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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.
Strawberry Red
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.
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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.”
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.
Wrinkles
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.
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.”
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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.
Burning sensation
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.
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.
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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.
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