[2] Iron-deficiency anemia is mainly caused by blood loss, such as may occur during menses or gastrointestinal hemorrhage.

[7] The appearance of the tongue in iron deficiency anemia has been described as diffuse or patchy atrophy with tenderness or burning.

[7] Vitamin B2 deficiency (ariboflavinosis) can cause glossitis, along with angular cheilitis, cheilosis, peripheral neuropathy and other signs and symptoms.

A painful tongue may be an indication of an underlying serious medical condition and nearly always merits assessment by a physician or dental surgeon.

[3] The dorsal tongue surface may be affected totally, or in patches, and may be associated with a burning sensation, pain and/or erythema.

[16] Atrophic glossitis is a non-specific finding,[16] and has a great many causes, usually related to iron-deficiency anemia, pernicious anemia, B vitamin complex deficiencies,[16] unrecognized and untreated celiac disease (which often presents without gastrointestinal symptoms),[17][18][19] or other factors such as xerostomia (dry mouth).

This condition is characterized by a persistent erythematous, rhomboidal depapillated lesion in the central area of the dorsum of the tongue, just in front of the circumvallate papillae.

[2][15] Median rhomboid glossitis is a type of oral candidiasis, and rarely causes any symptoms.

Rarely are there any symptoms associated with the lesions, but occasionally a burning sensation may be present, which is exacerbated by eating hot, spicy or acidic foodstuffs.

[22] Geometric glossitis, also termed herpetic geometric glossitis,[4] is a term used by some to refer to a chronic lesion associated with herpes simplex virus (HSV) type I infection,[23] in which there is a deep fissure in the midline of the tongue, which gives off multiple branches.

However, the association between herpes simplex and geometric glossitis is disputed by some due to a lack of gold standard techniques for diagnosis of intraoral herpetic lesions, and the high prevalence of asymptomatic viral shedding in immunocompromised individuals.

[8] Strawberry tongue is also seen in Kawasaki disease (a vasculitic disorder primarily occurring in children under 5),[27][28] and toxic shock syndrome.

Good oral hygiene is necessary, including thorough tooth brushing at least twice a day, and flossing at least daily.

Avoiding irritants (such as hot or spicy foods, alcohol, and tobacco) may minimize the discomfort.