Stick Out Your Tongue and Look in the Mirror

By Dr. Mercola

For many illnesses and diseases there are recognizable symptoms. In some cases those symptoms are not evident until late in the disease process, while in others they appear immediately. Recognizing symptoms and associating them with specific conditions no longer relies on the memory of a diagnostician. Using the computer, you can check your own symptoms and end up with a list of possible conditions.

In some cases a symptom is just a sign of another condition, while in others it may be the condition itself. It is important to pay attention to changes in your physical appearance and in how you feel each day. These observations are important to maintaining your health and wellness.

The appearance of your tongue is one such indicator. Being able to recognize changes will help you to make lifestyle choices, enabling you to enjoy better health. However, before discussing what changes may appear on your tongue, it’s helpful to know what your tongue should look like.

Structure and Appearance of Your Tongue

Your tongue is a strong muscle covered with pink tissue called mucosa. The muscle is anchored to your mouth and held down in the front by a small fold of tissue called the frenulum. This word comes from Latin, meaning “little bridle.”¹ In the back of the mouth the tongue is attached to the hyoid bone. Besides needing it for speech, your tongue is vital for chewing and swallowing food.

Another function is taste. When you experience some of the conditions described below, you may find your sense of taste is altered. The four common tastes are sweet, sour, bitter and salty. Although a taste map of the tongue used to describe areas most sensitive to these four tastes, the tongue actually has many nerves throughout the muscle transmitting signals to the brain. Since all parts of your tongue can detect all four of these common tastes, this taste map doesn’t really exist.²

When healthy, the tongue is covered with moist pink tissue and tiny bumps called papilla. The papilla give the tongue a rough texture and are home to thousands of taste buds, which are a collection of nerve-like cells connected to your brain. Evaluating your tongue is just one way of keeping track of your health. Stick out your tongue and look in the mirror; any deviations from its normal appearance, or any pain, may indicate it’s time to make some changes.

Vitamin Deficiencies May Be Evident on Your Tongue

Micronutrients are components, such as vitamins and minerals, required by your body in small amounts for development, disease prevention and well-being.³ Deficiencies in these micronutrients can have devastatingly negative health consequences in children and adults. Some of these include iron, folate, zinc and iodine.

Some changes to your tongue may be indicative of a vitamin deficiency. If your tongue is strawberry red, smooth and swollen, it may indicate a deficiency in iron, folate or vitamin B12.⁴ Also called glossitis, this swelling may cause the tongue to appear smooth. This means when the swelling goes down, the papilla will become more evident again. Naomi Ramer, DDS, director of Oral and Maxillofacial Pathology at Mount Sinai Hospital, explains:⁵

“Vitamin B12 and iron are needed to mature papillae on the tongue. If you are deficient in those vitamins, you lose those papillae, which can make your tongue appear very smooth.”

A vitamin B12 deficiency may also cause sensory changes on your tongue as the vitamin is crucial for the proper neurological function of your taste buds.⁶ This may result in feelings of tingling, burning sensations, tenderness or numbness in the absence of any specific lesions. This condition has been found more frequently in middle-aged and elderly women who also experience altered taste sensation and dry mouth.

A vitamin A deficiency may be responsible for physical changes to your tongue called scalloped tongue glossitis.⁷ This is a rare condition characterized by pain, tenderness and swelling, as well as color changes and a scalloped appearance of the edges of the tongue. While vitamin A deficiency is one cause, the condition may also result from allergies to toothpaste or mouthwash, chronic dry mouth, oral infections or the chronic use of irritating substances such as snuff, alcohol or highly spiced foods.

A strawberry red, swollen tongue may also be the result of a condition called Kawasaki disease, seen most frequently in children under the age of 5 and accompanied by a high fever.⁸ The fever is often higher than 102.2 degrees Fahrenheit (F) and lasts more than three days. Symptoms of the disease are driven by inflammation of medium-sized arteries throughout the body. Other vitamins and nutrients play a critical role in the health of your tongue. Symptoms of the most obvious deficiencies include:⁹

• Vitamin B

Deficiencies can lead to a swollen and sore tongue, fissures on the surface or teeth indentations. Food sources of vitamin B12 are found naturally in animal products. Consider a supplement if you are a vegetarian.

