In the olden days, doctors were very keen on asking patients to put out their tongue and made all sorts of diagnoses from its appearance. It is true that some conditions can alter the appearance of the tongue (for example, a smooth, red, sore tongue may be a sign of anaemia), but the appearance of the tongue normally varies a lot between individuals.
What Is Normal?
Papillae. Although the tongue feels smooth most of the time, it is actually covered with many tiny projections called papillae that contain the taste buds. If you could examine them under a microscope you would see that the papillae are tiny folds of the surface of the tongue. If we did not have any papillae, the tongue would be very smooth and slippery, and not very efficient at moving food round the mouth. Some animals (such as cats) have very prominent papillae, which is why their tongues feel so rasping.
There are three different sorts of papillae on the tongue (filiform, circumvallate papillae, fungiform). Noticeable swellings in a line across the back of the tongue are normal – these are larger papillae.
Sore Swollen Tongue
The tongue can become swollen and smooth (glossitis) if you have anaemia, vitamin B deficiency, candida thrush, or herpes simplex infection (cold sores). Other things such as dentures, too much alcohol or spicy foods, or smoking, can also cause your tongue to swell. If these factors don’t apply to you, or if the sore tongue persists after reducing alcohol or smoking, ask your doctor about the likely cause. It may be that eating a better diet or taking tables for anaemia or a vitamin deficiency will improve your sore tongue and make you feel generally better.
Red Patchy Tongue
The cells on the surface of the tongue normally have a short lifespan and are quickly replaced by new cells. About 2% of people have a patchy appearance of the tongue, called ‘geographic tongue’ in which the cells of the papillae are lost more rapidly than usual, leaving a bare red patch on the tongue for a few days. This sometimes runs in families. Most people have no symptoms, but some may have a sensitivity to hot or spicy foods. The patches are red areas with a distinct margin, and in these areas the slender papillae are reduced. It looks a bit like a map, which is how it got the name ‘geographic’. In some people, the papillae are lost only from the sides of the tongue, or the sides and tip. The papillae usually grow again but this can take a long time and, meanwhile, a new patch may form on another part of the tongue. As new papillae grow, the patch appears to move across the tongue. Geographic tongue is not a sign of disease – it is normal and nothing to worry about.
Instead of looking pink, your tongue may seem to have a greyish-white coating. This is not a sign of disease, although a white coating on the tongue can be a sign of candida. It is more common in heavy smokers, people who breathe through their mouth rather than their nose (look at the section on snoring) and people who eat mainly soft foods (perhaps because they do not want to wear their false teeth). Debris, bacteria and dead cells collect between the papillae and build up into a coating. Eating more high-fibre foods such as vegetables can help or you can discuss it with your dentist, who may suggest that you obtain a tongue scraper (look at the section on bad breath).
Black Hairy Tongue
Very occasionally, the tongue appears to be black and hairy. This condition is very imaginatively called ‘black hairy tongue’. It is caused by the papillae of the tongue growing longer than usual and becoming brown in colour. No one knows exactly why this happens, but it may be made worse by taking antibiotics, smoking, alcohol or poor oral hygiene. Black hairy tongue is harmless but lasts a long time. Try using a tongue scraper, or gently scrub the tongue with mouthwash using a toothbrush. Drugs are available that may help, but they have significant side effects. Discuss this with your doctor or dentist, who will tell you what treatments may help and will advise you about the downsides.
There are two main causes of white patches:
- White patches on the tongue and inside of the cheeks may be caused by thrush, a fungal infection that is common in babies and also in adults who have been taking antibiotics or have been unwell. These patches can be scraped off to leave red, sore areas underneath, and can be improved by special lozenges (normally nystatin drops) from your doctor.
- White patches that are not sore, cannot be scraped away and do not go away on their own (leukoplakia) are sometimes an early warning sign that the area could become cancerous in the future. These patches should be checked by your doctor or dentist so they can be removed before they develop further.
Ulcers and Lumps on the Tongue
Most people have ulcers on their tongue from time to time. Usually they are very sore, but so small that they are difficult to see. These ‘apthous’ ulcers are harmless, and there are many possible causes (a virus being just one of them). They will clear up in a day or two without any treatment. However, you must not ignore a lump on the tongue or an ulcer that doesn’t heal, even if it is painless, because it could be a cancer of the tongue or mouth. These larger ulcers are more likely to occur in someone who has been a heavy drinker of spirits or a smoker.
