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 (look at the section on snoring) 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 (look at the section on bad breath).

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 (British Medical Journal 2008;336:728)

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 (British Dental Journal 2000;188:657–8).

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 (Journal of Periodontology 2002;73:289 –97). 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.

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Thursday, June 3rd 2010

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Comments on this article

Posted by zoe on 15/07/2010 at 02:15:14 pm

i have a reddidh blosh on the left side of my tounge. what is it? is it serious?

Posted by Fairoz on 09/07/2010 at 09:39:55 pm

Dear Sirs/Madams, My son ,is facing a small proplem,his tounge front side came flat now,he is only 3 weeks now, Let me know it creates any problem? Regrds Fairoz

Posted by Optional on 07/07/2010 at 11:38:58 pm

The Tongue gets heavy in the late afternoom followed by general body weekness

Posted by Optional on 06/07/2010 at 06:20:28 am

I have a small, hard lump on my tongue. It has been there about 2 months. It is sore at times, and it sometimes looks pink and sometimes it looks white. I went to the dentist and he said it was something to do with a papilla and it would go away, but it still hasn't 2 months later. Should I be worried and ask him again?

Posted by Paul on 16/06/2010 at 03:55:34 pm

You write on Patchy tongue "Geographic tongue is not a sign of disease – it is normal and nothing to worry about." Geographic tongue is one of the primary symptoms of Vitamin B12 deficiency. This is a serious disease called pernicious anemia and is deadly if not treated. Ignore a geographic tongue can cause serious never and spinal cord damage. Please update your web site and learm more about pernicious anemia. Thanks, Paul for further info refer to: http://www.pernicious-anaemia-society.org

Posted by madhu on 16/06/2010 at 04:08:28 am

last six months I have the following problem. some red dots appear on the edge of the tongue. the inner walls of mouth/cheek also has some problem. I can feel it. spicy food irritates. a few days less and then increases and then partly subsides.

Posted by Optional on 14/06/2010 at 12:48:52 pm

Hi i had hot food last nite now the side of my tonuge hurts

Posted by Clayten on 09/06/2010 at 01:50:16 am

Hi, please help me out with determining what illness or desease i could be having, about a month a ago i got severe headaches, nausia, vomiting blood and lost a few kilo's. I have been to the docter twice and have been admitted in emergency where i was told i got a stamach ulcer.. I have tested for HIV through testing and through my urine.. Urine being clean and no sign of infection, my tongue now turns white with coating at the back when i wake up and my taste has become poor, and these headaches just don't want to go away! I also have pain in my legs sometimes cramps which are painful.. I have a strange looking bean that popped out a month ago on the top of my hand, my left knee also pains at times when i walk or just ly down without doing any activities.. Please help me please

Posted by Optional on 07/06/2010 at 11:08:51 pm

every year i frequently used to have red sore on my tongue which gives me huge burning sensation and my tongue dried up often.

Posted by Optional on 31/05/2010 at 01:54:36 pm

on the tip of my tounge approx the size of a dime is a bright red spot surrounded by a thin but obvious darker area, somtimes it is very sensitive to heat & cold, its been there about two weeks, what could it possibly be, incidentally it is flat

Posted by Optional on 29/05/2010 at 07:02:43 am

Had everything I needed to know, thank you.

Posted by Optional on 27/05/2010 at 10:40:45 am

funny taste in my mouth tongue feels like its been burned feels like got ulcers on the tip of tongue to

Posted by Optional on 22/05/2010 at 11:19:56 pm

To all those that are thinking about getting a tongue ring, DON'T DO IT! To those of you who already have one, TAKE IT OUT! Get something else pierced. I am a registered dental hygienist and I've seen many patients that have chipped their teeth or cracked pieces of them off. I've also noticed gingival recession (gums that have receeded) and grooves wore in the back of the anterior teeth from constant rubbing.This will cause extreme sensitivity and tartar will have an easier time building up due to the root exposure. I've also read about it causing periodontal disease. If your goal is to keep the teeth God gave you while your here on earth, my advice to you is to pierce anything but your tongue. If you choose to do so, you'll have a future filled with dental bills from trying to keep your teeth(if you have insurance or lots of money).

