1020 D3000 new imprint Word template Vol 13, No 1 (2025) ISSN 2167-8677 (online) DOI 10.5195/d3000.2025.1020 http://dentistry3000.pitt.edu Serum B12 and Folic Acid Level among a Sample of Iraqi Patients with Geographic Tongue Noor S. Mohammed Ali College of Den*stry, University of Baghdad, Baghdad, Iraq Abstract Objec4ve: To assess the serum concentraGons of vitamin B12 and folic acid in individuals suffering from geographic tongue. It also aims to invesGgate whether deficiencies in these hemaGnic nutrients are significantly linked to the occurrence of this condiGon. Subjects and Methods: The data for this retrospecGve analysis were obtained from the medical records of individuals with oral lesions who required laboratory tesGng for serum B12 and folic acid between October 2024 and May 2025 due to suspected anemia. 30 paGents had geographic tongue who examined by oral medicine specialist at college of denGstry/university of Bagh- dad and 30 healthy subjects, according to the inclusion and exclusion criteria. StaGsGcal anal- ysis was performed to compare mean levels between groups and to evaluate potenGal cor- relaGons. Results: The average serum levels of Vitamin B12 (p < 0.001) and folic acid (p < 0.05) were significantly decreased in paGents with geographic tongue compared to healthy controls. A considerable proporGon of these paGents had values falling below the normal reference range. These findings suggest a possible involvement of hemaGnic deficiencies in the underlying pathogenesis of geographic tongue. Conclusion: The study's findings indicate that deficiencies in vitamin B12 and folic acid may contribute to the development of geo- graphic tongue. EvaluaGng and addressing these nutriGonal gaps could be beneficial in the clinical approach to managing GT, parGc- ularly in paGents presenGng with symp- toms. AddiGonal longitudinal research is warranted to be]er understand the causal relaGonship and the potenGal benefits of targeted supplementaGon. Open Access Cita%on: Ali NSM. (2025) Serum B12 and Folic Acid level among a Sample of Iraqi Pa%ents with Geographic Tongue. Den%stry 3000. 1:a001 doi:10.5195/d3000.2025.1020 Received: August 18, 2025 Accepted: August 28, 2025 Published: September 10, 2025 Copyright: ©2025 Ali NSM. This is an open access ar%cle licensed under a Crea%ve Commons ATribu%on Work 4.0 United States License. Email: noorsaad2011@codental.uobaghdad.edu.iq Introduc)on Geographic tongue (GT) is a common and be- nign inflammatory disorder of the oral mu- cosa, generally manifesting as annular le- sions marked by the absence of filiform pa- pillae. These depapillated areas appear red and atrophic, often bordered by a distinct yellowish-white margin. The dorsal surface of the tongue is the most frequently affected site, although the lateral borders may also be involved in some cases [1]; It was first de- scribed in 1931 [2]. Among the many names for geographic tongue are migratory glossi- tis, annulus migrans, and erythema migrans as well. On the tongue, the disease manifests as irregular red spots with white borders that are somewhat elevated. These lesions frequently have a map-like appearance, which is the basis for the term "geographic" [3], the lesions associated with geographic tongue may persist for several days to months before resolving spontaneously, of- ten reappearing at different sites on the tongue. Notably, no scarring is observed dur- ing remission [4]. GT is predominantly local- ized to the dorsal surface of the tongue [5]. It impacts approximately 1-3% of the whole population and is present in the males and females [6], other studies indicate a slightly elevated prevalence in females, demonstrat- ing a female-to-male ratio of approximately 2:1 [7]. This could be linked to GT's correlation with female hormones [8]. Geo- graphic tongue primarily occurs in adoles- cents and adults, with instances documented in persons ranging from 5 to 84 years of age. Among adults the clinical signs are generally more apparent than in children [9-11]. Alt- hough the exact etiology of GT remains un- known, numerous contributing factors have been proposed. These include genetic pre- disposition, psoriasis, allergic conditions, di- abetes