of change of size, shape and site of these lesions on the dorsum of the tongue since last 6 months. The lesions persist for about 7 days and then regress spontaneously. She told that the child was suffering from these lesions with intermittent period of latency of about one to two weeks between two episodes. Medical and dental history was non contributory. History of allergy to any drug intake, use of dentifrices or any other specific food item was negative. On general physical examination, the child did not show any sign of systemic involvement.
On intraoral examination, the child presented with two reddish lesions, which were roughly ovoid in shape measuring about 2.5 × 1.5 centimeters and 2 × 1 centimeters in its maximum dimensions, covering the entire dorsum and right lateral border of the tongue. The lesions had raised hyperkeratotic circinated borders with irregular margins with erythmatous halo around. The interior of the lesion showed areas of depapillation of filiform papillae. There was no visible discharge present along the lesions [Figure 1].
On palpation all the inspectory finding were confirmed. The surface temperature was normal. The lesions were non tender and nonscrapable. Based on the history and clinical examination a working diagnosis of benign migratory glossitis was considered.
Exfoliative cytology was done to know the nature of the lesion. The cytological investigation by PAP staining revealed candidal association of the lesions. No sign of cellular dysplasia was found on the cytological examination. Blood examination revealed no signs of neutropenia.
The patient's mother was reassured about the nature of the condition. The patient was advised to undergo ozone therapy. Topical application of ozonized olive oilhad been used in the present case as follows:
Topical ozone therapy
Patient was asked to rinse the mouth with distilled water. The dorsum of tongue was isolated and ozonized olive oil was applied topically over the lesion with help of the sterile gloved finger. The viscous oil was massaged over the area for one minute. Patient was advised not to have anything to eat or drink for half an hour. The application was done twice daily till the time lesions subside. The patient was recalled weekly after the regression of lesion for a period of 6 months. During all the recall visits patient's signs, symptoms and size of the lesion were evaluated. No sign of recurrence was found in the patient [Figure 2].
| Discussion | | |
Because of this her mother was worried about the condition. We advised her to undergo ozone therapy. She was agreed and all the procedure was explained to the mother. Patients do not usually require treatment apart from reassurance. Various symptomatic treatments have been tried and include fluids, acetaminophen, mouth rinsing with topical anesthetic agent, antihistaminics, anxiolytics and steroids.[1] Helfman reported satisfactory results after treating three patients with topical tretinoin. Vitamin A therapy resulted in partial improvement in some patients.[4] The topical factors that exacerbate patient's symptoms such as very hot, spicy or acidic food, and dried salty nuts should be avoided.[1] Abe et al. reported marked improvement in a 54 year-old female with persistent and painful benign migratory glossitis (BMG), for about five years by systemic administration of cyclosporin. The systemic treatment of cyclosporinmicroemulsion pre-concentrate, 3 mg/kg/day, resulted in a satisfactory improvement. Two months later, patient was started on maintenance therapy with cyclosporinmicroemulsion pre-concentrate dosage to 1.5 mg/kg/day.[5]
Ozone is an inactivated, trivalent (O3) form of oxygen (O2). Ozone breaks down into two atoms of regular oxygen by giving up an atom of singlet oxygen over a period of 20 to 30 minutes.[6],[7] Ozone is considered one of the most potent oxidants in nature, but the mechanism of its therapeutic action is unclear. Some of the possible explanations for this include the generation of peroxides by ozonolysis with unsaturated fatty acids in cell membranes, activation or generation of reactive oxygen species which function as physiological enhancers of various biological processes (including increased production of ATP), and increased expression of intracellular enzymes with antioxidant activity. It has been reported that exposure to ozone results in a change in the level of a variety of biological factors, e.g., cytokines [IFNc, TNFa, TGFb and IL-8], acute phase reactants and adhesion molecules from the integrin family such as CD11b. Other reports suggest increased motility and adhesion of peripheral blood polymorphonuclear cells to epithelial cell lines after exposure to ozone. Similarly, major autohaemotherapy-induced leucocytosis and enhanced phagocytic activity of polymorphonuclear cells have been reported.
In the present case rehabilitation of the epithelial environment as mentioned above could be the reason for the effectiveness of the medication in the condition.
| Conclusion | | |
BMG or geographic tongue is a common benign disorder of unknown etiology. The clinical presentation may vary from asymptomatic to a painful and burning ulceration. The condition should be considered in the differential diagnosis of red and white lesions even in the early age group. Management of geographic tongue depends on the clinical presentation and should include reassuring the patients more so with cancer phobia about the benign nature of the disease.
Clinical photograph and case reports.
Financial support and sponsorship
Clinical photograph and case reports.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Benign migratory glossitis or geographic tongue: An enigmatic oral lesion. Am J Med 2002;113:751-5.  |
| 2. | Kovac-Kovacic M, Skaleric U. The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia. J Oral Pathol Med 2000;29:331-5. |
| 3. | Jainkittivong A, Langlais RP. Geographic tongue: clinical characteristics of 188 cases. J Contemp Dent Pract 2005;1:123-35. |
| 4. | Helfman RJ. The treatment of geographic tongue with topical retin - A solution. Cutis 1975;50:41-6. |
| 5. | Abe M, Sogabe Y, Syuto T, Ishibuchi H, Yokoyama Y, Ishikawa O. Successful treatment with cyclosporine administration for persistent benign migratory glossitis. J Dermatol 2007;34:340-3. |
| 6. | Bocci V, Zanardi I, Michaeli D, Travagli V. Mechanisms of action and chemical biological interactions between ozone and body compartments: A critical appraisal of the different administration routes. Curr Drug Ther 2009;4:159-73. |
| 7. | Bocci V, Zanardi I, Travagli V. Oxygen/ozone as a medical gas mixture. A critical evaluation of the various methods clarifies positive and negative aspects. Medical Gas Research 2011;1:6-15. |
[Figure 1], [Figure 2]
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