Background: Geographic tongue (GT) is a benign, recurrent inflammatory condition marked by atrophic and erythematous lesions, often asymptomatic but sometimes causing discomfort. This study evaluated some potential etiological and risk factors influencing Geographic Tongue Area and Severity Index (GTASI) and the relationship between GTASI scores and symptoms. Methods: A total of 163 GT patients (100 females [61.35%], 63 males [38.65%]) were assessed using the GTASI, which incorporates erythema, white halo, and fissured tongue (FT) scores. Statistical analyses investigated relationships between GTASI, symptoms, family history, tobacco using, allergy or atopy and medication, Categorical variables were analyzed using the chi-square test, while numerical variables were compared using the Mann-Whitney U test. A p-value of < 0.05 was considered statistically significant. Results: While GT severity showed no significant relationship with gender (p = 0.694), smoking (p = 0.907), allergic conditions (p = 507), medication (p = 0.364) or family history (p = 591). Among participants, 106 (65%) reported symptoms. A total of 137 patients (84%) had at least one fissured tongue lesion associated with GT. Higher FT scores were linked to an increased likelihood of symptoms (p = 0.048). Conversely, erythema scores were not associated with symptoms (p = 0.943). Conclusion: The study did not identify risk factors influencing overall GTASI scores. However, symptom presence is significantly associated with fissured tongue rather than GT severity suggesting that clinicians should focus on fissured tongue when evaluating symptomatic patients. Further longitudinal studies and microbiological assessments are warranted to explore the underlying mechanisms and progression of symptomatic GT.