in the medical philosophies , the tongue has been believed to be an indicator of health for several decades .
customarily , the tongue is known to be a mirror of the oral and general health .
hippocrates , galen , and others considered the tongue as the barometer of health . in the oral mucosal disorders ,
this difference may get along with racial factors , gender and systemic disorders , and so forth .
fissured tongue is an inherited disorder manifested with grooves that can vary in size and depth .
the rationale of this present study is a preliminary novel attempt to derive a classification for fissured tongue based on the pattern of fissuring , number of fissures on the tongue , and associated symptoms if any .
further correlation of these findings with the systemic health was also done to find out if any relevance exists .
the present study was conducted at the department of oral medicine and radiology , sibar institute of dental sciences , guntur .
a total of 1000 consecutive patients among the age groups of 10 to 80 years were included in the study .
the study was conducted from february 2012 to april 2012 by a single investigator as the fissured tongue is routinely noted as a common finding on intraoral examination . acquiescence to do the study was obtained from institutional review board and informed consent to take photographs was given by the study subjects . only those patients who gave the informed consent participated in the study .
a detailed history regarding the demographic data , systemic health , and associated tongue symptoms was recorded .
the subjects were seated on the dental chair and were examined using mouth mirror and straight probe and under illumination with dental chair light .
study subjects were asked to swish the mouth with sterile water before performing an intraoral examination of the tongue .
the study subjects were asked to open the mouth and protrude the tongue as much as possible .
the subjects were examined with sterile gloves and sterile gauze was used to hold the tip of the tongue to ease complete examination of the tongue .
clinical analysis regarding the pattern of fissuring of the tongue , number of fissures in tongue , and associated tongue anomalies was recorded .
statistical analysis was performed and a p value < 0.05 was considered to be statistically significant .
out of 387 subjects with fissured tongue , 235 ( 60.7% ) were male subjects and 152 ( 39.3% ) were female subjects . based on our observations , we have proposed a novel method of classification and classified fissured tongue as follows.based on pattern of tongue fissures.central longitudinal pattern in 196 ( 50.6% ) subjects ( figure 1 ) : vertical fissure running along the midline of the dorsal surface of the tongue.central transverse pattern in 42 ( 10.9% ) subjects ( figure 2 ) : horizontal fissure / fissures crossing the midline.lateral longitudinal pattern in 20 ( 5.2% ) subjects ( figure 3 ) : vertical fissure / fissures running laterally to the midline.branching pattern in 68 ( 17.6% ) subjects ( figure 4 ) : transverse fissures extending from the central longitudinal fissure ( branching tree appearance).diffuse pattern in 61 ( 15.8% ) cases ( figure 5 ) : fissures diffusely distributed across the dorsal surface of the tongue.based on number of tongue fissures.mild : tongue fissures ranging from 1 to 3 in number.moderate : tongue with more than 3 fissures.severe : tongue with more than 10 fissures.based on associated symptoms such as burning sensation and feeling of food lodgement.without burning sensation.with burning sensation . based on pattern of tongue fissures .
central longitudinal pattern in 196 ( 50.6% ) subjects ( figure 1 ) : vertical fissure running along the midline of the dorsal surface of the tongue.central transverse pattern in 42 ( 10.9% ) subjects ( figure 2 ) : horizontal fissure / fissures crossing the midline.lateral longitudinal pattern in 20 ( 5.2% ) subjects ( figure 3 ) : vertical fissure / fissures running laterally to the midline.branching pattern in 68 ( 17.6% ) subjects ( figure 4 ) : transverse fissures extending from the central longitudinal fissure ( branching tree appearance).diffuse pattern in 61 ( 15.8% ) cases ( figure 5 ) : fissures diffusely distributed across the dorsal surface of the tongue .
central longitudinal pattern in 196 ( 50.6% ) subjects ( figure 1 ) : vertical fissure running along the midline of the dorsal surface of the tongue .
central transverse pattern in 42 ( 10.9% ) subjects ( figure 2 ) : horizontal fissure / fissures crossing the midline .
lateral longitudinal pattern in 20 ( 5.2% ) subjects ( figure 3 ) : vertical fissure / fissures running laterally to the midline . branching pattern in 68 ( 17.6% ) subjects ( figure 4 ) : transverse fissures extending from the central longitudinal fissure ( branching tree appearance ) .
diffuse pattern in 61 ( 15.8% ) cases ( figure 5 ) : fissures diffusely distributed across the dorsal surface of the tongue . based on number of tongue fissures .
mild : tongue fissures ranging from 1 to 3 in number.moderate : tongue with more than 3 fissures.severe : tongue with more than 10 fissures .
severe : tongue with more than 10 fissures . based on associated symptoms such as burning sensation and feeling of food lodgement . without burning sensation.with burning sensation . without burning sensation . with burning sensation .
the predominantly observed fissuring pattern was the central longitudinal pattern ( 50.6% ) and the least observed pattern was the lateral longitudinal pattern ( 5.2% ) .
fissuring pattern and number of fissures were correlated with gender ( pearson chi - square is 0.528 ) results depicted that out of 387 subjects 235 were males and 152 were females .