Any ulcer that does not disappear on its own within 3 weeks should be checked by your doctor. Cancer of the tongue is unlikely under the age of 50.
Tongue piercing is normally safe, but it is theoretically possible that it could lead to infection with hepatitis B, hepatitis C or HIV, and it can cause other health problems. So, think very carefully about the risks before having it done.
Obviously, you must make sure that the person doing the piercing is experienced and that the piercing parlour is hygienic. This may be difficult, because there are no official qualifications or training standards for body piercers in the UK. Check the piercer uses clean needles for each person, disposable gloves and antiseptics, and has a ‘sharps’ box (as in a doctor’s surgery) for disposing of each used needle. The jewellery is not sterile, so ideally the piercer should sterilize it in an ‘autoclave’ (as in a doctor’s surgery). Usually, however, the jewellery is wiped with antiseptic or boiled before insertion; this lessens the risk of infection but not as absolutely as autoclaving. Ask about all of this before you decide to have it done.
Bleeding. There is a very slight risk of serious bleeding when you have the piercing done. This is because the tongue contains lots of blood vessels. Because you naturally swallow the blood, you may not realize how much you are bleeding. Doctors at the London Hospital, UK, have given the following advice to anyone having a tongue piercing (British Dental Journal 2000;188:657–658).
- Reduce the risk of swelling by sucking ice cubes hourly for the rest of the day.
- If your tongue swells, making it difficult to swallow or breathe, go to the nearest Accident and Emergency Department straight away.
- Every 4 hours, and after eating, give yourself a salt-water mouth bath to help prevent infection. This means dissolving 1 teaspoonful of salt in a glass of hot water and immersing the site of the piercing for at least 2 minutes. This is awkward but possible – you have to fill the glass fairly full.
- If the area round the jewellery becomes red and tender, you may have an infection. Go to your doctor or an Accident and Emergency Department.
- If part of the jewellery becomes dislodged and you may have swallowed or inhaled it, go to your nearest Accident and Emergency Department.
- If the piercing bleeds, press it firmly with a clean cloth (for example, a clean handkerchief) for half an hour. If it continues to bleed, go immediately to the Accident and Emergency Department.
Other problems. Bleeding is the most serious, but tongue piercing can cause other problems.
- The jewellery may damage your teeth and gums. A study from Ohio State University found that almost half the people wearing a tongue stud for more than 4 years had chipped teeth, and 35% had receding gums because of the stud banging against the gum (Journal of Periodontology 2002;73:289–297). The longer the stud had been present, the worse the damage.
- The pierced site could become infected, but this seems to be fairly unusual in the tongue compared with other parts of the body (maybe because of its good blood supply). Resist the temptation to fiddle with the newly inserted stud.
- Some people find that a piercing affects their sense of taste. It can also cause slight difficulty in speaking clearly. If you need an operation, you will be asked to remove the tongue jewellery, because it can cause difficulties with the anaesthetic.
- Allergy is another problem because the metal may not be pure. You may think that you have pure gold or steel jewellery, but it may contain substantial amounts of nickel, which can cause a sensitivity. Surgical stainless steel with the mark 316L is of good quality and is unlikely to cause sensitivities. Niobium is an expensive metal but is least likely to cause sensitivities.
- The piercing can allow bacteria to enter the bloodstream.
- We each probably have about 10,000 tastebuds on our tongues. Tastebuds in all locations on the tongue can detect only four tastes – sweetness, saltiness, acidity, and bitterness. Sense of smell helps to increase our range of tastes, which is why we lose our sense of taste when we have a cold
- The tongue is one of the most touch-sensitive organs in the body; for example, it can detect tiny hairs that our fingers are unable to feel
- Without our tongues, we would not be able to chew, swallow, taste or talk
- The tongue doubles in length, width and thickness between birth and adolescence
First published on: embarrassingproblems.com
Reviewed and edited by: Dr Anna Cantlay
Last updated: October 2020