What Your Tongue Says About Your Health

Feeling under the weather?

Keeping an eye on your tongue could help clue you in to your overall wellbeing.

By Korin Miller Published on January 10, 2022

When you want to do a quick check-in on your health, you probably zero in on a few key areas of your body: your forehead to see if you have a temperature and your neck to scope out your lymph nodes. But there's one more spot worth investigating that you might be surprised to know: your tongue.

What does your tongue say about your health? It can actually signal whether or not you might have certain illnesses. "Your tongue can be affected by systemic diseases like the rest of your body," says Bridget Burgess, M.D., an otolaryngologist (ear, nose, and throat doctor) at Mass Eye and Ear. "Unlike some changes that can only be seen on blood work or by a specialty exam at your doctor's office, diabetes or immune deficiencies, for example, can manifest as changes on your tongue, which you may be able to see when you look in the mirror." But that's not all your tongue can teach you about your health. A change in color might hint at a fever while a suddenly glossy tongue could suggest that you're not getting enough of certain nutrients. And while you might be more accustomed to looking at other areas of the body when you're feeling under the weather, "there are some conditions that show up almost right away on the tongue," notes Mark Wolff, D.D.S., Ph.D., dean of the University of Pennsylvania School of Dental Medicine. That floppy organ in your mouth won't help you diagnose everything — nor should it, consult your doc for a final word — but what your tongue says about your health can be, well, telling. So, what should you be looking for on your tongue? First, it's important to understand the baseline or what's "normal" for a tongue. A healthy tongue is typically pink in color, although the hue can vary slightly to be darker or lighter depending on the individual. It's also covered with small nodules or bumps called papillae, according to the Cleveland Clinic. Anything outside of that, though, should be discussed with a doc. Now, here's what your tongue can say about your health — and what to do about it, depending on what you see. If Your Tongue Has a White Coating or White Spots.

Oral Trush

Oral thrush, aka candidiasis, is an infection caused by a yeast called Candida, according to the Centers for Disease Control and Prevention. Candida normally lives on your skin and inside your body without causing any problems but sometimes it can multiply and cause an infection in your mouth or other areas. (And yes, in case you were wondering, this is the same type of yeast that causes vaginal yeast infections.) In addition to white patches on your inner cheeks and tongue, this condition can come with some other uncomfortable symptoms, including a cotton-like feeling in your mouth, loss of taste, and pain while eating or swallowing, says Uchenna Akosa, D.D.S., director of Rutgers Health University Dental Associates. "It's a very white coating [on the top and sides of the tongue] and underneath [the tongue] can be red and raw," she explains. While anyone can technically get oral thrush, the condition tends to be more common in people who are immunocompromised or taking antibiotics or corticosteroids, adds Akosa. And just like the yeast infections of down under, candidiasis in the mouth is usually fairly easy to treat with either topical or oral antifungal medications depending on the severity, according to the CDC. Diabetes