mellitus, hormonal imbalances, nutri- tional deficiencies, psychological stress, and the use of certain medications such as oral contraceptives. Additionally, this condition has been documented in conjunction with Serum B12 and Folic Acid Level among a Sample of Iraqi PaGents with Geographic Tongue Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.1020 http://dentistry3000.pitt.edu 2 systemic disorders like Reiter's syndrome, Down syndrome, and lichen planus [12,13]. Hematologic deficiencies, especially those related to vitamin B12 and folic acid, have garnered significant attention as potential contributing factors. These vitamins are cru- cial for DNA production, cellular division, and the preservation of epithelium integrity. Deficiencies can result in various mucosal changes, including glossitis and other oral le- sions [14]. Several studies have suggested a potential association between geographic tongue and low serum levels of these nutri- ents [14,15]. The present study aims to examine serum concentrations of vitamin B12 and folic acid in persons diagnosed with geographical tongue to healthy controls, and to evaluate the possible link between these de\iciencies and the presence of the condition, with the goal of informing appropriate clinical man- agement strategies. Subjects and Methods This retrospective analysis utilized data ob- tained from the medical records of patients with oral lesions submitted for laboratory assessment of serum vitamin B12 and folic acid since there was clinical suspicion of ane- mia. The data collection period extended from October 2024 to May 2025. A total of 30 patients diagnosed with geographic tongue, examined by an oral medicine specialist at the College of Dentistry, University of Bagh- dad, were included in the study group. The control group comprised 30 healthy individ- uals, chosen based on identical eligibility and exclusion requirements as patients visiting the same center. All participants reported that they had not taken any vitamin supple- ments in the eight weeks prior to the study. Individuals with systemic diseases, such as chronic renal disorders, psoriasis, Reiter’s syndrome, dermatitis, insulin-dependent di- abetes, and bronchitis, as well as pregnant women, were excluded from the study [16]. Control subjects were con\irmed to be free of geographic tongue and the designated sys- temic disorders and had not utilized any drugs. In this investigation, blood B12 vita- min levels of ≤ 220 pg/ml and folic acid lev- els of < 4 ng/ml are considered insuf\icient (17,18). SPSS software, version 18.0 (SPSS Inc., Chicago, IL), was used for statistical analysis. Welch's t-test was used to determine statis- tical signi\icance because the data was quan- titative. Statistical signi\icance was de\ined as a p-value of less than 0.05, while ex- tremely signi\icant was de\ined as a p-value of less than 0.001. Results Thirty people with geographic tongue and thirty healthy controls were included in the \inal analysis. Age and gender were used to match the GT group with the control group. Every participant was sourced from the Uni- versity of Baghdad's College of Dentistry's outpatient oral medicine clinic. The average age of the 19 female and 11 male members of the GT group was 34.83 ± 8.66 years. The mean age of the 14 male and 16 female mem- bers of the control group was 32.03 ± 8.71 years. The demographic characteristics of both groups are shown in Table 1. Table 1. Demographic data of the GT patients and healthy controls. Welch's t-test was used in this study to com- pare the serum vitamin B12 levels of pa- tients with geographic tongue (GT) and healthy controls. For those with low serum vitamin B12 levels, the GT group's mean value was 143.8 ± 36.5 pg/mL (n = 18), while the control group was 202.6 ± 11.5 pg/mL (n = 8). A highly signi\icant difference between the two groups was indicated by the statistically signi\icant difference (t ≈ -6.18, df ≈ 23, and p < 0.00001). The GT group had a mean of 396.15 ± 124.3 pg/mL (n = 12) for persons with normal serum vitamin B12 levels, whereas the control group had a mean of 519.5 ± 138.7 pg/mL (n = 22). Additionally, there was statistical signi\icance in this