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While the art of “tongue diagnosis” is well known and accepted in Chinese medicine, it is not well developed in the West. Usually when a doctor asks you to open your mouth, stick out your tongue and say “Ahhh” they are simply trying to get a better look at the back of your throat. But paying attention to what your tongue looks like can give you, and your doctor, some surprising clues as to what might be ailing you.
A healthy tongue is typically pink with a thin white coating and features numerous small, fleshy bumps called papillae. Changes in the color, texture, and appearance of your tongue can indicate various health issues. Here’s what different tongue colors and conditions might mean:
White Tongue: Creamy White Spots: These may indicate thrush, a fungal infection that often occurs after an illness or antibiotic use disrupts the balance of bacteria in the mouth.
Lacy White Patches: This could be lichen planus, an autoimmune condition where the immune system attacks the tissues in your mouth.
Hard, Flat White Areas: Known as leukoplakia, these patches can’t be scraped away and may be linked to cancer. It’s important to notify your dentist if you see these.
Hairy Tongue: A coating that looks like black, brown, or white fur may indicate a condition called hairy tongue. This occurs when proteins turn normal small bumps into longer strands that trap food and bacteria. Brushing or scraping your tongue can help alleviate this. If the hairy patches are white and can’t be scraped off, it might be oral hairy leukoplakia, associated with viral infections such as Epstein-Barr or HIV.
Black Tongue: A black tongue can result from taking antacids containing bismuth. This harmless condition occurs when bismuth mixes with saliva and stains the tongue, disappearing once you stop the medication.
Red Tongue: Strawberry-Red Tongue: This could be an early sign of Kawasaki disease, a rare condition that inflames blood vessels, or scarlet fever. A smooth red tongue accompanied by mouth pain might suggest a deficiency in vitamin B3.
Glossy Red Tongue: A tongue that appears glossy red without the usual small bumps may indicate a deficiency in nutrients like iron, folic acid, or B vitamins. It can also result from infections or certain medications.
Burning Mouth Syndrome: If your tongue feels scalded and tastes metallic or bitter, you might have burning mouth syndrome. This could be due to nerve issues or conditions such as dry mouth, infections, acid reflux, or diabetes. Certain acidic foods, toothpaste, or mouthwash might also cause this burning sensation.
Smooth Tongue: A tongue with smooth patches alongside bumpy areas could be geographic tongue, which is generally harmless but might be linked to psoriasis or lichen planus.
Canker Sores: These small, painful sores can appear under the tongue and typically resolve on their own.
Transient Lingual Papillitis: These painful bumps, often called “lie bumps,” can appear if your tongue gets irritated.
Persistent Lump or Pain: A lump that doesn’t go away or persistent pain could indicate oral cancer, and you should consult your doctor or dentist.
Enlarged TongueAn oversized tongue that shows imprints of teeth on its sides may be due to conditions like hypothyroidism, infections, or allergies.
Grooved Tongue: Deep grooves or fissures can form on your tongue as you age, and are sometimes linked to conditions like Down syndrome, psoriasis, or Sjögren's syndrome. While generally harmless, it’s good practice to brush your tongue to prevent food and bacteria buildup.
Warning Signs for Cancer: Be aware of sores that don’t heal, lumps, persistent tongue pain, and difficulty chewing or swallowing. If these symptoms last more than two weeks, seek medical advice.
While many changes in tongue appearance are harmless, some can indicate serious health issues.
Regular self-examinations of your tongue can help you spot potential problems early. If you notice any unusual changes or persistent symptoms, it’s important to consult your healthcare provider to rule out or treat underlying conditions.