Diabetes is a condition where your body either doesn't make enough insulin, a hormone that helps sugar enter your cells, or can't use the insulin it makes as well as it should, according to the CDC. And, when your body doesn't have enough insulin, you can end up with high levels of blood sugar circulating through your body. "Patients with diabetes can become immunocompromised if their blood sugars are not well controlled," says Burgess. "High blood sugar can impair the immune system's ability to do its job. Because of this, diabetics can develop oral thrush. Dry mouth is also common." Meaning, you could have a sandpaper-esque feel to your tongue or develop white patches. "It looks like a coating of the tongue," adds Akosa. If you've already been diagnosed with diabetes and your blood sugar isn't under control, these tongue changes can be a sign that you need to make some modifications to your treatment plan. But if you haven't received a diabetes diagnosis and are dealing with symptoms such as frequent urination, increased thirst, and weight loss without trying — in addition to a noticeably drier and whiter mouth — it's time to check in with your doctor. (See also: The 10 Diabetes Symptoms Women Need to Know About) Leukoplakia Open your mouth and notice white or gray patches in there? Then you might be dealing with leukoplakia, a condition that affects the mucous membranes of the mouth, thereby causing these white or gray patches to form on your tongue, cheeks, or gums, according to the U.S. National Library of Medicine (NLM). While the exact cause of this disorder is unknown, it may be brought on by irritation, such as that from rough teeth (a potential result of enamel erosion), rough spots on dentures, fillings or crowns, smoking or chewing tobacco, and drinking a lot of alcohol. Once the culprit is removed, leukoplakia and its patches should disappear, according to the NLM. That being said, it can be an early warning sign of oral cancer, so you'll want to check in with your doc — especially if it doesn't go away. "This should be looked at closely by a professional and possibly biopsied," says Cho. Oral Cancer A white or reddish patch that (unlike, say, a canker sore may or may not cause pain) inside your mouth, potentially on your tongue, could be a sign of mouth cancer, particularly when it presents at the same time as a growth on your tongue. It's important to note that a bump or sore on your tongue could technically be the result of any of the health situations covered here or otherwise, such as trauma (think: accidentally biting or burning your tongue on food) or a cold sore. But there's also a chance it could signal cancer, according to Mayo Clinic, so it's a good idea to check in with your doctor to have it evaluated. FWIW, there are two types of tongue cancer: cancer of the oral tongue (the front two-thirds of the tongue that you can stick out of your mouth) and cancer of the base of the tongue (the back one-third of the tongue that extends down the throat. The former typically presents as a lump on the side of the tongue that touches the teeth; it often resembles an ulcer, has a grayish color, and bleeds if bitten or touched. The latter, unfortunately, isn't typically noticeable until later stages, at which point it can cause pain, a sense of fullness in the throat, difficulty swallowing, voice changes, or ear pain, according to Cedars Sinai. If Your Tongue Has Indentations or Is Dry.

Anxiety More than 40 million adults in the U.S. have an anxiety disorder, according to the National Alliance on Mental Illness (NAMI). And while anxiety isn't usually something necessarily you can see, there are little clues on your tongue that you may be grinding and clenching your teeth as a result of it, whether it's more situational (e.g. due to a big presentation at work or, ya know, the pandemic) or due to a more chronic condition (e.g. general anxiety disorder), says Julie Cho, D.M.D., a general dentist in New York City. "A white scalloping will form on the sides of the tongue in heavy clenchers from the pressure the tongue exerts on the lower teeth," she says. Some people may also press their tongue against their front teeth firmly when they clench or grind, creating indentations in the tip of the tongue that match the teeth they're pushing up against, adds Wolff. "It looks weird but it's an exact fit around the teeth," he adds. Treatment can range depending on the severity of your mental health, some might benefit from just wearing a mouthguard to curb the grinding and clenching while others might also consider therapy to address the anxiety, explains Cho. "Once the…habit is addressed, for example, with a nightguard, the tissue will rebound." Meaning, the indentations should eventually go away from your tongue. As for the scalloping? Your best bet is to work on your overall mental health. (After all, everyone can benefit from trying therapy at least once.) Dry Mouth Dry mouth, aka xerostomia, is a feeling that there isn't enough saliva in your mouth, according to the U.S. National Library of Medicine. "It's a very common side effect we are seeing more and more with a multitude of medications from allergy meds to antidepressants," shares Cho. "Patients report their tongues feeling like sandpaper because the mouth gets so dry." This condition can also make your mouth feel sticky and can cause trouble chewing and swallowing, cracked lips, and even lead to an infection in the mouth if it goes on too long. If you're struggling with dry mouth and suspect a medication is to blame, it's a good idea to check in with your doctor to see if there are alternatives. But Cho says you can also try drinking more water and sucking on sugar-free candy to stimulate your salivary flow to try to get relief ASAP. If Your Tongue Is Smooth and Glossy.

