What Your Tongue Can Tell You About Your Health

An unhealthy tongue may look red, smooth, or black. Other signs of tongue health include soreness and enlarged and swollen papillae, or the small bumps on your tongue. Tongue changes are sometimes the first signs that something is amiss. Symptoms of many acute and chronic infections and illnesses can appear on your tongue.

Your tongue is typically pinkish-red in color. Folic acid or vitamin B12 deficiency can cause your tongue to appear red or glossy. This change could also just be from red foods or beverages or hot soup that burned your mouth. 

Keep in mind that you cannot diagnose nutrient deficiencies by looking at your tongue. Other symptoms include:

• Hyperpigmentation, or skin color changes
• Impaired vision
• Mental state changes

Dietary changes or supplements can often correct nutrient deficiencies. Before starting any supplements, talk to a healthcare provider or pharmacist.

Papillae may become inflamed or swollen, which makes them larger and more noticeable than usual. Transient lingual papillitis (lie bumps) is the result of a lack of sleep, excessive smoking, and stress. These bumps are not usually a cause for concern. You can treat symptoms at home with pain relievers and saline mouthwash.

Other bumps that may occur on your tongue include:

• Canker sores: Painful ulcers caused by allergies, hormones, menstruation, and stress
• Chancres: Develop with syphilis, which is a sexually transmitted infection (STI)
• Lymphoepithelial cysts: Bumps that usually grow underneath the tongue
• Mucocele: A disorder of the salivary glands that causes mucus-filled cysts in your mouth
• Red sores: Occur with herpes and human immunodeficiency virus (HIV)
• Squamous papilloma: Typically occur with human papillomavirus (HPV) and are mostly benign, but large lesions can become cancerous

A dentist may want to check any bumps and sores on your tongue or elsewhere in your mouth that linger longer than two weeks. Oral cancers typically grow on the lateral and ventral surfaces of the tongue.

Glossitis is inflammation and swelling of the tongue that makes it look smooth. Atrophic glossitis, also known as “bald tongue” or “smooth tongue,” occurs if you lose some or all papillae. You may have symptoms like pain and taste changes.

Research has shown that atrophic glossitis is sometimes the only symptom of celiac disease. This autoimmune disorder, which is triggered by gluten, damages the small intestine. The hallmark symptoms of celiac disease are usually abdominal pain, bloating, constipation, and diarrhea. You might also notice that you lose the little hairs that dot the surface of your tongue.

Sjögren’s syndrome is another cause of atrophic glossitis. This autoimmune disorder targets the glands in your eyes and mouth that create moisture.

An overgrowth of the yeast (fungus) Candida albicans causes oral thrush. This yeast infection looks like a heavy, white coating on your tongue.

Conditions that may cause oral thrush include:

• Diabetes: Oral thrush is common among people with diabetes, especially if their blood glucose (sugar) is not within a healthy range. Some people with diabetes develop a weak immune system. This makes it hard for the body to fight off germs.
• HIV: Oral thrush is one of the first signs of HIV. A weak immune system, as with diabetes, is often the cause.
• Sjögren’s syndrome: Dry eyes and mouth may lead to oral thrush. Yeast starts to grow out of control if you do not have enough saliva.

An uncontrolled growth of cells in your mouth may produce white patches on your tongue that look similar to oral thrush. This condition, known as leukoplakia, can be harmless or lead to certain types of cancer. A healthcare provider may surgically remove the affected area. See a healthcare provider right away if you notice white cauliflower-like masses on your tongue.

Hairy-looking growths, or hairy leukoplakia, may appear on the sides of your tongue. Hairy leukoplakia normally goes away on its own. A healthcare provider may prescribe medications to treat them if they are severe or cause pain.

Common causes of hairy leukoplakia include:

• Epstein-Barr virus (EPV), which commonly causes infectious mononucleosis (mono)
• HIV/AIDS
• Weak immune system

A build-up of dead skin cells commonly causes a black tongue, which is generally not a sign of a severe condition. Dead skin cells may stop shedding due to poor oral hygiene or certain medications, including antibiotics.

Smoking and drinking a lot of coffee or tea can also cause a black tongue. Tobacco and caffeine can stain the papillae, which make your tongue look black.

A sore tongue might occur with diabetes. Canker sores, which are often a sign of stress, can also cause soreness. Try easing stress with deep breathing, exercise, meditation, and yoga.

Here are some ways to alleviate soreness:

• Take over-the-counter (OTC) pain relievers
• Gargle with warm salt water
• Avoid greasy foods in favor of soft and cold foods like yogurt

A burning sensation, or burning mouth syndrome, can be a symptom of xerostomia (dry mouth). Dehydration and certain medications commonly cause dry mouth.

Other causes of burning mouth syndrome include:

• Allergies to dental appliances or foods
• Depression
• Gastroesophageal reflux disease (GERD), which causes stomach acid to flow backward into the esophagus
• Nerve damage
• Nutritional deficiencies 
• Oral thrush
• Teeth grinding or jaw clenching

Macroglossia causes your tongue to be larger than average. It’s most common in people with conditions that are inherited or congenital (present at birth). Examples include Down syndrome and congenital hypothyroidism, or an underactive thyroid gland.

Fissures are deep grooves on your tongue in which food particles can become trapped. Common causes include older age, dehydration, and vitamin deficiencies. Conditions like Down syndrome and Sjögren’s syndrome, which causes dry eyes and mouth, may also cause fissures.

Your tongue may be able to tell you a lot about your overall health. It’s important to know what your tongue looks like when it’s healthy. A healthy tongue is a pinkish-red color. A moist layer of tissue, or mucosa, lines the surface of your tongue.

You will notice papillae, which look like small bumps on the back of your tongue. Your taste buds, which help you taste the salty, sweet, or sour flavors of food, sit among papillae.

A healthcare provider can prescribe treatments based on your symptoms and what’s causing them. It’s essential to see a dentist at least twice per year to make sure your teeth and tongue are healthy.

Here are some ways you can clean your tongue at home naturally:

• Avoid tobacco and caffeine: Avoid smoking and drinking coffee or tea to avoid staining the papillae on your tongue.
• Brush your tongue: You can clean your tongue using a soft-bristled toothbrush while brushing your teeth. Make sure to brush your teeth at least twice per day with fluoride toothpaste.
• Eat a nutrient-rich diet: Limit sugary foods and drinks.
• Use a tongue scraper: This U-shaped tool cleans your tongue. It pulls bacteria and dead skin cells off of it.

Reach out to a healthcare provider if symptoms do not improve or if it’s hard to breathe or eat. Make sure to keep note of symptoms like pain, swelling, breathing problems, dysphagia (difficulty swallowing), and problems with speaking or moving the tongue. A healthcare provider may order blood tests or a biopsy to check for other conditions.

Your tongue helps you taste, eat your food, and talk, and it also provides a snapshot of your overall health. Signs like a red, smooth, black, or sore tongue and bumps or soreness may be signs of several infections and illnesses. Consult a healthcare provider if you notice your tongue is not its normal pinkish color or develops thick, cottage-cheese-looking spots or ulcers.