Tongue Talk: Things Your Tongue is Trying to Tell You About Your Health

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Find a mirror. Stick out your tongue and look closely at it. If it looks pretty much the same as it always does, you’re probably fine. But you may want to be vigilant for any changes, especially if they seem to get worse.

Welltuned spoke with Dr. Ghiath Almasri, a medical director with BlueCross BlueShield of Tennessee, about tongue health and how to identify potential health issues.

Your tongue can vary in appearance

Dr. Almasri: Generally speaking, your tongue should be pink and covered with small nodules or bumps called papillae. But there are some benign conditions that can affect your tongue and make it look a little different. That doesn’t mean there’s anything to worry about, here are some examples:

  • Geographic tongue. Also known as benign migratory glossitis, you lose some of the papillae in patches on your tongue, giving it a map-like appearance. This condition is common and benign, but it can make you a little more sensitive to spicy and sugary foods.
  • Fissured tongue. You can have furrows or grooves on the top of your tongue, usually in the middle third of your tongue. You don’t have to do anything about it but cleaning your tongue may prevent irritation.

4 signs of problems with your tongue

Dr. Almasri: Things can go wrong inside your mouth. Sometimes, they’re minor problems that can easily be remedied. But others may require more care. Some changes to watch out for include:

1. White patches or plaques

White patches or plaques on your tongue can be a sign of thrush or lichen planus. Thrush is a fungal infection that’s caused by yeast. The white patches can make your mouth feel uncomfortable. They can be wiped off, but you’ll need an antifungal medication to make them go away. Lichen planus is a chronic condition that causes white patches to bloom on the tongue. You may also get red patches on your gums. Milder cases usually go away on their own. More severe cases may require corticosteroids or other treatments.

However, white or whitish-gray patches that can’t be scraped off may also herald a potentially malignant condition called oral leukoplakia. The patches can also be speckled with red. Smoking is usually the number one culprit of oral leukoplakia. While mild cases may go away on their own, more severe cases can eventually develop into cancer. A biopsy can reveal whether it’s leukoplakia or not. If so, your doctor will remove the patch as soon as possible to keep it from spreading.

2. A darker color

A lack of abrasion to the top of the tongue can make protein build up, causing the papillae to become longer and resemble hair. This is a condition known as yes, hairy tongue. Bacteria can get caught in the web of hair, making it look brown, white, green, pink or even black. It can also make your breath smell bad.

Black hairy tongue tends to be more common in older men, but tobacco and alcohol use, radiation therapy and some medications can also contribute to the development of this condition. A toothbrush or tongue scraper can help you eliminate the build-up. In some cases, an antibiotic or antifungal treatment may be necessary, too.

3. Red tongue

Your tongue is usually some variation on a shade of pink. But if you notice that it’s a much brighter color than it usually is, this could be a sign of several possible conditions:

  • Vitamin B-12, iron, or folic acid deficiencies.
  • Allergic reaction to gluten
  • Scarlet fever
  • Kawasaki disease, although this is usually only seen in very young children.

4. Bumps or sores

Sores or ulcers could just be a sign of injury or trauma to the mouth. But there can be other causes:

  • Transient lingual papillitis. The papillae at the front of your tongue may become irritated and inflamed. They can also appear white or yellowish in color and may only last for a few days. If you notice that you also have swollen lymph nodes or other symptoms, you might want to check in with your doctor. Stress or irritation to the tongue can cause transient lingual papillitis, but so can an infection, which may require treatment.
  • Canker sores. These small, raw, painful sores tend to be white or yellow, surrounded by a red halo. Canker sores are pretty common and can occur all over the inside of your mouth. Rinsing your mouth with a saltwater solution or numbing mouth rinse can bring some relief. They do usually heal on their own, but if they don’t go away within two weeks, contact your doctor.
  • Oral cancer. You can develop cancer on the front two-thirds of your tongue (also called oral tongue cancer), or at the base of your tongue. The most common kind of tongue cancer is squamous cell carcinoma. Oral tongue cancer can start as a lump or grayish-pink ulcer on the side of the tongue that easily bleeds. It’s harder to detect cancer at the base of the tongue. If you develop trouble swallowing, a sense of fulness in your throat, pain or changes to your voice, notify your doctor so you can be evaluated.

3 steps to keep your tongue healthy

If your tongue doesn’t exhibit any signs of potential illness right now, that’s good news. But you don’t want to wait around for anything to develop.

1. Watch for changes

Keep an eye out for changes that occur to your tongue and the rest of your oral cavity. You might want to watch out for a partial or complete loss of your sense of taste or your ability to distinguish between sweet, salty, sour and bitter flavors. If you develop pain, swelling, a burning sensation, or trouble moving your tongue, that may warrant a call to your doctor to get checked out.

2. Don’t smoke

Smoking contributes to an increased risk for many conditions affecting your mouth and tongue, such as oral cancer, oral leukoplakia, and periodontal disease. Stop smoking and discontinue any other tobacco use to boost your chances of good dental health—and good tongue health.

3. Brush your teeth

Good oral hygiene can help you maintain the health of your tongue, teeth, and mouth. The Centers for Disease Control and Prevention (CDC) recommends thoroughly brushing your teeth twice per day with a fluoridated toothpaste and flossing daily between your teeth. You should also see your dentist at least once a year for a professional cleaning and examination. If you take any  medication that gives you dry mouth, ask your doctor about other options.

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Jennifer Larson

Jennifer Larson is Nashville-based writer and editor with nearly 20 years of experience. She specializes in health care and family issues.

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BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also use tools and resources to help improve health and well-being by logging into BlueAccess and going to the in the Member Wellness Center under the Managing Your Health tab.