Dal and fortified rice ruled out as causes of tongue inflammation

Yangchen C Rinzin

The ministry of education is yet to confirm the cause of glossitis (inflammation of the tongue) after several schools reported of students suffering from various tongue inflammation. 

Many schools reported glossitis outbreak to the ministry at different stages since April this year. 

A team comprising of education and health ministry officials are planning a detailed investigation to ascertain the cause of the glossitis and come up with relevant interventions. 

About five different central schools, through national early response and surveillance system, reported more than 300 cases of suspected glossitis outbreak, according to record with the education ministry’s nutrition division. 

The first case was reported from Wangbama Central School, Thimphu, on April 26 when a team of health officials from Gidakom hospital visited the school to conduct a comprehensive school health programme. During the dental examination, the team noticed about eight students suffering from similar tongue lesions with white patches on the tongue.

An official from the ministry said that the health team then informed the food and nutrition laboratory (FNL), Royal Centre for Disease Control (RCDC) and education ministry. A team was immediately sent to conduct a comprehensive study and took samples of fortified rice, chickpeas and dal (lentils). 

 “We took both cooked and raw samples,” an official said.     “We took dal sample as a probable suspect because of discolouration, but not as a suspect for glossitis, we made sure to check fortified rice too.”

The FNL and RCDC tested for total plate count like yeast/mould and total coliform. An official said that a team also collected blood samples and oral swab as a part of the investigation.

 “Blood samples studied ruled out nutrient deficiency as the cause of glossitis.”

Glossitis refers to the inflammation of the tongue that causes tongue to swell in size, change in colour, and develop a different appearance on the surface, according to nutritionists.

The team also investigated presence of artificial coloration agent in dal samples after most of the school kitchen complained of colour of dal and the colour getting washed away while cooking. 

BAFRA sent samples to a third laboratory and confirmed the presence of artificial colouring agent while the fortified rice was found to be in its normal range and did not show any presence of agents. 

A nutritionist said that following the investigation, the ministry suspended serving dal in all schools and stopped supply from the Food Corporation of Bhutan (FCBL).

The ministry during the suspension period ensured schools were served alternative protein source like chickpeas, soya chunks, egg and meat. 

 “We also returned the stock to FCBL that was supplied during the third quarter, which is from August to September,” an education ministry official said. 

From the fourth quarter, which is from October to December, both the supplier to FCB and dal was replaced by BAFRA. Supply of dal has also resumed in all the schools. 

Although it was not confirmed, officials suspect the causes of glossitis to the deficiency of one of the B vitamins that has not been included as a fortificant in the fortified rice. 

 “We’ve planned for a detailed investigation and would be able to find the causes soon.”

Meanwhile, records show that since the fortified rice was introduced in 2017, the ministry did not receive a single case of peripheral neuropathy outbreak in schools.