What does a healthy tongue look like?
The top surface of a healthy tongue is pink, slightly rough and moist. This rough texture is created by small projections covering the top of the tongue, called papillae. The fine and numerous filiform papillae give the tongue a velvety look; the redder, rounder fungiform papillae scattered among them help with taste. The larger papillae arranged in a V shape at the back of the tongue are normal and are sometimes mistaken for a lump.
A thin whitish coating on the top of the tongue in the morning is usually normal too. What matters is being able to notice new, pronounced or persistent changes on the tongue.
What is geographic tongue?
Geographic tongue (medically known as benign migratory glossitis or erythema migrans) is a condition in which papillae are lost on the top and sides of the tongue, creating smooth red areas. These red areas are usually bordered by a thin white or yellowish line, and the appearance resembles a map.
- Most distinctive feature: The patches are not fixed; they change shape and position over days or weeks, and can disappear and reappear.
- Cause: Not known for certain. Its occurrence in families suggests a genetic predisposition; it has been reported to flare with stress and to share features with psoriasis.
- Symptoms: Most people have no complaints. Some feel burning with spicy, hot or acidic foods.
- Treatment: Usually not needed. If there is burning, avoiding irritating foods and soothing measures recommended by the clinician can help.
A similar appearance can also occur outside the tongue, on the inner lip or cheek mucosa; this is called ectopic geographic tongue.
What causes hairy tongue?
In hairy tongue, the keratin on the surface of the filiform papillae does not shed as it normally would; it builds up and the papillae lengthen. As a result, the top of the tongue, especially the middle and back, looks hairy or carpet-like. It may be white, or yellow, brown or black when substances from tea, coffee, tobacco and pigment-producing bacteria accumulate on the lengthened papillae.
Contributing factors include:
- Inadequate tongue cleaning and a soft, low-fibre diet
- Smoking and heavy tea and coffee consumption
- Changes in the oral flora after antibiotic use
- Dry mouth and mouth breathing
- Long-term, inappropriate use of certain mouthwashes
Hairy tongue is harmless but can cause bad breath and changes in taste. The basis of treatment is gently cleaning the tongue every day with a soft toothbrush moistened only with water, or a tongue cleaner. It usually clears up completely, but it can recur if the habits continue.
A condition not to be confused with it: A white appearance that cannot be wiped off, in the form of vertical lines on the sides of the tongue (oral hairy leukoplakia), is not hairy tongue; it may be associated with conditions in which the immune system is suppressed and always requires assessment by a clinician.
What are fissured tongue and median rhomboid glossitis?
Fissured tongue means having deep grooves and cracks on the top of the tongue. It affects about five per cent of the population and can become more pronounced with age. It is not a disease in itself; however, if food debris collects in the grooves, irritation and bad odour can develop. Regular cleaning with a soft brush is usually enough. It is common for it to occur together with geographic tongue.
Median rhomboid glossitis is a smooth, oval or diamond-shaped red area without papillae, in the midline of the top of the tongue, near the back third. It is thought to be associated with candida (yeast) infection. Some cases regress with antifungal treatment while others remain unchanged. Although it is a typically located, unchanging area, it is advisable to show it to a clinician when you first notice it.
How can tongue changes be told apart?
| Condition | Appearance | Does it move? | General approach |
|---|---|---|---|
| Geographic tongue | Map-like red areas with white borders | Yes, within days | Usually no treatment needed; support if there is burning |
| Hairy tongue | White, brown or black hair-like coating | No | Daily tongue cleaning, reducing triggers |
| Fissured tongue | Deep grooves and cracks | No | Cleaning the grooves |
| Median rhomboid glossitis | Smooth red area in the midline | No | Examination, antifungal treatment if needed |
| Suspicious lesion | White or red patch, or sore, on the side or underside | No | Examination and biopsy without delay |
What do redness, smoothness and burning of the tongue indicate?
When the whole tongue becomes red, shiny and smooth (atrophic glossitis), it is often the oral reflection of an internal condition. Iron, vitamin B12 or folic acid deficiency, oral thrush, dry mouth and some medicines can cause this picture. A burning tongue, changes in taste and pain may accompany it. In this case, in addition to an examination, blood tests and, if necessary, an assessment by a family doctor or internal medicine specialist are recommended. It is important to identify the cause first rather than starting supplements on your own.
When is a change on the tongue dangerous?
See a clinician without delay in the following situations:
- A white or red patch on the side or underside of the tongue that cannot be wiped off
- A patch or sore that does not move and does not go away within two weeks
- Hardness, a raised area or a lump when touched
- Numbness of the tongue, restricted movement or a change in speech
- Bleeding with no identifiable cause
- A lump in the neck that does not go away
The side and underside of the tongue are among the most common sites of oral cancer. For this reason, it is especially important for people who smoke and drink alcohol to have these areas checked regularly.
Frequently asked questions
Is geographic tongue contagious?
No. Geographic tongue is not an infection, it is not contagious and it does not turn into cancer. Its higher frequency in some families suggests a genetic predisposition.
Why has my tongue turned black?
The most common cause is black hairy tongue, where the fine projections on the tongue’s surface lengthen and pigments from coffee, tea, tobacco and bacteria build up on them. Antibiotic use, dry mouth and inadequate tongue cleaning make it more likely. It usually regresses with regular tongue brushing.
Is brushing the tongue really necessary?
Yes. The top of the tongue is an area where bacteria and food debris build up. Gently cleaning it with a soft brush or tongue cleaner reduces bad breath and helps prevent irritation in hairy tongue and fissures.
Why does a white patch on the side of the tongue matter?
The side and underside of the tongue are among the most common sites of oral cancer. Any white or red patch in this area that cannot be wiped off, does not move, becomes hard or does not go away within two weeks should be examined by a clinician and biopsied if necessary.
What causes a burning tongue?
Geographic tongue, oral thrush, dry mouth, iron, B12 or folic acid deficiency and some systemic diseases can cause a burning tongue. Finding the cause requires an examination and, if necessary, blood tests.
Related pages
Not sure about a change on your tongue? For an examination at our clinic in Bahçelievler, Istanbul, message us on WhatsApp or call +90 544 289 66 33.
Sources: Ibsen OAC, Phelan JA. Oral Pathology for the Dental Hygienist, 6th ed., Saunders/Elsevier, 2014. Abubaker AO, Benson KJ (eds). Oral and Maxillofacial Surgery Secrets, 2nd ed., Mosby/Elsevier, 2007.
This article is for information only; diagnosis and treatment planning are determined solely by a doctor after an examination.
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\"Dr. Dt. Mehmet Fuat Bozaba, İstanbul Medipol Üniversitesi Periodontoloji Anabilim Dalı\'nda doktorasını tamamlamış uzman diş hekimidir. Bahçelievler\'de Yayla Dental Akademi bünyesinde ileri klinik uygulamalarla hizmet vermektedir. Temel uzmanlık alanları arasında dental implantlar, Khoury ve Urban teknikleriyle ileri kemik rejenerasyonu ve diş eti çekilmelerinin tedavisi (pembe estetik) yer almaktadır. Bugüne kadar 1000\'den fazla implant ve gömülü yirmilik yaş diş cerrahisi ile 700\'ü aşkın diş eti grefti operasyonunu başarıyla gerçekleştirmiştir. Sağlık turizmi kapsamında yurt dışından gelen hastalar için ileri düzeyde İngilizce dilinde tedavi imkanı sunmaktadır.\"
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