• Iron

Deficiencies may cause swelling and painful sores in the mouth. Iron-rich foods include sardines, pastured, organic beef and spinach.¹⁰

• Vitamin C and zinc

Your body uses vitamin C to keep capillaries and tissues strong. Deficiencies in vitamin C and zinc may lead to bleeding gums and an increased risk of infection. Foods rich in vitamin C include strawberries, pineapple, mango and Brussels sprouts.¹¹ Foods rich in zinc include organically raised and pastured meat and dairy products, nuts and seeds.¹²

Poor Oral Hygiene May Result in More Than Cavities

Just like the hair on your head, the papilla on your tongue continue to grow throughout your life.¹³ Normally, these papilla are worn down through everyday chewing and drinking.¹⁴ Sometimes, if they become overgrown, they offer a unique hiding place for fungus and bacterial growth. This may result in what is called a black hairy tongue.

The black coating is the result of overgrowth of bacteria and yeast and may occur after a course of antibiotics.¹⁵ Individuals who suffer from diabetes or who have been receiving chemotherapy may also be at higher risk for developing black hairy tongue.¹⁶ In some cases it is just the result of poor oral hygiene and may be triggered by lifestyle choices such as smoking or drinking dark coffee and teas.

While visually unappealing and may be accompanied by bad breath or taste abnormalities, this condition is not life-threatening. It is important to determine the underlying cause of the overgrowth of papilla and bacteria or yeast, as it’s important to remove the offending source. It may also be a sign you should be evaluated for diabetes.

In some cases hairy tongue may be the result of Epstein-Barr virus (EBV) infection in HIV positive individuals.¹⁷ Chronic administration of penicillin may also increase your risk of a fungal overgrowth, specifically aspergillus.

When not the result of infections concurrent with chronic administration of antibiotics or the results of an EBV infection, the condition will often resolve by removing the offending cause and practicing good oral hygiene. Brushing your tongue or using a tongue scraper twice a day prior to brushing your teeth is a good way to clean the papilla. Consider rinsing your mouth with diluted hydrogen peroxide once or twice to help remove the discoloration and include probiotics to help improve your gut function.¹⁸

Stress and Irritation May Trigger Pain and Discomfort

Canker sores are shallow ulcers forming in the mouth and tongue, which often make eating and talking uncomfortable. A simple canker sore is shown on this video and may occur when you’re stressed. These are most painful for the first four to five days.¹⁹

The intensity of the pain subsides, but the sore does not completely resolve for nearly two weeks. According to Dr. Dale Amanda Tylor, general and pediatric otolaryngologist at Washington Township Medical Foundation,²⁰ “We don’t really know why people get canker sores, but it’s probably something viral. People who are run down or stressed are prone to these ulcers.”

In some individuals, foods that are acidic, such as citrus fruits, can trigger a canker sore.²¹ In other cases a sharp surface, such as a dental appliance or braces, may also trigger the formation of a canker sore on the inside of the mouth or tongue. Although they look similar, they are not the same as cold sores, also called fever blisters, which are triggered by the virus herpes simplex type 1. Unlike canker sores, which are not contagious, cold sores are caused by a virus and are extremely contagious.

Another reaction to chronic irritation to the mucous membranes of your mouth is leukoplakia. These are white or gray patches that can develop at any time during life, but is most commonly seen in seniors.²² An unusual form of leukoplakia is hairy leukoplakia, often triggered by EBV and usually only seen in people infected with HIV. Common leukoplakia white patches are the result of an excess growth of cells and usually painless.²³

They are associated with smoking and have up to 17 percent chance of developing into oral cancer. The condition is triggered by irritation to the mucous membranes, so when the offending source has been eliminated, the lesion should disappear within a week or two. Dr. Ada Cooper, an American Dental Association consumer adviser, advises you see your dentist if the patches don’t disappear in two weeks, as your dentist may recommend a biopsy.