Vitamin or Nutrient Deficiency There are a whole host of vitamin and nutrient deficiencies that can show up on your tongue, says Wolff. These may include low levels of folic acid, vitamins D and B, and iron to name a few. "All of the sudden, the tongue becomes glossy and loses texture," he says. "That's a real defining moment. The tongue is an amazing location in that respect that so many nutrient-bound conditions just pop right out on the tongue." Iron deficiencies (aka anemia), in particular, can cause a "flat, shiny, and red appearance of the tongue called atrophic glossitis," says Burgess. "This is from sloughing of the taste buds thought to be due to a lack of oxygenation as patients with anemia carry less oxygen in their blood." Especially low levels of vitamin B12 can also make your tongue sore, sleek, and "beefy-red in color," according to Stanford Medicine. This is more of a potential sign rather than an actual diagnosis, though. If you're concerned you might have a nutrient deficiency, it's important to check in with your health care provider, as they can do a blood test to determine your levels of specific nutrients. Treatment varies depending on the deficiency, but generally includes the use of supplements. (Just a friendly reminder that the Food and Drug Administration does not regulate supplements, so it's especially important to consult your doc before adding any to your routine.) If Your Tongue Is Red.

Kawasaki Disease Also known as Kawasaki syndrome, this illness causes inflammation and swelling in blood vessels throughout the body, such as those in your mouth, according to the Mayo Clinic. While it mostly impacts children, it can show up in adults, too. In addition to a very red, swollen tongue, telltale symptoms include a high fever (usually about 101°F) red eyes and/or rash on the main part of the body or genital area, swollen palms, and enlarged lymph nodes. "The tongue actually looks like a red strawberry," says Wolff. Kawasaki disease is treatable, and the sooner upon onset of symptoms, the better. So, the Mayo Clinic recommends reaching out to a practitioner if you or your loved one has a high fever for more than three days, experience so-called strawberry tongue, and any of the aforementioned symptoms (which, BTW, don't necessarily occur in tandem). Treatment for the red, swollen tongue caused by the condition comes down to treating the Kawasaki disease itself. That can include an IV infusion of an immune protein called gamma globulin that can lower the risk of coronary artery problems (remember: the disease causes swelling of the arteries) and high doses of aspirin. COVID-19 There isn't a ton of research out there about the so-called COVID tongue, but there is some. A research letter published in the British Journal of Dermatology in September 2020 found that more than 45 percent of 666 COVID-19 patients at a temporary field hospital in Spain had some kind of symptoms in the mouth, eyes, or parts of their genitalia. More than 25 percent of those patients had symptoms in their mouth, including redness and swelling of the tongue. (Read more: What Is COVID Tongue, and Is It a Sign You've Been Infected With the Virus?) But COVID tongue "depends on the severity of the infection," explains Akosa. "If you have a mild or moderate infection, you may just see a red tongue and slight white coating," she adds. And, of course, COVID-19 is linked with a loss of taste (and smell). "A smaller portion of patients with COVID-19 will also get tongue inflammation and some sloughing of taste buds that will actually alter the taste," says Burgess. "This is thought to be because of the ACE receptor that the virus uses to enter the cells. The cells of the tongue have a lot of these receptors on them." If you develop symptoms of COVID tongue, alongside other COVID-19 symptoms such as a cough, fever, or sore throat, it's important to get yourself tested. (See also: Everything You Need to Know About Coronavirus Testing) If Your Tongue Is Black and/or Hairy It sounds — and looks — rather freaky, but black hairy tongue (yes, that is how it's referred to by experts) is a temporary, harmless condition that, as you probably guessed, makes your tongue look dark and furry. That "fur" is actually the result of a buildup of dead skin cells on your papillae on the surface of your tongue. The papillae on your tongue grow over time (just like the hair on your head) and, in some people, they can become rather long. As such, they can easily trap and be stained by substances such as bacteria, yeast, tobacco, and food, according to the Mayo Clinic. This is what eventually causes a black, hairy tongue. Treatment usually involves practicing good oral hygiene (e.g. brushing your teeth twice a day) and weeding out factors that could cause the condition in the first place, such as smoking, excessive amounts of coffee or black tea, or using irritating mouthwashes. But, if you've tried that and you're still having issues, talk to your doctor.

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