The Truth About Your Tongue Problems

In the olden days doctors were very keen on asking patients to put out their tongue, and made all sorts of diagnoses from its appearance. It is true that some conditions can alter the appearance of the tongue (for example, a smooth, red, sore tongue may be a sign of anaemia), but the appearance of the tongue normally varies a lot between individuals.

‘Bald’ tongue

The tiny projections that cover the surface of the tongue are called ‘papillae’. If you could examine them under a microscope you would see that the papillae are tiny folds of the surface of the tongue. Each is surrounded by a trench, rather like a castle surrounded by a moat. In each trench, there are several clusters of cells sensitive to various tastes; these are the actual taste buds. If we did not have any papillae, the tongue would be very smooth and slippery, and not very efficient at moving food round the mouth. Some animals (such as cats) have very prominent papillae, which is why their tongues feel so rasping.

 

There are two different sorts of papillae on the tongue – flat ones and slender ones. The slender type are paler in colour. The flat type are bright red in colour and slightly shiny.

 

Bald sides of the tongue. It is normal for the sides of the tongue to look balder than the middle. The main surface of the tongue is covered by the pale, slender papillae. The flat, shiny papillae cover the sides and tip of the tongue (with a few scattered on the main surface of the tongue, looking like small red spots). Therefore it is normal for the edges of the tongue to look flatter and more shiny.

Patchy tongue

About 2% of people have a patchy appearance of the tongue, called ‘geographic tongue’. This sometimes runs in families. The patches are red areas with a distinct margin, and in these areas the slender papillae are reduced. It looks a bit like a map, which is how it got the name ‘geographic’. In some people, the papillae are lost only from the sides of the tongue, or the sides and tip. The papillae usually grow again but this can take a long time and, meanwhile, a new patch may be occurring on another part of the tongue. Geographic tongue is not a sign of disease – it is normal and nothing to worry about.

Furred tongue

Instead of looking pink, your tongue may seem to have a greyish-white coating. This is not a sign of disease. It is more common in heavy smokers, people who breathe through their mouth rather than their nose and people who eat mainly soft foods (perhaps because they do not want to wear their false teeth). Debris, bacteria and dead cells collect between the papillae and build up into a coating. Eating more high-fibre foods such as vegetables can help or you can discuss it with your dentist, who may suggest that you obtain a tongue scraper.

 

Very occasionally, the tongue appears to be black and hairy. This is caused by the papillae of the tongue growing longer than usual and becoming brown in colour. No one knows exactly why this occurs, but it may be made worse by taking antibiotics, using antiseptic mouthwashes, smoking and poor oral hygiene. Try using a tongue scraper and, if it persists, ask your dentist for advice.

White patches

There are two main causes of white patches.

• White patches on the tongue and inside of the cheeks may be caused by thrush, a fungal infection that is common in babies and also in adults who have been taking antibiotics or have been unwell. These patches can be scraped off to leave red, sore areas underneath, and can be improved by special lozenges from your doctor.
• White patches that are not sore, cannot be scraped away and do not go away on their own (leukoplakia) are sometimes an early warning sign that the area could become cancerous in the future. These patches should be checked by your doctor so they can be dealt with before they develop further.

Ulcers and lumps on the tongue

Most people have ulcers on their tongue from time to time. Usually they are very sore, but so small that they are difficult to see. They are harmless, and clear up in a day or two without any treatment. However, you must not ignore a lump on the tongue or an ulcer that doesn’t heal, even if it is painless, because it could be a cancer. Get it checked by your doctor if it is still there after 2 weeks. Cancer of the tongue is unlikely under the age of 50.

Dark, swollen tongue

If your tongue suddenly becomes dark in colour and swells up, see your doctor straight away to check the condition of your temporal arteries. Narrowing of these arteries can reduce blood supply to the tongue.

Tongue piercing

Tongue piercing is normally safe, but it is theoretically possible that it could lead to infection with hepatitis B, hepatitis C or HIV, and it can cause other health problems. So think very carefully about the risks before having it done.

 

Obviously you must make sure that the person doing the piercing is experienced and that the piercing parlour is hygienic. This may be difficult, because there are no official qualifications or training standards for body piercers in the UK. Check the piercer uses clean needles for each person, disposable gloves and antiseptics, and has a ‘sharps’ box (as in a doctor’s surgery) for disposing of each used needle. The jewellery is not sterile, so ideally the piercer should sterilize it in an ‘autoclave’ (as in a doctor’s surgery). Usually, however, the jewellery is wiped with antiseptic or boiled before insertion; this lessens the risk of infection but not as absolutely as autoclaving. Ask about all of this before you decide to have it done.

 

Bleeding. There is a very slight risk of serious bleeding when you have the piercing done. This is because the tongue contains lots of blood vessels. Because you naturally swallow the blood, you may not realize how much you are bleeding. Doctors at the London Hospital, UK, have given the following advice to anyone having a tongue piercing.

• Reduce the risk of swelling by sucking ice cubes hourly for the rest of the day.
• If your tongue swells, making it difficult to swallow or breathe, go to the nearest Accident and Emergency Department straight away.
• Every 4 hours, and after eating, give yourself a salt-water mouth bath to help prevent infection. This means dissolving 1 teaspoonful of salt in a glass of hot water, and immersing the site of the piercing for at least 2 minutes. This is awkward but possible – you have to fill the glass fairly full.
• If the area round the jewellery becomes red and tender, you may have an infection. Go to your doctor or an Accident and Emergency Department.
• If part of the jewellery becomes dislodged and you may have swallowed or inhaled it, go to your nearest Accident and Emergency Department.
• If the piercing bleeds, press it firmly with a clean cloth (for example, a clean handkerchief) for half an hour. If it continues to bleed, go immediately to the Accident and Emergency Department.

Other problems. Bleeding is the most serious, but tongue piercing can cause other problems.

•    The jewellery may damage your teeth and gums. A study from Ohio State University found that almost half the people wearing a tongue stud for more than 4 years had chipped teeth, and 35% had receding gums because of the stud banging against the gum. The longer the stud had been present, the worse the damage.
• The pierced site could become infected, but this seems to be fairly unusual in the tongue compared with other parts of the body (maybe because of its good blood supply). Resist the temptation to fiddle with the newly inserted stud.
• Because different parts of the tongue are sensitive to different tastes, some people find that a piercing affects their sense of taste. It can also cause slight difficulty in speaking clearly. If you need an operation, you will be asked to remove the tongue jewellery, because it can cause difficulties with the anaesthetic.
• Allergy is another problem, because the metal may not be pure. You may think that you have pure gold or steel jewellery, but it may contain substantial amounts of nickel, which can cause a sensitivity. When scientists in Finland tested body jewellery, they found that 11 of the 12 items they tested exceeded the EU safety limits for nickel. Surgical stainless steel with the mark 316L is of good quality and is unlikely to cause sensitivities. Niobium is an expensive metal, but is least likely to cause sensitivities.
• The piercing can allow bacteria to enter the bloodstream. In a recent case in the USA, the bacteria from a tongue piercing damaged the valves of the heart.