On the Tip of my Tongue

The tongue is a hugely important muscle in your mouth. It helps you talk and taste, so it is necessary to examine it at your semi-annual cleaning and check-ups and between visits in your bathroom mirror. Early detection leads to a better prognosis should something go wrong with your tongue cells.

A healthy tongue will look moist and rough, with its normal tongue-like color. When it’s been affected by something, the tongue may look patchy, fissured, red, or coated. When the tongue is unhealthy, it might present as areas with patches (red, white, or a mix of both) that are ulcerated or swollen.

If an examination finds something “different” and the change can be attributed to an obvious source (e.g., “I bit my tongue two days ago”), the area can be observed over the course of a few days or weeks. However, if there is any doubt regarding a spot or lesion, it may be appropriate to refer to an oral pathologist. Tongue lesions sometimes require a biopsy to diagnose.

According to the National Health and Nutrition Examination Survey, the prevalence of tongue lesions in US adults is 15.5 percent. Lesion prevalence is increased in those who wear dentures or use tobacco. The most common tongue condition is geographic tongue, followed by fissured tongue and hairy tongue.


geographic tongueGeographic tongue, also known as benign migratory glossitis, affects 1 to 14 percent of the U.S. population and is of unknown cause. Although previous research pointed to associations with diabetes, psoriasis, seborrheic dermatitis, and atopy, recent analysis of population data from U.S. patients does not support these findings. The prevalence is higher among white and black persons compared with Mexican Americans, and it has an association with fissured tongue and an inverse association with cigarette smoking.


Fissured_TongueWith fissured tongue, deep grooves can develop due to physiologic deepening of normal tongue fissures. These typically occur with aging and require no treatment, unless trapping of food and bacteria leads to inflammation of the fissures. Gentle brushing of the tongue is useful in persons with symptomatic inflammation. Fissured tongue has been associated with Down syndrome, acromegaly, psoriasis, and Sjögren syndrome.


black_hairy_tongue_1_highAccumulation of excess keratin on the filiform papillae on the tongue’s surface leads to the formation of elongated strands that resemble hair. The color of the tongue can range from white or tan to black. Darker coloration results from the trapping of debris and bacteria in the elongated strands. This occurs most commonly in smokers and in persons with poor oral hygiene. Hairy tongue has been associated with use of certain antibiotic medications. Most patients are asymptomatic, but some have bad breath or abnormal taste. No treatment is required, but gentle daily debridement with a tongue scraper or soft toothbrush can remove keratinized tissue.


rhomboidMedian rhomboid glossitis is characterized by a smooth, shiny, red, asymptomatic, plaque-like lesion in the middle of the tongue’s surface with a defined edge. Men are affected three times more often than women. Most persons with the condition are asymptomatic, but burning or itching is possible. Median rhomboid glossitis is commonly associated with a candidal (fungal) infection and responds to antifungals (e.g., nystatin, fluconazole [Diflucan], clotrimazole). If the palate of the mouth is also affected, it may be indicative of immunosuppression.

If you suspect a problem with your tongue, call Bell Dental, PA and make an appointment with Dr. Katie Bell or one of her team to check it out.