See something funky in the mirror? From white spots to red bumps, a number of diseases can show up on your tongue. Here’s what to know about tongue pain and tongue disease.
It could mean: You have a vitamin deficiency. A glossy, bright red tongue may be a sign your body is lacking iron or B12. “Vitamin B12 and iron are needed to mature papillae on the tongue,” says Naomi Ramer, DDS, director of Oral & Maxillofacial Pathology at Mount Sinai Hospital. “If you are deficient in those vitamins, you lose those papillae, which can make your tongue appear very smooth.”
In severe cases, this “balding” can cause pain when eating hot liquids or spicy food. Vegetarians are especially prone to low levels of B12, which is found in certain meats. “If you notice your whole tongue is a strawberry red color, and you are a vegetarian, ask your doctor about taking supplements,” says Dale Amanda Tylor, MD, MPH, general and pediatric otolaryngologist at Washington Township Medical Foundation. Notable vitamin deficiencies can also be associated with an autoimmune disease in the GI tract, in which the stomach doesn’t absorb vitamins.You see:
Brown or Black Fuzz
It could mean: You don’t have the best oral hygiene. A tongue covered in dark hairs (actually called “black and hairy tongue”) may look nasty, but doctors agree that it’s not cause for major concern. “We have papilla, small bumps on the surface of our tongue, which grow throughout our lifetime,” explains Ada Cooper, DDS, an American Dental Association consumer advisor spokesperson and practicing dentist in New York City.
Papillae are normally worn down by chewing and drinking, but sometimes they can become overgrown, which makes them more likely to harbor bacteria or become discolored from food. This can cause bad breath or taste abnormalities. “Typically [black and hairy tongue] is brought on by smoking, drinking coffee and dark teas, or poor dental hygiene,” says Jack Der-Sarkissian, MD, a family physician with Kaiser Permanente in Southern California. “Removing the offending cause, like smoking, and brushing the tongue or using a tongue scraper, may be all you need.”
You see: Cottage Cheese White
It could mean: You have a yeast infection. A lumpy, white-coated tongue could be thrush, an oral yeast infection caused by overproduction of candida. The condition is often linked to antibiotics. “Your tongue is home to naturally occurring bacteria and yeast. When you take an antibiotic, which selectively kills off bacteria, it can allow yeast, which is not killed by antibiotics, to take over,” says Dr. Tylor. Thrush, which might cause taste disturbances or a bit of pain, can also occur in those with weakened immune systems. Typical in young children, thrush also affects people with autoimmune diseases, people with diabetes that isn’t well controlled, chemotherapy patients, and the elderly. If you suspect you might have thrush, see your doctor. Unlike other yeast infections, thrush can’t be treated with over-the-counter products.
It could mean: You’re getting older (yes, even our tongues show signs of aging). Fissures and cracks in the tongue are typically harmless, but problems can arise if poor dental hygiene leads to infection within the crevices. “Once in a while a fungal infection can develop inside the clefts,” says Dr. Ramer. “You will suddenly have pain, a foul smell, and sometimes burning.” Often the infection is treated with a topical antifungal medication. Some dental appliances, like dentures, can also cause indentations on the tongue. “Make sure your dental fixtures fit well, drink enough water, and practice good oral hygiene like brushing your tongue,” says Dr. Der-Sarkissian.
You see: Small Patches of White
It could mean: Something is irritating your mouth. Painless white patches (called leukoplakia) are caused by an excess growth of cells. Often associated with smokers, the lesions have about a 5 to 17 percent chance of developing into cancer. “If you’re a smoker, this is your body telling you that it’s starting to develop these precancerous lesions,” says Dr. Tylor. In many cases, leukoplakia can reverse when you stop smoking.
Not a smoker? “The patches can also sometimes result just from the abrasion of the tooth constantly rubbing against the tongue,” says Dr. Cooper. “But if it doesn’t go away in a week or two, it’s extremely important to see your dentist, who might recommend a biopsy.”
You see: Persistent Red Lesions
It could mean: You have signs of tongue cancer. Not be confused with a canker sore, which resolves itself within two weeks, red lesions or patches that don’t go away could be serious. Get it checked immediately, doctors say. “With tongue cancer, you often think of an older, unhealthy person,” says Dr. Tylor. “But if you’re young and healthy and you have these, it doesn’t mean you’re OK. I’ve seen it in a 17-year-old girl.” Though typically attributed to tobacco use, oral cancer can also be caused by the HPV virus. Get it checked out even if it’s not bothering you—many oral cancers don’t hurt in their early stages.
It could mean: You’re postmenopausal, or using the wrong toothpaste. If your tongue stings and burns as though it’s been scalded—but looks perfectly normal—hormonal changes could be to blame. Though burning tongue syndrome can happen to anybody (it affects up to 15 percent of the population), women are seven times more likely to experience it than men. It’s uncertain why this occurs, and the condition goes away in some individuals while it persists in others.
