Q I had ulcers on my tongue about eight months ago.

After I recovered, my tongue turned red.

It is also very sensitive and painful whenever I eat spicy, sour, salty and solid food.

I have seen a doctor five times and was prescribed vitamin pills but there is hardly any improvement.

What could be the problem?

A An inflammation of the tongue, also called glossitis, typically leads to a change in the appearance of the tongue surface.

Apart from the tongue being red, you may also notice that it is smooth due to the loss of finger-like projections on the tongue surface.

Glossitis can be due to many causes and they have almost similar symptoms which you mentioned.

Common causes include infection (bacterial, fungal or viral); vitamin deficiency; hormonal changes (such as post-menopause); various medical conditions (anaemia, diabetes, pemphigus); immune-deficiency states (HIV); allergies and reactions to mouthwash, toothpaste and tobacco or irritation from tooth edges or dentures. Some lesions which are thought to be pre-cancerous such as leukoplakia and lichen planus have similar symptoms although they tend to have whitish edges.

In addition, some cases of glossitis may be inherited - it flares up whenever these patients are under stress or involved in a trauma.

Your doctor should do an examination to exclude dangerous lesions such as cancer.

A biopsy may be required. Blood tests will help exclude various medical conditions mentioned above.

Non-specific advice includes avoid eating curry and spicy food and dishes with cinnamon.

Mint in all forms, including minted toothpaste, should be avoided. You may need a bland diet for a while.

Specific treatment depends on the cause of the glossitis and may include anti-fungal, vitamin replacements (which your doctor has tried) or referral to other doctors for treatment for hormone replacement or for HIV.

Urgent treatment should be sought if ulcers with raised edges appear or if you can feel the lymph glands in the neck region. These are signs of malignancy.

Dr Huang Shoou Chyuan

This article was first published in Mind Your Body, The Straits Times.