What the Tongue Says About Health

The bulk of the tongue is made of muscle that is covered with a moist tissue called mucosa, the same tissue that lines other parts of the inside of your body, including the nose, mouth, and lungs. Small bumps called papillae cover the upper surface of the tongue and between these are the taste buds. The primary functions of the tongue are to help you form words and to chew and swallow. At any point in time, up to 15% of adults will have some condition affecting the tongue. These can vary from harmless curiosities to life-threatening conditions. Just as abnormalities of the eyes or skin can be an indicator of disease, certain medical conditions can be suspected based on abnormalities affecting the tongue. These abnormalities include pain, changes in the normal color of the tongue, and alterations in the normal tongue surface.

1. Growths and ulcerations

   • Cold sores are caused by a herpes virus and more commonly occur on the lips. Cold sores tend to be recurrent since the virus stays in the body, becoming reactivated due to factors such as fever, menstruation, stress, or fatigue. Cold sores will resolve on their own but can also be prevented or treated with anti-viral medications.
     
     
   • Aphthous ulcers are small, painful ulcers commonly known as "canker
     sores". The cause of canker sores is unknown, but may develop after a minor injury to the mucosa of the mouth or from sensitivity to certain foods, such as nuts. Aphthous ulcers are unrelated to herpetic cold sores and resolve on their own in a week or so.
     
     
   • A persistent growth or ulcer on the tongue could indicate the presence of oral cancer, most commonly, squamous cell carcinoma. Oral cancer is more common in people who smoke and/or drink alcohol heavily, but can also be caused by the human papilloma virus (HPV). When a persistent tongue growth is detected, biopsy is usually needed to distinguish benign conditions from cancer.
     
     
   • Benign lesions appearing on the tongue include fibromas (fibrous tumor), cysts, and papillomas (wart-like growth).
     
     
   • Tongue enlargement can occur with a severe form of hypothyroidism known as myxedema. Sudden swelling of the tongue can be caused by an allergic reaction or a side effect of medications.
     

2. Color changes

   • White patches on the tongue may be due to lichen planus, yeast (Candida albicans) infection, or to leukoplakia. The most common finding in people with lichen planus are itchy, purplish skin lesions near the wrists or ankles. Candida infections affecting the mouth (thrush) occur more due to a suppressed immune system, as a side effect of taking a corticosteroid medication (e.g. prednisone), or in infants. Leukoplakia is a white patch affecting the mucous membranes of the mouth. It is thought to develop from chronic irritation such as rubbing against a rough tooth or ill-fitting dentures. Leukoplakia is usually benign, but can progress to cancer in rare instances.
     
     
   • Hairy tongue, also known as "black hairy tongue", is a harmless condition in which the tongue looks hairy or furry because the papillae grow longer and don't shed like normal. Most people who have hairy tongue are coffee or tea drinkers, often in addition to using tobacco. Debris or bacteria collect between the enlarged papillae causing the discoloration. Practicing good oral hygiene and eliminating contributing factors is the usual treatment for hairy tongue. Some people find that using a toothbrush or tongue scraper help to remove the elongated papillae.
     
     
   • Geographic tongue is one of the most common tongue abnormalities, resulting from inflammation of the surface on the tongue (glossitis). It appears as red patches that are surrounded by wavy, white border. This creates a map-like, or geographic, appearance. Geographic tongue usually does not cause symptoms, although some people with this condition report a burning sensation or an irritation of the tongue with hot or spicy foods. When symptomatic, geographic tongue can be treated with topical steroids or antihistamine rinses.
     
     
   • Red tongue can indicate a nutritional deficiency of iron, folic acid, vitamin B12, riboflavin, or niacin. The redness is due to inflammation and loss papillae on the surface of the tongue. Correcting the underlying deficiency addresses this tongue condition.

3. Tongue pain

   • Minor infections or irritations are the most common cause of tongue soreness. Cold sores, canker sores, and glossitis are common causes.
     
     
   • Burning tongue syndrome (or burning mouth syndrome) is a cause for tongue pain without an obvious source. An altered sense of taste and dry mouth are common accompanying symptoms. Burning tongue syndrome occurs most frequently in women around the time of menopause. Treatment can be challenging since there is no obvious cause. Two treatments that have been shown to work in clinical trials include a lozenge form of the anticonvulsant medication clonazepam (Klonopin), alpha-lipoic acid (a strong antioxidant), and capsaicin, the substance that makes peppers hot.

Many tongue abnormalities are harmless and do not require treatment. If uncertain of the cause of a tongue lesion, however, it is best to have a biopsy performed or consult with an oral surgeon or Ear Nose and Throat specialist.