Infections May Pass From One to Another

Oral thrush is a yeast infection that can be easily passed between infant to breast during breastfeeding or from person to person with an exchange of oral fluids, such as when kissing. The infection appears as a white patch, often the consistency of cottage cheese.

The elderly, individuals with weakened immune systems, people with diabetes, individuals using inhaled steroids for asthma and those who have recently taken antibiotics are more likely to experience oral thrush.²⁴ The yeast infection is caused by the overgrowth of candida, which may change your taste or cause discomfort.

Aging and Allergies Contribute to Symptoms on Your Tongue

Fissures, or deep grooves that form on the tongue surface, may be the result of aging, but may also be an inherited trait, occurring normally in 10 percent of the population.²⁵ In most cases, they are not cause for concern. A fissured tongue may have cracks, grooves on the top and sides but affect only the tongue and vary in depth.

While they are not dangerous, they do allow debris to build up and increase the potential for an infection triggering bad breath and altered taste.²⁶ These fissures often appear first during childhood, but do deepen with age and become more pronounced as you get older.²⁷

Geographic tongue is a condition characterized by patches changing in size and location, which have a map-like appearance.²⁸ In some cases, you may experience soreness or burning. Typically harmless, the condition affects up to 14 percent of Americans and may look like hills and valleys on your tongue.²⁹ It can be triggered by stress, hormonal changes or allergies and once the offending source has been removed, the condition often resolves.

Higher Rates of Oral Cancer in Men Than Women

In 2017 an estimated 51,000 Americans were diagnosed with oral cancer.³⁰ The rates of oral cancer are more than twice as high for men as they are for women and it is the eighth most common cause of cancer among men. While the number of men diagnosed with oral cancer has remained steady in recent years, the number of women has decreased slightly.

Cancer of the tongue is the second most common head and neck cancer.³¹ Major risk factors include tobacco and alcohol use.³²Persistent red lesions that do not resolve, or patches that don’t go away, maybe a sign of lingual cancer. Tylor comments,³³ “With tongue cancer, you often think of an older, unhealthy person. 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.”

Oral cancers can also be caused by the human papillomavirus (HPV) and many lesions don’t cause any pain or discomfort in the early stages. Other signs of oral cancer include bad breath from an infected ulcer, ear pain affecting one side of your head, unexplained weight loss, numbness in your mouth and unexplained loose teeth.³⁴

Sources and References

• ¹ Biology Dictionary, Frenulum
• ² WebMD, Picture of the Tongue
• ³ Centers for Disease Control and Prevention, Micronutrient Facts
• ^4, 17, 32 Stanford Medicine, Examination of the Tongue
• ^{5, 14, 19, 20, 23, 26, 29, 33} Readers Digest, 9 Surprising Secrets Your Tongue Can Reveal About Your Health
• ⁶ Journal of Pharmacy and Bioallied Sciences, 2014; 6(Supplement1):S21
• ⁷ Scalloped Tongue, What Vitamin Deficiencies Cause Scalloped Tongue?
• ⁸ WebMD, Kawasaki Disease
• ^{9, 15, 18, 25, 28} Evolve Dental, The Tales Your Tongue Tells About Your Health
• ¹⁰ WebMD, Iron Rich Foods
• ¹¹ Prevention, May 23, 2016
• ¹² Dietitians of Canada, Food Sources of Zinc
• ^13, 16, 24 Cleveland Clinic, What Your Tongue Can Tell You About Your Health
• ²¹ WebMD, Dental Health and Canker Sores
• ²² WebMD, Dental Health and Leukoplakia
• ²⁷ WebMD, Fissured Tongue
• ^30, 31 American Society of Clinical Oncology, Oral and Oropharyngeal Cancers: Statistics
• ³⁴ Reader’s Digest, 13 Silent Signs of Oral Cancer You Shouldn’t Ignore

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