DocSpot: Strange tongue

Rough and ready?

Although the tongue feels smooth most of the time, it actually is covered with many tiny swellings called papillae that contain the taste buds. Noticeable swellings in a line across the back of the tongue are normal - these are larger papillae. Each taste bud detects one type of taste best - sweet, salt, bitter or sour. The sweet and salt taste buds tend to be at the tip of the tongue, those which detect sour tend to be at the sides and those for bitter taste at the back of the tongue. The number of taste buds gradually reduces as we get older - which may be why food always seems to have tasted better in our youth!

The tongue can become swollen and smooth (glossitis) if you have anaemia, vitamin B deficiency or herpes simplex (cold sore) infection. Other things, such as dentures, too much alcohol or spicy foods, or smoking, can cause your tongue to swell. If these factors don’t apply to you, or if the sore tongue persists after reducing alcohol or smoking, ask your doctor about the likely cause. It may be that eating a better diet or taking tablets for anaemia or vitamin deficiency will improve your sore tongue and make you feel better generally.

My tongue has gone black!

Very occasionally, the tongue appears to be black and hairy. This condition is very imaginatively called ‘black, hairy tongue’. It’s harmless but lasts a long time, and is caused by the papillae of the tongue growing longer than usual and becoming brown in colour. It may be made worse by taking antibiotics, smoking, alcohol or poor oral hygiene. Try scrubbing the tongue gently with mouthwash using a toothbrush. Drugs have recently become available that may help, but they have significant side-effects. Discuss this with your doctor, who will tell you what treatments may help and advise you about any downsides.

A taste of the world?

The cells on the surface of the tongue normally have a short lifespan, being quickly replaced by new cells. In ‘geographic tongue’, the cells of the papillae are lost more rapidly than usual, leaving a bare red patch on the tongue for a few days. As new papillae are grown, the patch appears to move across the tongue. This condition is harmless and painless, rarely causing problems.

White patches

White patches on the tongue and inside of the cheeks may be caused by thrush, a fungal infection which 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 with special lozenges from the 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 lesion could become cancerous in the future. These patches should be checked by a doctor or dentist so they can be removed before they develop further.

Ulcers on the tongue

Most people suffer from tiny ulcers in the mouth, which are very sore but so small they are usually difficult to see, at some time. These ‘apthous’ ulcers are harmless and probably due to a virus. They clear up on their own within a day or two and don’t need any treatment. Occasionally, larger ulcers, which are not particularly painful, can appear. Sometimes due to cancer of the tongue or mouth, they are more likely to occur in someone who has been a heavy drinker of spirits or a smoker. Any ulcer that does not disappear on its own within a fortnight should be checked by your doctor.

Jonathan Belsey and Alison Martin

Last updated; Saturday, April 27th 2013

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