Dawaa Reference

Clinical reference

Atrophic glossitis & burning mouth syndrome

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Egyptian National Drug Formulary - Blood Disorder Medications 2025 · Egyptian National Drug Formulary - Nervous System 2025 (clonazepam monograph)

Verified against2 documents
  • Egyptian National Drug Formulary - Blood Disorder Medications 2025
  • Egyptian National Drug Formulary - Nervous System 2025 (clonazepam monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Tongue pain, redness, swelling, loss of the papillae, or a new visible lesion [redness]
  • Symptoms may wax and wane with particular foods or with something in the environment
  • Ask about nutrition, dietary restriction, tobacco and alcohol, and about immunosuppression, cancer, autoimmune or endocrine disease
  • A family history of geographic tongue is worth asking for

Signs — what you find (8)

  • Atrophic glossitis: a red tongue that has lost its papillae and looks smooth, shiny and dry [atrophy]
  • Median rhomboid glossitis: a rhomboid red plaque-like patch in the middle of the tongue back, sometimes tender [plaques]
  • Migratory glossitis: smooth papilla-free patches with a white rim that shift position and can be sensitive to touch or certain foods
  • Red flag for cancer: a patch that stays put and is white or mixed red and white, rather than migrating
  • Geometric glossitis: painful straight cracks running across the mobile tongue
  • Strawberry tongue: a red stripped-looking dorsum with fungiform papillae standing out
  • Rubbing from a sharp tooth can produce mucosal change or ulcers that mimic disease of the tongue itself
  • Note whether the mucosa is wet or dry, red, or shows white plaques, and check the state of the teeth [plaques]

Tests (7)

  • History and examination carry most of the diagnostic weight here
  • Biopsy any lesion that is stable or looks worrying, to exclude cancer; it also helps identify blistering disease
  • Check vitamin levels where deficiency is suspected or the area is high risk
  • Rheumatoid factor, anti-Ro, anti-La, ESR and CRP when an autoimmune cause such as scleroderma is in mind
  • Full blood count and an HIV test when immunosuppression or an opportunistic infection is suspected
  • HbA1c and thyroid function help if diabetes or thyroid disease is the suspected driver
  • No imaging is needed routinely; contrast CT of the neck is for suspected or known cancer

If not this — what else fits (12)

  • Protein-calorie malnutrition
  • Vitamin B12 deficiency
  • Bullous disease of the mouth
  • Oral candidiasis
  • Xerostomia, a dry mouth
  • Burning mouth syndrome, where the tongue looks normal
  • Diabetic neuropathy
  • Post-herpetic glossitis
  • Acid reflux
  • Geographic tongue
  • Squamous cell carcinoma of the tongue
  • Oral lichen planus

SourceStatPearls "Glossitis" - disease-level clinical article

Presentation findings are traced to the source above.

1

MULTIVITAMIN

1st line

Formoral.solid

Adult dose and duration

Take 1 B-complex + Iron + Folic acid tablet daily with meals x 1-3 months

Paediatric dose

Child: age-appropriate pediatric multivitamin drops/syrup daily

Dose source

Egyptian National Drug Formulary - Blood Disorder Medications 2025

Why

Primary treatment targets nutritional deficiencies (iron, B12, folate, riboflavin) causing papillary atrophy

Cautions
  • Perform full blood count, serum ferritin, vitamin B12, and folate levels to identify exact hematatinic deficiency.
  • Dark stools may occur due to iron content.
Egyptian brands
Egyptian brandManufacturerIndicative price
LIMITLESS PRENATAL ORIGINAL 30 TABS.EVA PHARMA190.00 EGP (6.33/unit)
ZSWEV MAMA CARE 30 CAPSULESDAWA EGYPT > ADVENT PHARMA220.00 EGP (7.33/unit)
LIMITLESS PRENATAL MAX 30 TABS.EVA PHARMA230.00 EGP (7.67/unit)
THYROGREEN 30 CAPS.COPAD > NEW BOSTON PHARMACEUTICALS330.00 EGP (11.00/unit)
BIOVITA KIDS 60 GUMMIESNUTRIXIA > INFINITY PHARM250.00 EGP
PHAROTITA SYRUP 120 ML? strength differs? different route - not oral solidORGANICS > PHARO FOR SUPPLEMENTS220.00 EGP
2

CLONAZEPAM

2nd line

Strength0.5 mg

Formoral.solid

Adult dose and duration

0.25-0.5 mg tablet held in mouth/sucked without swallowing for 3 minutes then expectorated (or low oral dose 0.25 mg at bedtime) x 2-4 weeks

Paediatric dose

Not indicated in children

Dose source

Egyptian National Drug Formulary - Nervous System 2025 (clonazepam monograph)

Why

Topical or low-dose oral neuropathic agent for primary dysesthetic burning mouth syndrome when nutritional screen is negative

Cautions
  • Clonazepam is a benzodiazepine: sedation, cognitive impairment, and physical dependence are risks.
  • Avoid alcohol and driving.
  • The formulary doses clonazepam systemically for seizures and panic. Sucking a tablet for local effect in burning mouth syndrome is an off-label use of the tablet and is not a dose the formulary gives.
Egyptian brands
Egyptian brandManufacturerIndicative price
RONATRIL 0.5MG 10 TAB.HI-PHARM1.75 EGP (0.17/unit)
SIGOTRYL 0.5MG 10 TAB.SIGMA1.75 EGP (0.17/unit)
AMOTRIL 0.5 MG 30 TAB.AMOUN16.50 EGP (0.55/unit)
APETRYL 0.5 MG 50 TAB.MULTI-APEX45.00 EGP (0.90/unit)
KLOZEPAM 0.5MG 20 TABS.SIGMA24.00 EGP (1.20/unit)
KLOZEPAM 2.5MG/ML 15ML ORAL DROPS? strength differs? different route - not oral solidSIGMA40.00 EGP
RIVOTRIL 2.5MG/ML ORAL DROPS 10ML? strength differs? different route - not oral solidF.HOFFMAN LA ROCHE > EGYPTIAN PHARMACEUTICAL TRADING COMPANY87.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.