What Your Tongue Says About Your Oral Health: Colour, Coating, Ulcer

Tongue is one of the vital sensory organs which plays an important role from eating to speaking. It provides a nidus for food debris, bacteria, and contaminants. When tongue is not cleaned properly, it can cause bad breath, tooth decay or an oral lesion. There seems to be a direct relation between your tongue and oral health. Tongue oral health is determined by pink colour and has nodules on it called papillae. Any deviation from normal appearance of it or pain could be a matter of concern.

Who is this article for?

This article is for patients who notice changes in their tongue colour, coating, texture, ulcers, burning, bad breath, or soreness and want to know when it is normal and when it needs dental attention. It is especially useful for people with white tongue, red patches, tongue cuts, dry mouth, tobacco habits, diabetes, vitamin deficiency, dentures, or recurrent mouth ulcers. The tongue cannot diagnose the whole body by itself, but it can show early signs of oral hygiene problems, infection, irritation, nutritional deficiency, or oral disease.

What does a healthy tongue usually look like?

A healthy tongue is usually pink, moist, and slightly rough because of small natural bumps called papillae. A thin coating may be normal, especially in the morning, but a thick white layer, painful red patch, non-healing ulcer, swelling, bleeding, or lump should be checked. Patients should not panic about every colour change, but any change that persists for more than two weeks needs professional evaluation.

Why dentist check tongue oral health during routine visits

During a dental check-up, the dentist does not only check teeth. The tongue, cheeks, lips, palate, throat area, and floor of the mouth are also examined for ulcers, patches, swelling, injury, tobacco-related changes, and oral cancer warning signs. This is why regular dental visits are important even when there is no tooth pain.

Colours of your Tongue and Oral Health

Open your mouth and look at your tongue. That may sound strange, but your tongue can tell a lot about your oral health. For example, a black and hairy looking tongue can signal poor oral hygiene, or diabetes. If your tongue is bright red like a strawberry, it could signal a deficiency in folic acid, vitamin B12, or iron. A red tongue may indicate heat in the body like a fever or a hormonal imbalance. A reddish purple tongue is a sign that there may be inflammation or an infection in the body somewhere. A pale pink tongue may be a sign of a vitamin deficiency, a weak immune system or a lack of energy.

White coating on Tongue

Oral Thrush or Candidiasis: Its caused by a yeast called Candida Albicans. White layer over the tongue resembles a cottage cheese. Most commonly seen in infants, denture wearers and people with weak immunity. This seen in patients with diabetes, or who are under steroid treatment. Long term antibiotic use may cause Oral Thrush in few patients.

Leukoplakia: In this condition there a white patch on tongue that cannot be scrapped-off. It may be a pre-cancerous lesion. Advanced forms may develop red patches which are a matter of clinical concern. This may lead to bad breath.

Oral-hairy Leukoplakia: It presents as corrugated hairy white lesion on sides of the tongue caused by Epstein Virus, commonly seen in HIV positive patients with weaker immunity.

Oral Lichen Planus: It presents as interlacing network of raised white lines on it. Clinically, not of much significance and should be kept under observation only.  

Red colour is associated with burning mouth in oral health:

Vitamin Deficiency: Folic acid and Vit B12 deficiency cause red lesions on it. Screening by blood test will help determine their levels. This may lead to bad breath.

Geographic tongue’s: It is an inflammatory disorder. The affected tongue presents a bald, reddish area that surrounded by an irregular white border. The appearance results from loss of papilla. 

• Scarlet Fever: It is an infection of the tongue which gives a strawberry like appearance, caused by bacteria known as Streptococus pyogens. Antibiotics are helpful in treating the infection. 

• Kawasaki Disease: It is seen in children under the age of 5 years. It is a condition in which the tongue presents with a strawberry like appearance. 

• Hypothyroidism: Enlarged tongue with indentation on the lateral surface is indicative of a thyroid gland dysfunction.  

Causes: Stress, psychological factors, habits, allergies, diabetes, hormonal disturbances. 

• Ulcerations: Ulcers are a common concern due to a tongue bite. An ulcer should heal within 2 weeks. If any ulcer stays longer than 2 weeks, then a further investigation is necessary.  Watch the video to know more about oral ulcers.

• Tongue Piercing: More common in certain cultures. It leads to greater wear and tear of the natural tooth. There is a higher chance of  tooth breakage.  

Dentist sees relation between Tongue and oral health

1. Your dentist will look for any abnormalities within the mouth or symptoms that could possibly lead to oral cancer. For cancer prevention, your dentist will check your lips, head, neck, and mouth tissues.
2. Upon a closer examination of the tongue, your dentist will check the size and texture of the tongue to ensure a healthy mouth.
3. Your dentist may always check each and every one of your visible teeth during a dental check-up.
4. Your dentist would also take a close look at your tonsils and throat for any signs of infection or swelling. 

FAQs

Can tongue colour show oral health problems?

Yes, tongue colour and coating can sometimes suggest oral hygiene problems, dry mouth, infection, irritation, vitamin deficiency, tobacco effects, or fungal infection. However, colour alone is not enough for diagnosis. A dentist should check persistent changes.

When should I worry about a tongue ulcer?

A tongue ulcer should be checked if it does not heal within two weeks, keeps recurring, bleeds, becomes hard, or is associated with tobacco use, sharp teeth, burning, numbness, or difficulty swallowing.