pattern of fissuring and number of fissures were correlated and the results showed that the majority of mild cases were associated with central longitudinal pattern ( 76.9% ) followed by central transverse ( 15.3% ) and lateral longitudinal ( 7.8% ) patterns . in moderate group of cases , the majority belonged to branching type ( 95.7% ) followed by central transverse type ( 4.3% ) . in the severe group of cases , the majority were of diffuse type ( 96.8% ) followed by branching type ( 3.2% ) ( fisher 's exact test < 0.001 ) .
out of these 22 subjects , 6 ( 27.3% ) subjects were in central longitudinal and diffuse types , 4 ( 18.2% ) subjects were in central transverse and branching types , and 2 ( 9.1% ) subjects were in lateral longitudinal type . pattern of fissuring in patients was correlated with their medical history .
out of 387 subjects with fissured tongue , 289 subjects were without any medical disorder and the remaining 98 subjects had associated systemic history ( table 1 ) .
hypertension was present in 57 subjects , 18 subjects had diabetes , and 3 subjects had both hypertension and diabetes .
several other systemic disorders also coexisted with the occurrence of fissured tongue . in our observation
it included asthma , gastritis , trigeminal neuralgia , epilepsy , candidiasis , carcinoma , and down 's syndrome .
several associated tongue disorders have also been observed in the subjects ( table 2 ) .
fissured tongue is believed to be a normal variant in fewer than 10% of the population and perhaps genetically oriented .
the exact cause of fissured tongue is unidentified ; nevertheless a polygenic mode of inheritance is alleged because the situation is seen clustering in families . the asymptomatic fissured tongue is frequently perceived during intraoral examination as a subsidiary finding
. fissured tongue may be apparent at birth or become apparent during later stages with varying degree of depth from 2 to 6  mm [ 4 , 5 ] .
gender based occurrence of fissured tongue was similar to a libyan based adult population study that depicted that males were commonly affected .
but the findings were conflicting with the study conducted in jordan that depicted that increased prevalence of fissured tongue in female subjects .
fissured tongue has been discussed in the literature based on position as medial and lateral types .
several variations have been proposed in the presentation of grooves or furrows that are typically situated in the dorsolateral area of the tongue .
the next pattern is a central fissure with several fissures branches at right angles from the central form . in the severe form ,
burning sensation on the tongue may probably correlate with the systemic factors and poor oral hygiene .
local factors implicated in the etiology are ill fitting prosthesis , infection , parafunctional habits , allergic reaction , xerostomia and galvanism , and so forth .
systemic factors concerned with burning sensation include medication , anemia , esophageal reflux , deficiency of vitamin b complex , zinc , iron , esophageal reflux , and psychological factors . according to the literature , fissured tongue is usually asymptomatic .
the circumstance is worsened by entrapment of food particles within the fissures and poor oral hygiene and nutrition .
a hungarian epidemiological survey depicted that fissured tongue was coexistent with diabetes mellitus followed by hypertension .
but in our study , most of the systemically debilitated patients had hypertension followed by diabetes .
most of the hypertensive patients had central longitudinal pattern of fissuring which was found to be the common type in patients without any medical history .
reports suggest that an association exists between geographic tongue and fissured tongue [ 11 , 12 ] . contradicting to the previous reported studies , coated tongue was found to be more associated with fissured tongue rather than geographic tongue which was similar to the observation of the jordanian study .
fissured tongue was found to be associated with certain syndromes like melkersson - rosenthal syndrome , coffin - lowry syndrome , fraser 's syndrome , down 's syndrome , oral - facial - digital syndrome type i , mohr syndrome , pierre robin syndrome , maroteaux - lamy syndrome , ecc syndrome , and even sjgren syndrome [ 13 , 14 ] .
this study portrays the newer classification for fissured tongue , its pattern , frequencies of pattern , associated symptoms , and coexisting systemic disorders .
the association of fissured tongue with several systemic disorders has to be extensively studied in a larger population to validate its specific relation with systemic illness .
further , if this genetic preponderance is substantiated in multicentre trials , fissured tongue diagnosed in early stages of life might be supportive of earlier diagnosis of systemic disorders .
 
 introduction . 
 fissured tongue is a commonly encountered tongue disorder in dental practice . 
 but there is a lack of data on different pattern , severity , and association of fissuring with various systemic disorders and other tongue anomalies . 
 this study attempts to establish a classification system for fissured tongue and to know the correlation with the systemic health and other disorders of the tongue . 
 materials and methods . 
 a total of 1000 subjects between the age groups of 10 and 80 years were included in the study . 
 pattern of fissuring , allied systemic diseases , and related tongue anomalies were tabulated . 
 results . out of 1000 subjects , 387 subjects presented with fissured tongue . 
 out of 387 subjects , hypertension was present in 57 cases , 18 subjects had diabetes , and 3 subjects had both hypertension and diabetes . 
 central longitudinal type was found to be the most common type of tongue fissuring . conclusion . 
 fissured tongue has been found to be associated with certain systemic disease and further researches are required to know positive correlation . if a correlation exists , such disorders could be diagnosed earlier by identifying fissured tongue at an earlier age . 
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusion