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, including providing a snapshot of your overall health.
Symptoms of many chronic and acute illnesses can appear on your tongue. In fact, sometimes they’re among the very first signs that something is amiss.
So what’s normal for a tongue? “Pinkish-red–not bright red–with bumps and waves,” says Sally Cram, DDS, consumer advisor for the American Dental Association and a practicing periodontist in Washington, DC.
Anything else could be a sign of one of these health conditions.
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, white coating on your tongue, says Cram. Some people describe it 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 specialist at Piedmont Healthcare in Atlanta. “The tongue can be kind of shriveled up and lose some of its normal appearance.”
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 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.
Nowadays, there are many effective treatments for HIV/AIDS, including medication to prevent infection and its many consequences.
In celiac disease, eating gluten triggers the immune system to attack the small intestine. Bowel symptoms like constipation, diarrhea, 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" 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. Anything acidic or spicy or containing alcohol can really burn.”
Celiac disease can make your tongue burn or feel 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, 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'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 bump or sore on your tongue (or elsewhere in your mouth) that lingers longer than two weeks needs to be checked out.
A condition called leukoplakia can produce white patches on your tongue caused by uncontrolled growth of cells in your mouth. Leukoplakia can be harmless, but it 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.
A healthy tongue is pinkish-red in color. A bright red tongue could be a sign of not enough folic acid, vitamin B12, or iron. Often these deficiencies can be corrected with supplements and/or tweaks to your diet.
Don’t automatically freak out if your tongue blares red in the mirror. It could just as easily be from that strawberry smoothie or some too-hot soup that burned. Taste buds grow back!
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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 bumps on your tongue can also be from grinding your teeth or biting 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.