dif- ference (t = -2.65, df ≈ 27, p ≈ 0.012). The mean serum B12 levels for GT patients were 244.74 ± 82.94 pg/mL (n = 30), whereas the mean for healthy controls was signi\icantly higher at 434.99 ± 120.2 pg/mL (n = 30). There was a signi\icant difference (t = -7.13, df = 58, p < 0.001). Twelve GT patients and fourteen controls were included to examine serum folic acid levels among those with low folic acid levels. Statistical signi\icance was indicated by the mean values of 1.4 ± 0.6 ng/mL and 2.3 ± 1.2 ng/mL, respectively, with t ≈ -2.36, df = 24, and p ≈ 0.027. The GT group had a mean of 10.5 ± 3.2 ng/mL (n = 18) for people with normal folic acid levels, while the control group had a mean of 15.32 ± 4.3 ng/mL (n = 16). There was a signi\icant difference (t ≈ -3.74, df = 32, p ≈ 0.0007). Overall, the GT group's mean folic acid level was 6.86 ± 2.52 ng/mL, compared to 9.24 ± 3.25 ng/mL for the control group. A statisti- cally signi\icant difference was discovered (t ≈ -3.17, df = 58, p ≈ 0.0024). Table 2 provides a summary of all the data. Discussion The serum levels of folic acid and vitamin B12 in people with geographic tongue (GT), a benign but occasionally symptomatic oral disorder of unknown cause, were investi- gated in this study. When compared to healthy controls, the results showed that vit- amin B12 and folic acid deficits were far more common in GT patients. Previous re- search indicates that nutritional deficiencies, especially haematinic factors like B 12 and folate, may play a role in the pathogenesis of GT. These vitamins are essential for DNA synthesis and epithelial cell regeneration. In- sufficient levels of these nutrients may hin- der the regeneration of the oral mucosa, re- sulting in epithelial atrophy and desquama- tive lesions hallmark of GT [18,19]. Our re- sults are in line with those reported by Alikhani et al., who found significantly lower serum levels of vitamin B12 and folate in GT patients compared to healthy individuals [20]. Similarly, Jahanbani et al. observed an association between hematinic deficiencies and GT, underscoring the importance of eval- uating systemic nutritional status in affected individuals [21]. It is well-established that vitamin B12 deficiency may lead to glossitis, mucosal atrophy, and burning sensations in the oral cavity—clinical features that can mimic or overlap with those seen in GT [22,23]. Likewise, folic acid deficiency has been linked to increased mucosal fragility and susceptibility to inflammatory changes on the tongue [24]. However, not all GT pa- tients in our study demonstrated deficien- cies in these vitamins, suggesting that nutri- tional factors, while important, are not the sole contributors to GT. The etiology of GT is likely multifactorial, involving a combination of genetic predisposition, immunological mechanisms, psychological stress, hormonal influences, and possibly allergic or atopic conditions [25]. Nutritional status itself is a complex indicator influenced by socio-eco- nomic factors, food availability, and individ- ual metabolic needs. The World Health Or- ganization views nutritional status as both a determinant and a consequence of overall development and health [26]. Optimal nutri- tion remains crucial for the maintenance of oral and dental tissue integrity [27]. The serum levels of folic acid and vitamin B12 in people with geographic tongue (GT), a benign but occasionally symptomatic oral disorder of unknown cause, were investi- gated in this study. When compared to healthy controls, the results showed that vit- amin B12 and folic acid deficits were far more common in GT patients. Previous re- search indicates that nutritional deficiencies, especially haematinic factors like B 12 and folate, may play a role in the pathogenesis of GT. These vitamins are essential for DNA GT patients Healthy control No. of subjects 30 30 Age 34.83 ± 8.66 32.03 ± 8.71 Male:Female 11:19 14:16 Serum B12 and Folic Acid Level among a Sample of Iraqi PaGents with Geographic Tongue Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.1020 http://dentistry3000.pitt.edu 3 synthesis and epithelial cell regeneration. In- sufficient levels of these nutrients may hin- der the regeneration