Sure, your tongue helps you chew, swallow, and taste food–then gab about how delicious (or not!) the meal was. But your tongue can also do much more, but your tongue may say a lot about your health, including providing a snapshot of your oral and overall health.
Symptoms of many chronic and acute illnesses can appear on your otherwise healthy tongue. In fact, sometimes they’re among the very first signs that something is amiss. So what’s normal for a tongue? “A healthy tongue is pinkish-red–not bright red–with bumps and waves,” says Sally Cram, DDS, consumer advisor for the American Dental Association and a practising periodontist in Washington, DC.
Anything else on your usual healthy tongue could be a sign of poor oral hygiene or one of these health problems.
Diabetes
Oral thrush is common among people with uncontrolled diabetes. In fact, it can be the first sign that you have the chronic condition simply because people often see their dentist more regularly than a doctor. Thrush is usually the result of a weakened immune system. Thrush–essentially a fungal yeast infection and also called oral candidiasis–looks like a heavy, thick white coating on your normally healthy tongue, says Cram. Some people describe this fungal infection as the consistency of cottage cheese.
People with diabetes are also more likely to have dry mouth. “Most folks with diabetes are somewhat dehydrated,” says Ryan Kauffman, MD, an ear, nose, and throat doctor at Piedmont Healthcare in Atlanta. “The tongue can be kind of shriveled up and lose some of its normal appearance.”
HIV
Decades ago, when HIV/AIDS was an almost-certain killer, the white pasty covering on the tongue of oral thrush could be one of the first, ominous signs of infection.
Like with diabetes, a weakened immune system due to HIV or AIDS makes it hard for you to fight off organisms like yeast that normally co-exist happily in your whole body.
Red sores on your tongue and elsewhere in your mouth can also be a sign of HIV/AIDS, as can white hairy-looking growths on the sides of your tongue called hairy leukoplakia tongue.
Nowadays, there are many effective treatments for HIV/AIDS, including medication to prevent infection and its many consequences.
Celiac disease
In celiac disease, eating gluten triggers the immune system to attack the small intestine. Bowel symptoms like constipation, diarrhoea, bloating, and pain are the hallmarks, but celiac can also cause you to lose the little hairs that dot the surface of your tongue.
This is called atrophic glossitis–also known as “bald tongue”, “geographic tongue”, or “smooth tongue”–and it can cause taste changes and be painful, says Cram. “When you lose [those] hairs it can be very, very sore. Any acidic foods or spicy or containing alcohol can really burn.”
Celiac disease can make your tongue feel sore, burning, and dry if vitamins and minerals aren’t being absorbed properly through your small intestine. It can also lead to frequent canker sores on the tongue or other parts of the mouth.
The only way to manage celiac disease is to follow a strictly gluten-free diet.
Sjogren’s syndrome
Sjogren’s syndrome, another autoimmune disease, can attack many parts of the body, but it often affects the salivary glands and the tear ducts. This results in dry eyes and dry mouth, and dry mouth can lead to oral thrush.“
When you don’t have saliva with its protective enzymes, that fungus living at low levels starts to proliferate,” Cram explains. The signature white spots of thrush may appear, or your tongue may become red and smooth if the little hairs there have disappeared, she says.
Some people with Sjogren’s also have a burning sensation and cracking of the tongue.
Cancer
Cancer’s probably the last thing you think of when you go for a cleaning, but your dentist could be the front line in detecting head, neck, and oral cancers.
Any small bumps or sore on your tongue (or elsewhere in your mouth) that lingers longer than two weeks needs to be checked out for oral cancer.
A condition called leukoplakia can produce white patches on your tongue caused by the uncontrolled growth of cells in your mouth. Leukoplakia white patches can be harmless, but these white patches can also herald cancer down the line and should be checked.
Dr. Kauffman has seen an increase in one form of oral cancer in particular.
“There’s been a preponderance of HPV-related squamous cell carcinoma of the base portion of the tongue,” he says. “Kids [should be] vaccinated because we’ve seen this huge uptick that’s related to HPV.” Current guidelines recommend the HPV vaccine for girls and boys around age 11 or 12; it’s also recommended for women and men who weren’t vaccinated as preteens up to ages 26 and 21, respectively.
Vitamin deficiencies
A healthy tongue is pinkish-red in colour. Therefore, tongue colour analysis can tell a lot about your overall health and oral hygiene. A bright red tongue could be a sign of not enough folic acid, vitamin B12, or iron deficiency. Often these vitamin deficiency issues can be corrected with supplements and/or tweaks to your diet.
A bright red tongue could be telling signs of strep throat or Kawasaki disease. Kawasaki disease is a rare and usually treatable condition that causes inflammation in some blood vessels, typically among small children.
Don’t automatically freak out if you see a red tongue discoloration instead of a healthy tongue in the mirror. It could just as easily be from that strawberry smoothie or some too-hot soup that burned. Taste buds grow back!
Stress
Canker sores–not to be confused with cold sores, which are caused by a virus–can be a sign of stress. They can appear on your tongue or other parts of your mouth.
If you have these small, shallow sores, try gargling with warm salt water and avoiding greasy foods in favor of soft and cold picks like yogurt. Sores and small bumps on your tongue can also be from grinding your teeth or trouble chewing your tongue. “We see lots of benign masses and ulcerations on the tongue … just from bite trauma,” says Dr. Kauffman.
Ease stress with exercise, yoga, or meditation–and slow down while you’re chewing.
Note: All content and media on the Elevate Dental Richmond website and social media channels are created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice.