Posted by ANNIE on 17/05/2010 at 03:04:35 pm

I have white pimples on top,peeling on left side ,and a clusterlike pimples on the right side of my tongue. Iwas told that they are ulcers, or my taste buds are swollen .Help

Posted by Optional on 08/05/2010 at 07:54:23 pm

I sometimes get one small blister on the underside of the tip of my tongue. It seems to occur usually when I'm eating crap or drinking a lot, but I'm not sure if diet is related. They're uncomfortable, but popping them usually makes them go away and feel better quite quickly. What causes these?

Posted by Optional on 08/05/2010 at 05:18:02 pm

i have had a white ulcer on the side of my tongue for about 2 weeks which is very painful any possible suggestions for a cure

Posted by Rose on 07/05/2010 at 12:01:50 pm

Hello, I have just recently felt that i got black spot on my tongue and i feel pain when i try to talk, I am very worried what to do? Please advice.

Posted by Optional on 06/05/2010 at 01:11:42 pm

White tongue,but mine is black due to smoking. Apart from tongue scraper and stopping smoking, is there any medication I can take? I have false teeth. Thank you.

Posted by optional on 18/04/2010 at 10:05:18 am

what is it when there are white patches on your tongue and on the side of your mouth? What can i do to get it to go away?Why does it hurt so bad when i talk or even eat?

Posted by Jaadsz on 14/04/2010 at 03:32:24 pm

- Yeah , this helped me out , buut can i still use my ordinary toothpaste that i use now if i want to get my tongue peirced , like for example colgate , annd for a mouthwash can i use corsodyl.. ?

Posted by Optional on 28/03/2010 at 10:28:36 pm

Hi i have recently pierced my tounge aprox 5 days ago. Out of no were on one side of my tounge has become raw what do i do.

Posted by Lea on 25/03/2010 at 07:38:53 am

i got my tongue pierced a week ago and still can hardly eat or drink as everything stings. i think i might have ripped it whilst eating as the hole is bigger than it was and is alot more painful than it was a few days ago. can anyone help?

Posted by Vijay on 24/03/2010 at 08:32:52 am

Sirs, I have been suffering very cronic ulcer on my left side of tongue and I cunsulted so many/different doctors and done biopsy twice, after all everybody prescribing multivitamins and antibiotics but so far no any cure, still it is increasing with very painfully. so, what is the ultimate remedy and whom I cunsult properly. please let me know. Thanks and your valued information would be very delightfull and appreciable. Vijay

Posted by Frosty on 24/03/2010 at 07:46:06 am

woke up one morning, (after a weekend of too much sugar) and i noticed a thin white line along the right side of my tongue at the front. i had something similar 3 years ago, it was removed and not cancerous. looks like this ----- but white, same length and same thickness any ideas? i will be seeing the doctor in one week if this doesn't go away. no pain no discharge. it's just there.

Posted by Nana on 24/03/2010 at 02:05:18 am

I have black dots on my tongue, what does that mean?

Posted by Optional on 23/03/2010 at 06:40:55 am

thankza

Posted by Optional on 23/03/2010 at 05:17:28 am

I use to bite my tongue with my grinding teeth , and everytime small skins get teared out, I like this , this has become my habbit. what should I do ? Is it dangerous ?

Posted by Optional on 22/03/2010 at 12:29:58 pm

i have white tounge since a long time now. i think its been there for years now. since the last one week i have been trying hard to get rid of it. i know that i have started off late. but i am hoping for a miracle to happen that would turn my tounge into pink healthy colour.

Posted by Harpreet on 22/03/2010 at 01:34:45 am

excellent explanations of every thing related to the problem

Posted by Kirstie on 16/03/2010 at 06:31:10 am

ive had my tongue pierced just over a year and in the past couple of days ive had a titanium bar in. i had to take it out because its started to swell up so i changed it back to the stainless steel one. but the swelling still hasnt went down. is there anything i can do to make it go down?

