Review ArticleAbstract
Background: Median rhomboid glossitis (MRG) is the condition with the central papillary atrophy of the tongue, and it affects 1% of the population. Rogers and Bruce stated that men are affected 3 times more often than women.
Objectives: To know the correlation between median rhomboid glossitis and fungal infection. Problem Statements: Median rhomboid glossitis often occurs in people with diabetes mellitus or others immunocompromised condition. This condition also can lead the fungal infection in oral cavity.
Discussion: In people who is smoker can increase the candidal carrier rate in both diabetic and healthy subjects. Diabetic patients with oral candidiasis who were smokers had significantly higher candidal load than diabetic patients with oral candidiasis who were ex-smokers or who did not smoke. MRG is higher in immunosuppressed patients, diabetics, and in patients on broad-spectrum antibiotics.
Conclusion: There was a highly significant statistical correlation between MRG and Candida species. In particular, the midline of the tongue is suitable for intense overgrowth of Candida organisms.
Keywords: MRG; Fungal Infection; Immunocompromised
Introduction
Median rhomboid glossitis (MRG) is clinical appearance with
atrophy of central papillary tongue. This conditions happens within
almost 1% among individual. Study said that men more likely to had
this condition compare to women. Moreover, this gender dominant
was found due to many predisposition factor. Another study found
among 28 MRG patients, 7 patients is women, and the rest is men.
MRG is mainly visible in the midline of tongue, could be dorsal
or central. Clinical appearance of MRG is commonly symmetric
but could be asymmetry, there is loss of papill area arising from
anterior to dorsal. Sometimes MRG also appears in the paramedial
location. Surface conditions of MRG was smooth. Dominant patients
with MRG had no pain or asymptomatic, but some of them migh
had persistent pain, and irritation [1]. Median rhomboid glossitis is
present in about 1% of the population and most often affects men
between the ages of 30 - 50 years of age. It typically presents as an
ovoid area about 2 - 3 centimeters long in its longest dimension
(Figure 1).
As most cases of median rhomboid glossitis are without
symptoms, it is often first noticed by the dentist during a routine
examination. However, some patients may experience a burning
sensation when eating certain foods. Median rhomboid glossitis
is currently thought to represent a chronic fungal (candidiasis)
infection in this area of the tongue [2]. There are several predisposing
factors associated with MRG such as smoking, denture wearing, diabetes mellitus, as well as candidal infections. Aim of this study
is to review association MRG and relationship with predisposition
factors, such as aging, dominance of men in prevalent, smoking
habits, denture wearer, and systemic conditions especially diabetes
mellitus [3].
Figure 1: Clinical Appearance in Median Rhomboid Glositis.
Aim of this study
To know the correlation between median rhomboid glossitis and fungal infection.
Discussion
Clinical Manifestation
Median rhomboid glossitis (MRG) is defined as the central papillary atrophy of the tongue and it affects 0.01%-1.0% of the population. MRG is typically located around the midline of the dorsum of the tongue. It occurs as a well-demarcated, symmetric, depapillated area arising anterior to the circumvallate papillae. However, it sometimes appears in the paramedial location. The surface of the lesion can be smooth or lobulated. While most of the cases are asymptomatic, some patients complain of persistent pain, irritation, or pruritus. When MRG is concomitant with a palatal inflammation, which is called the kissing lesion [4].
Prevalence
Prevalence of MRG in population just in little amount, is 0.9% to 5.4%. Previous study found that average country in the world had 0.2% prevalence. But study in Turki said in its country, their population had MRG almost 0.7% higher than the rest of the world. Moreover, another country reported that 2-3% among population. Interestingly, gender dominant with MRG prevalence was men, more dominant 3 until 5 times than women. Study also conclude that the prevalence ratio MRG in population was one patient among 12 individual.
