This page covers the evidence-based approach to atrophic glossitis (AG) in patients with confirmed iron deficiency — defined as serum iron ≤ 70 mg/dL in men or ≤ 65 mg/dL in women — without concurrent vitamin B12 or folic acid deficiency.
Among AG patients, isolated iron deficiency is a distinct subgroup. The diagnosis is confirmed when serum iron falls below the sex-specific threshold (≤ 70 mg/dL for men; ≤ 65 mg/dL for women), while vitamin B12 and folic acid levels remain within normal limits.
The protocol for this group involves a combination of oral B-vitamin supplementation together with an additional oral iron preparation. The complete agent selection, dosing schedule, and monitoring plan are detailed in the full protocol.
Clinical targets include raising serum iron and blood haemoglobin to normal levels, reducing elevated serum homocysteine, and achieving complete resolution of oral symptoms — burning sensation of the oral mucosa, dry mouth, numbness of the tongue, and dysfunction of taste — over a mean treatment period of approximately 8–12 months.
DOI: 10.1016/j.jfma.2019.04.015
AG patients with the serum level of vitamin B12 ≤ 450 pg/mL, folic acid ≤6 ng/mL, or iron ≤70 mg/dL for men and ≤ 65 mg/dL for women are defined as having vitamin B12, folic acid or iron deficiency, respectively.
Moreover, our 91 AG patients can be divided into five groups: group I, patients with vitamin B12 deficiency only (n = 39); group II, patients with folic acid deficiency only (n = 10); group III patients with iron deficiency only (n = 9), group IV, patients with both vitamin B12 and iron deficiencies (n = 19); and group V, patients without definite hematinic deficiencies (n = 14).
In brief, all 91 AG patients are treated with oral administration of vitamin BC capsule (one capsule, twice a day; each capsule contained 10 mg of vitamin B1, 5 mg of vitamin B2, 5 mg of vitamin B6, 5 mg of vitamin B12, 20 mg of calcium pantothenate, 50 mg of nicotinamide, 150 mg of vitamin C, and 60 mg of calcium).
Moreover, groups I, II, and III patients are treated with additional intramuscular injection of vitamin B12 (one ampule per week for 2 months and one ampule per month thereafter; each ampule contained 1000 mg of hydroxocobalamin in 1 ml of distilled water), oral administration of folic acid tablet (2 tablets per day for 2 months and one tablet per day thereafter; each tablet contained 5 mg of folic acid), and oral administration of iron tablet (one tablet per day; each tablet contained 100 mg of Fe (OH)3 polymaltose complex), respectively.
We found that our supplement treatments for groups I, II, III, IV, and V patients can reduce the high serum homocysteine levels to significantly lower levels after a mean treatment period of 8.3–11.6 months.
The end point of vitamins, iron or zinc supplement treatments is the disappearance of all oral symptoms including the burning sensation of oral mucosa (91 patients), dry mouth (71 patients), numbness of the tongue (51 patients), and dysfunction of taste (22 patients).
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