Some people can also experience burning sensations from developing an allergy to certain toothpastes. An ingredient called sodium lauryl sulfate (SLS), which helps toothpaste get foamy, can cause stinging—sometimes suddenly. “Someone might be using one toothpaste their entire life, and then suddenly, their mouth starts hurting,” says Dr. Tylor. “Switching to toothpaste without SLS, like Sensodyne, can help reduce some of the irritation.” For other causes, a doctor may be able to prescribe treatments such as antibiotic rinses or pills for neuropathic pain.
You see: Hills and Valleys
It could mean: Absolutely nothing. A very normal, common condition, “geographic tongue” refers to a tongue that looks like bumpy terrain. Typically harmless, geographic tongue affects between 1 and 14 percent of the U.S. population. Though the cause isn’t exactly clear, it could have to do with taste buds. “Taste buds sometimes can randomly shrink away,” says Dr. Tylor. “They can regenerate, so some go away and some don’t.” Geographic tongue typically requires no treatment or checkup, but if it becomes painful, a doctor may be able to prescribe an anti-inflammatory steroid paste or antihistamine rinse.
You see: Painful Sores
It could mean: You’re stressed. Many people have had the unpleasant experience of a canker sore. These are punched-out, painful areas that occur on the tongue or cheeks. They are most painful for the first four to five days, then subside and eventually disappear within two weeks. “We don’t really know why people get canker sores, but it’s probably something viral,” says Dr. Tylor. “People who are run down or stressed are prone to these ulcers.” Good news for your partner: They’re not contagious. Just make sure it’s not a cold sore, which is an extremely contagious sore (caused by the herpes simplex virus) that typically appears on the lips.
If your tongue has a white coating or white spots
A white tongue, or white spots on your tongue, could be an indication of:
Oral thrush: a yeast infection that develops inside the mouth. It appears as white patches that are often the consistency of cottage cheese. “Oral thrush is most commonly seen in infants and the elderly, especially denture wearers, or in people with weakened immune systems,” says Dr. Allan. “People with diabetes and those who are taking inhaled steroids for asthma or lung disease can also get it. Oral thrush is more likely to occur after you’ve taken antibiotics.”
- Leukoplakia: a condition in which the cells in the mouth grow excessively, which leads to white patches on the tongue and inside the mouth. “Leukoplakia can develop when the tongue has been irritated,” Dr. Allan says. “It’s often seen in people who use tobacco products. Leukoplakia can be a precursor to cancer, but isn’t inherently dangerous by itself. If you see what you think could be leukoplakia, contact your dentist for an evaluation.”
- Oral lichen planus: a network of raised white lines on your tongue that look similar to lace. “We don’t always know what causes this condition, but it usually resolves on its own,” says Dr. Allan.If your tongue is red
A red tongue could be a sign of:
- Vitamin deficiency: “Folic acid and vitamin B-12 deficiencies may cause your tongue to take on a reddish appearance,” Dr. Allan says.
- Geographic tongue: This condition causes a map-like pattern of reddish spots to develop on the surface of your tongue. “These patches can have a white border around them, and their location on your tongue may shift over time,” says Dr. Allan. “Geographic tongue is usually harmless.”
- Scarlet fever: an infection that causes the tongue to have a strawberry-like (red and bumpy) appearance. “If you have a high fever and a red tongue, you need to see your family doctor,” Dr. Allan says. “Antibiotics are necessary to treat scarlet fever.”
- Kawasaki disease: a condition that can also cause the tongue to have a strawberry-like appearance. It is seen in children under the age of 5 and is accompanied by a high fever. “Kawasaki syndrome is a serious condition that demands immediate medical evaluation,” says Dr. Allan.
If your tongue is black and hairy
Much like hair, the papillae on your tongue grow throughout your lifetime. In some people, they become excessively long, which makes them more likely to harbor bacteria.
“When these bacteria grow, they may look dark or black, and the overgrown papillae can appear hair-like,” Dr. Allan says. “Fortunately, this condition is not common and is typically not serious. It’s most likely to occur in people who don’t practice good dental hygiene.”
He says people with diabetes, taking antibiotics or receiving chemotherapy may also develop a black hairy tongue.
If your tongue is sore or bumpy
Painful bumps on your tongue can be due to:
- Trauma: “Accidentally biting your tongue or scalding it on something straight out of the oven can result in a sore tongue until the damage heals,” says Dr. Allan. “Grinding or clenching your teeth can also irritate the sides of your tongue and cause it to become painful.”
- Smoking: Smoking irritates your tongue, which can cause soreness.
- Canker sores: mouth ulcers. “Many people develop canker sores on the tongue at one time or another,” Dr. Allan says. “The cause is unknown, but stress is believed to be a factor.” Canker sores normally heal without treatment within a week or two.
- Oral cancer: “A lump or sore on your tongue that doesn’t go away within two weeks could be an indication of oral cancer,” says Dr. Allan. “Keep in mind that many oral cancers don’t hurt in the early stages, so don’t assume a lack of pain means nothing is wrong.”
Watch your tongue!
Dr. Allan says everyone should check their tongue on a daily basis when they brush their teeth and tongue. “Any discoloration, lumps, sores or pain should be monitored and evaluated by a medical professional if they don’t go away within two weeks,” he says.