Factor Predisposition
Factor predisposition among MRG patients was plenty. First
was smoker, smoker could increase incidence rate, especially with
systemic disease. But smoker in health subjects also can increase
MRG or candidiasis in oral cavity. Moreover, Patients with systemic
disease, especially diabetes, had the highest candida count in oral
cavity using fungicidal examination. Also, this condition happens
to patients with systemic condition, although the patients was quit
smoking years ago. Especially uncontrolled diabetic condition,
study found higher candida culture [5]. This condition also found in
both diabetic type 2 and 1. 85% MRG patients smoked tobacco was
found in previous study, compared healthy subjects in 40 patients.
That study was justification with age or gender in same proportion.
Another factor was denture wearers, MRG was significantly high in
this condition. Denture weares is local condition just in oral cavity,
not systemic one, so this suggest that local factors also had role in
MRG condition [6].
Few previous studies also underline that diabetes was main
factor in development of MRG. Next factor was smoking tobacco,
might had role in development of MRG. Another local factor was
dental prosthesis or denture wearers, traumas, and its combination
might be predisposition factor to MRG. Also, there is evidence report
about denture wearers and MRG. But there is one to notice that
individual who using denture wearers commonly elderly. Elderly
oral cavity had slight transformation, including oral microbiota,
immune aging might play role in development of MRG. However,
the exact pathophysiology between MRG and denture wearers still
lack information [7,8].
Correlation between Median Rhomboid Glossitis and Fungal Infection
MRG study could not be separated with Candida study, especially
candida albicans. Many study focus that candia albicans species is
main etiology of MRG. However, candida albicans is normal flora
in oral cavity, but might be change quantity if there is another
factors. Previous study also concludes that dysbiosis of candida
albicans was first condition in development of MRG, and there is
high correlation impact between candida albicans and MRG. There
is proof that almost 88% MRG dominated by candida albicans using
culture study [9].
Common places for candida albicans in oral cavity are tongue or
glossa, study reported that almost 50% of the candida population
might turn to dysbiosis if there are predisposition factors. Glossa is
the valuable oral source for Candida. nevertheless, the mid of the
glossa is suited against quick overgrowth of Candida organisms.
This chance occurs because impaired bloodline accommodate to
the mid-dorsal approach of the glossa might predispose it to the
developing of candidiasis and, presumptively, to the resultant loss
of filamentous papillae [10].
These days, MRG might be identified as an oral disease, that
commonly dominated by candida albicans. These diseases related
with disease that come forward from Candida infections. However,
the pathway mechanism is still be a controversial and needed
further study. One that we know, beside candida albicans, there is
another predisposition factors had role in MRG. Few predisposing
factors has been mentioned before, such as smoking habits, denture
wearer, and systemic disease as human immunodeficiency virus,
diabetes mellitus and might immune conditions. Another factors
are pharmacological treatment in several diseases, the example
is use of corticosteroid, steroid and inhalers for autoimmune
condition. Moreover, study sill had conclusion that candida albicans
is main cause, from culture fungal or using imunohistopathology
examination. There is high correlation report using significant
statistical relationship of MRG and Candida species. Another proof
is oral cavity, especially glossa midline is highly suitable for intense
overgrowth of Candida organisms [11].
MRG is frequently a symptomless lesion. besides, whole of the
cases before were symptomless. Consequently, they did not demand
any treatment; nevertheless, these patients still should keep under
observance. Another problem to concern, although MRG was
found in HIV patients, not all MRG had HIV. But MRG should be as
manifestation of systemic disease such as diabetes. Unlikely kissing
lesions on the hard palate that might symptoms in HIV, we should
consider that another predisposition factors might be induce this
condition, such as smoking habits or local factors as trauma and
denture wearers. Moreover, there is no clear association between
MRG and cancer, but there was evidence reports of malignant
transformation from MRG conditions [12,13].
Conclusion
There was a specific correlation with strong amount candida albicans in MRG conditions. Common places for MRG are glossa midline that very suitable for intense overgrowth of Candida organisms.
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