What the tongue says about your health

One of the first things doctors are taught in medical school is to examine the tongue and eyes of patients for subtle signs of health problems. These two organs can give clues on underlying organ dysfunction, including kidney or liver problems and even blood abnormalities. Bumps and spots on your tongue are often harmless, but sometimes, they can point to a serious health issue.

Pale tongue

The tongue and the rest of the mouth should ideally be a healthy pink colour. If it appears pale, you are likely to be anaemic. Anaemia is a medical condition caused by lack of micro-nutrients such as iron. It can also occur in people who have been unwell for long periods – for example, those who have kidney failure or women with abnormal uterine bleeding. People with anaemia complain of weakness, constant fatigue and dizzy spells. Treatment of anaemia targets the underlying cause.

White spots/patches

Fungal infection (oral thrush): this is a yeast infection of the mouth. It tends to occur in infants, the elderly (especially those who wear dentures) and people with a compromised (weakened) immune system— this includes diabetics, HIV positive people, people on long-term steroid use and patients on cancer therapy.

In a few cases, a mild case of oral thrush can occur after a prolonged course of antibiotics.

Oral thrush is treated with anti-fungal drops or tablets/syrup.

Leukoplakia:This is a condition in which the cells in the mouth grow excessively, leading to white patches on the tongue.

It tends to be more common in smokers and can be a precursor to cancer of the tongue. For this reason, you must always consult your doctor or dentist if you are concerned about persistent white patches on your tongue.

Oral lichen planus: This causes a network of raised white lines on your tongue that look similar to lace. The exact cause of these changes is not well understood and it often resolves on its own.

Black/brown and hairy tongue

Poor oral hygiene: The papillae of the tongue (tiny bumps on the surface of the tongue) can overgrow and allow bacteria to thrive leading to a brownish appearance of the tongue.

People with diabetes or receiving chemotherapy may also develop a black hairy tongue. Usually, this blackish/brown coating can be brushed/scraped off.

Medication: Some antacids or stomach ulcer drugs contain an ingredient known as bismuth, which can lead to a blackish coating of the tongue. This blackish tinge disappears once you stop taking the medication.

Geographic tongue

This condition causes a map-like pattern to develop on your tongue. There are reddish spots with a white border. A geographic tongue is harmless and does not need treatment.

Red/strawberry tongue

This could be a sign of vitamin B deficiency, scarlet fever or a rare disease affecting blood vessels known as Kawasaki’s disease. A strawberry tongue resolves once the underlying condition is treated.

It’s Painful...

Mouth ulcers:These are popularly known as ‘canker sores’ or ‘apthous ulcers’. These are painful shallow ulcers on the surface of the tongue, gums or inside of your cheeks. They usually resolve in a week or so (even without treatment).

Trauma:This could be as a result of biting the tongue or burning yourself whilst drinking/eating something hot. Poor fitting dentures can also injure your tongue, as does grinding your teeth.

Smoking:Smoking can irritate your tongue and dry your mouth leading to pain. Chewing tobacco can have similar effects. This resolves once you stop usage of tobacco products.

Drugs:Some medication can cause a metallic taste in the mouth. This includes some antibiotics. This usually disappears once you stop ingesting the drugs.

Burning mouth syndrome: in this condition, your tongue may have a bitter taste or it may feel like you scalded it with hot tea.

This is thought to be due to a problem with the nerves in your tongue. A bitter taste in the mouth may also be due to acid reflux.

Fissured or grooved

Deep grooves have been associated with Down syndrome, psoriasis, and Sjögren's syndrome.

They can also form on your tongue as you age. It is important to thoroughly clean these grooves when brushing your teeth. Bacterial overgrowth can lead to bad breath and tooth decay.

Red flag: Cancer of the tongue

Cancer of the tongue can present as a lump or sore that does not heal. Usually, the lump is painless in the initial stages. Your doctor or dentist should review any lump or sore that does not resolve in two weeks. Inexplicable tongue pain, difficulty chewing or swallowing should also elicit a medical review.

Hygiene and check-ups

The tongue must be cleaned twice daily with a soft brush to remove all food debris and discourage tooth decay, gum disease and bad breath. Dental check-ups must include a proper examination of your tongue. Dentists are trained to look for subtle clues of mouth cancer and may discover ‘red flag’ signs that you may not notice. Ensure you have properly fitted dentures and braces. Stop usage of tobacco products – they are the leading cause of mouth cancer.