of the oral mucosa, re- sulting in epithelial atrophy and desquama- tive lesions hallmark of GT [18,19]. Our re- sults are in line with those reported by Alikhani et al., who found significantly lower serum levels of vitamin B12 and folate in GT patients compared to healthy individuals [20]. Similarly, Jahanbani et al. observed an association between hematinic deficiencies and GT, underscoring the importance of eval- uating systemic nutritional status in affected individuals [21]. It is well-established that vitamin B12 deficiency may lead to glossitis, mucosal atrophy, and burning sensations in the oral cavity—clinical features that can mimic or overlap with those seen in GT [22,23]. Likewise, folic acid deficiency has been linked to increased mucosal fragility and susceptibility to inflammatory changes on the tongue [24]. However, not all GT pa- tients in our study demonstrated deficien- cies in these vitamins, suggesting that nutri- tional factors, while important, are not the sole contributors to GT. The etiology of GT is likely multifactorial, involving a combination of genetic predisposition, immunological mechanisms, psychological stress, hormonal influences, and possibly allergic or atopic conditions [25]. Nutritional status itself is a complex indicator influenced by socio-eco- nomic factors, food availability, and individ- ual metabolic needs. The World Health Or- ganization views nutritional status as both a determinant and a consequence of overall development and health [26]. Optimal nutri- tion remains crucial for the maintenance of oral and dental tissue integrity [27]. Despite being frequently asymptomatic and discovered incidentally, GT can cause dis- comfort in some patients. In such sympto- matic cases especially those reporting burn- ing sensations it is advisable to assess serum levels of hematinic nutrients. Although treat- ment with vitamin supplementation has led to symptomatic relief in some individuals, the supporting evidence remains limited and largely anecdotal [28]. Conclusion The results of this study confirm that the ex- istence of geographic tongue is significantly correlated with low serum levels of folic acid and vitamin B12. Even though not every pa- tient had these deficits, they seem to have played a significant role in the pathophysiology and clinical presentation of GT. As a result, when evaluating GT patients clinically, especially those who exhibit symp- toms like burning or mucosal irritation, hem- atinic status assessment should be consid- ered. To investigate the therapeutic poten- tial of vitamin supplementation in the man- agement of GT, more prospective research is necessary. Conflict of Interest None. References 1. Hashemipoor M, Rad M, Dastboos A. Prevalence, clinical features of geographic tongue. Journal of Dentistry.2015: 1558; 8:93–81. 2. Campana F, Vigarios E, Fricain JC, Sibaud V (2019) Geographic stomatitis with palate involve- ment. Ann Bras Dermatol 94(4): 449-451. 3. Picciani B, Santos VC, Teixeira ST, Izahias LM, Curty A, et al. (2017) Investigation of the clinical features of geographic tongue: unveiling its rela- tionship with oral psoriasis. Int J Dermatol 56(4): 421-427. 4. Ogueta CI, Ramirez PM, Jimenez OC, Cifuentes MM (2019) Geographic Tongue: What a Dermatol- ogist Should Know. 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Coll. Dent. Vol. 36, No. 4. 2024 28. Mignogna MD, Fortuna G, Leuci S, Adamo D. Symptomatic benign migratory glossitis (geo- graphic tongue): successful treatment with topical tacrolimus. Clin Oral Investig. 2011; 15(6):991– 998. Serum B12 and Folic Acid Level among a Sample of Iraqi PaGents with Geographic Tongue Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.1020 http://dentistry3000.pitt.edu 4 Table 2. Comparison of serum vitamin B12 and folic acid levels in patients with GT and healthy controls. Variable GT patients Healthy control No. Mean ± SD No. Mean ± SD Vitamin B12 (pg/ml) Low 18 143.8 ± 36.5 8 202.6 ± 11.5** Normal 12 396.15 ± 124.3 22 519.5 ± 138.7* Total 30 244.74 ± 82.94 30 434.99 ± 120.2 ** Folic acid (ng/ml) Low 12 1.4 ± 0.6 14 2.3± 1.2* Normal 18 10.5 ± 3.2 16 15.32± 4.3** Total 30 6.86 ± 2.52 30 9.24 ± 3.25* * P < o.o5 ** P < o.oo1