Examination of the tongue is a time-honored important diagnostic aid, but in my experience, it is unusual for patients to present with pain in the tongue. Nevertheless, there is a plethora of causes. The mnemonic VINDICATE lends itself best to prompting the recall of these causes.
· V—Vascular disorders suggest pernicious and iron deficiency anemia.
· I—Inflammation recalls Vincent stomatitis, herpes simplex, tuberculosis, and syphilis. The referred pain from gingivitis and abscessed teeth should also be considered here.
· N—Neoplasms remind one that carcinoma of the tongue often presents with pain.
· D—Degenerative and deficiency diseases remind one of pellagra and other avitaminoses.
· I—Intoxication and idiopathic disorders call to mind tobacco, plumbism, mercurialism, and glossopharyngeal or trigeminal neuralgia.
· C—Congenital anomalies of the tongue are rare.
· A—Allergic and autoimmune diseases, in contrast, suggest dermatomyositis and angioneurotic edema.
· T—Trauma suggests the numerous times we bite our tongues and may prompt a search for epilepsy when a patient presents with syncope.
· E—Endocrine disorders remind one of hypothyroidism.
Approach to the Diagnosis
The approach to the diagnosis includes a CBC, sedimentation rate, serum B12 and folic acid levels, serum ferritin, serology, tuberculin test, and perhaps biopsy of the lesion. A trial of vitamin therapy may be indicated.