Posted by Nicole on 16/03/2010 at 01:36:48 am

umm... so i got my piercing like for christmas so i had it for 3-4months, and its been fine. i've been looking things up on the internet and im like thats never happened but everyones different. and so i would say if you want the piercing just go for it because you can take it out but make sure you think it through and dont just let any piercer pierce you make sure they check your tongue and make sure they dont hit a vien or so. and it doesnt hurt when they pierce it, it does hurt after tho like when the swelling comes, but it works. and you have to eat like water.ish things like yogurt or ice cream and cold things mostly for 2weeks or 1 depends. and stay away ! from hot foods or drinks like soup coffee ect. and i've had mine no problems so just because some things scare you dont worry bcuz theres a small chance it will happen to you, and just remember its a piercing you can always take it out. FOR DATERS~ you can take it out (duh!) and my boyfriend loves it, he did get used to it considering we kiss (haha) and now he says he loves it, my guy friend kissed me (hahaha) to see what it felt like he liked it and then he kissed a normal girl (aka. no piercing) and he was like wow the piercings a bit more fun. and now he wants to get one (ahahahahah) but ya i love it, my bf loves it (espically the kissing part) (aahahhaha) and ya. and sorry bout the ( ) parts i just want them to be there insted of saying hahaha anyways so ya, if anyone has question just say HEY NICOLE I GOT A QUESTION FOR YA. (haha) and btw it does not cause cancer, other shit does. ~ hope i helped and any question ? ~

Posted by Optional on 12/03/2010 at 02:00:10 pm

I want to get my tongue pierced but does it cause cancer? x

Posted by Optional on 06/03/2010 at 08:05:15 pm

i got mine done and my eye keeps twiching i dnt no whyy :(

Posted by Optional on 05/03/2010 at 06:13:03 pm

My mother told when I was born that I had a skin that came off of my tongue. The whole skin came off and left my tongue raw like. I've been having my whole life with tongue, anything I eat or drinks bothers me. My grandmother took me to the doctor, but he said he never seen anything like this before. So, he gave me some drops to put on it, but it stills bothering me. Recently, how ever the crack has split to the tip of my tongue. It doesn't hurt, but it's kinda of disturbing looking. I don't know what to do, I opinion before going to the doctor again.

Posted by Optional on 04/03/2010 at 04:22:25 pm

iv had my tounge done now for over a year, i love it. took me years to get corrage to get it done. anyway the place where i went was great, nice girl did it. she told me everything before & after. i had time to look into this coz i was scared off having it done for over 4 years. lol my dad went mad but mum was bit better, anyway i was old enough & its my body. it didnt really hurt , just uncomfy. it was over in a jif. it did bleed {trust me} but stoped. she said id have to take it out if it didnt stop. anyway everything was fine, i drunk cold ice drinks,sucked on ice cubs etc etc. but now iv notticed iv got something under the bottom bar bit,its like extra skin or something & my piercering is a littel sore.it feels bit like iv just had it done. im scared to go to doctors just in case i have to take it out, but im going to go on monday. i dont want it to get worse or anything & im not telling my parents either. : [ some peopel to might think we all stupid for getting it done but stupid peopel is the ones who dont get it done by experts, like doing it themselves or a m8 doing it. getting tounge piecerd is no joke

Posted by Optional on 03/03/2010 at 11:04:59 am

I have a sore tongue which stings, and there are a lot of cracks and splits at the end. Even sensitive toothpase stings, and special mouthwashes

Posted by Anonymous on 17/02/2010 at 07:42:43 am

Had tongue done 6 days ago, going to get bar changed tomorrow, no problems, yeah i struggled to talk when it was swollen i find it difficult to eat with the bigger bar in, no expert but yeah it will bleed and puss, the peircer should have warned you about this

Posted by Optional on 17/02/2010 at 01:52:08 am

My problem is a stromg yellowing of the tongue and bad breath

Posted by colin mcmillan on 10/02/2010 at 06:42:00 pm

there is a patch on my tonuge that is red raw the doctors say it is not thrush?

