Letter to the editor
I did enjoy reading Dr. Fritz and Ms. Rosenboom’s article titled: “Geographic tongue beyond the dorsum” published in the October edition. Thank you for the reminder that the geographic tongue can have multiple locations and presentations. It is indeed an interesting and unusual case.
I could not but notice that the patient’s medical history includes HBP, dislipidemia, diabetes, stroke, atrial fibrillation and renal disease. I wonder if the renal disease is manifested as an increase in uric acid. All these “diagnoses” happen to be comorbidities of obstructive sleep apnea (OSA). As science tells us, OSA can actually cause hypo-oxygenation, oxidative stress and frequent CNS arousals associated with frequent production of epinephrine and cortisol. These, in turn, contribute to the medical conditions this patient has.The patient’s oral signs can be suggestive of OSA. As much as can be visible in the attached photographs, the scalloping of the tongue borders, the wear on the anterior incisal margins and the higher mallampati index do increase the possibility of OSA.
These and other oral signs, when observed during “dental” visits, can be the trigger to suggest to the family physician to refer for a polysomnogram. We have seen many cases where managing the OSA lead to the resolution of the HBP, diabetes, gout and/or hypercholesterolemia often leading to the patient not needing to rely on medication.
This is another proof of the oral-systemic connection. Thank you for the opportunity to shed another light on this important link. 
– Dr. Nabil Tabbara, Immediate Past President, American Academy of Craniofacial Pain, Canadian Chapter. Adjunct Clinical Professor, Schulich School of Medicine & Dentistry, Western University. Diplomate, American Board of Craniofacial Dental Sleep Medicine. Distinguished Fellow, American Academy of Craniofacial Pain. Fellow, International Association of Orthodontics.
Response from Dr. Peter Fritz
Iwould like to thank Dr. Tabbara for his thoughtful engagement with our article, “Geographic Tongue Beyond the Dorsum”, and for offering his perspective on the systemic associations that may arise in complex clinical cases.
Our primary objective with this article was to highlight an unusual clinical and histopathologic presentation of geographic tongue, particularly in a location not commonly reported, the ventral surface of the tongue and floor of mouth. While our focus was not on systemic interpretation, we appreciate Dr. Tabbara’s contribution in expanding the conversation to include the potential role of obstructive sleep apnea (OSA), and how oral findings may serve as indicators for further medical evaluation.
His comments underscore the importance of interdisciplinary collaboration and a holistic view of patient care, something we strongly support. We are grateful for the opportunity to contribute to this ongoing dialogue within the dental and broader healthcare communities.
Sincerely,
Peter C. Fritz, BSc, DDS, FRCD(C), PhD (Perio), MBA, LLM, LLM