Vitamin B12 deficiency: The sign to spot on the tongue’s surface

Dr Dawn Harper on signs of vitamin B12 and vitamin D deficiency

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Once vitamin B12 is stored in the liver, it upholds the body’s needs for years. For this reason, the appearance of symptoms is likely to be slow and gradual, so warning signs often go amiss. Changes in the mouth, however, may be among the most blatant signs of the deficiency.

According to Stanford Medicine, the most common cause of a smooth tongue is the use of dentures.

It adds, however, that it may sometimes reflect nutritional deficiencies in iron, folate, and vitamin B12 deficiency.

The health body explains: “B12 deficiency will […] make the tongue sore and beefy in colour.

“Glossitis, by causing swelling of the tongue, may […] cause the tongue to appear smooth.”

Hunter’s glossitis is a well-known oral feature of B12 deficiency that initially presents as diffuse bright red patches which gradually progresses to atrophic glossitis.

The lesions occur primarily on the dorsal and ventral surfaces and the edge of the tongue.

Few studies have focused solely on the value of oral beefy red patches as a key indicator of B12 deficiency, but its clinical relevance has been assessed.

In one study published in the journal of Therapeutics and Clinical Risk Management, researchers noted: “A potentially useful clinical marker is oral mucosal changes in B12 deficiency.

“The oral mucosa is composed of rapidly dividing cells, and is therefore susceptible to cobalamin deficiency-related disorders in DNA synthesis.”

Research published in the BMC journal of Oral Health found the most common oral symptoms such as glossitis in patients with a deficiency tended to be tongue pain.

The most common findings were Erythema and depapillation of the tongue, the authors found.

In fact, a dentist or health care provider conducting an exam tends to look for finger-like bumps that may be missing, medically known as depapillation of the tongue.

Erythema of the tongue, on the other hand, is characterised by red patches without evidence of ulceration.

The Canadian Medical Association Journal stated in 2013 that Glossitis presented in roughly 25 percent of cases of B12 deficiency.

The report said it initially presented as inflammatory changes characterised by bright red plaques, but may subsequently change appearance.

It continued: “It may then evolve into the atrophic form, noted as atrophy of the lingual papillae, affecting more than 50 percent of the tongue’s surface.”

These changes tend to be accompanied by problems chewing, swallowing or speaking, according to MedlinePlus.

What’s more, the tongue may appear pale or bright red and swollen, which may in some cases cause blockage of the airways.

Because the most common cause of B12 is malabsorption, treatment typically involves injections or B12 supplements.

A qualified health practitioner should always be consulted before taking nutritional supplements, however.

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