Posted by Anonymous on 07/02/2010 at 02:27:00 pm

I have white tounge with red smooth looking areas and the tounge feels more sense to hot drinks and less sense of taste, at the same time i have a sore throat and mouth ulcers. What should i do?

Posted by rob on 06/02/2010 at 12:01:00 pm

i have a yellow lump on my side of my tongue half the size of a finger nail been there 2 years i bit my tongue at the time 2 years ago and its been there ever since

Posted by ~Dj~ on 02/02/2010 at 04:06:00 pm

ight so i pierced my tounge myself and for the first week or two it was swollen and it was hard to eat...it also discharged a little but that's perfectly normal....for anyone with questions the best i can tell you is talk with a docter an understanding, adult, your piercer, and go to google and look it up on your own....thats the best way to decide wheather or not you still want it. Look up the dangers and pics of what infections look like that way you also know if you get one.

Posted by samantha on 01/02/2010 at 10:28:00 pm

my tongue feeld like iv burnt it, but i havent. it looks very pale and as what looks like little tiny cracks on my togue. what could is be?

Posted by maddison on 21/01/2010 at 05:18:00 pm

I just had mine pierced last week and was so freaked out when I researched it online. I went in with a huge list of questions and my piercer and I went over each one it detail. He made me feel so much better about having my tongue pierced. They will check your tongue and make sure you don't have any veins in the way. I ended up closing my eyes tight and humming to myself and before I could get halfway through my child's favorite nursery rhyme, it was over! It was really swollen the next day but i could still eat solids just in smaller bites and taking more time.

Posted by paige on 20/01/2010 at 09:44:00 pm

Im about to have my tongue done for my birthday next week. My moms not keen on the idea and had asked me to research it b4 i do it. Ive looked it up on the net and have read all kinds of stories about paralising and trouble breathing? Im not sure i want it done now ... its really put me off. Is there any1 out there who actually never experienced problems? I was soo set on gettin this done ...

Posted by Anonymous on 17/01/2010 at 12:20:00 pm

My tongue has little cuts/cracks on the side and on the top for as long as I can remember. It looks more painful than it actually is, yet sometimes they burn a little or feel like ulcers. what is is??

Posted by Abbiee on 12/01/2010 at 03:04:00 pm

I had my tongue pierced in october and for about a week i found it hard to eat with the long bar in but after i got it changed to a smaller one i couldnt even tell it was in my mouth, i got a big of greenish discharge coming out of it for about 2 weeks but thats normal so dont worry. if it carrys on for more than 3 weeks after you got it pierced though you might want to get it checked out at the hospital. i had to block mine up about 5 weeks after i got it done due to work, and i really miss it loads, so getting it done again soon. a tip after getting it pierced is keep sucking on icebubes too keep the swelling down and keep eating soft food for about 4 days, and keep taking painkillers in the recommended amount of times apart for around 4 days too. Also be careful not to catch forks on the bar after just getting it pierced, trust me, it hurts! Hope this helps x

Posted by anonymous on 12/01/2010 at 02:51:00 pm

i have a light red patch on center of tongue, no pain or sensitivity when eating or brushing it. its shaped almost like a diamond. Been 6 months now & has not gone away..going to doctor today to check it..will write again w/ results..stay tuned.

Posted by vampiress on 11/01/2010 at 10:16:00 pm

hello i had a friend tell me that its not good to have your TONGUE PIERCED cause it has been proven to be very unhealthy for you with all the bactirea and stuff. it may cause heart problems cause i have mine done so is all this true?

Posted by Anonymous on 31/12/2009 at 10:29:00 pm

i got my tongue done yesterday it is swollen and i ave noticed puss can any 1 help

Posted by anonymus on 29/12/2009 at 10:57:00 am

I've had my tongue pierced for about two months.After the first month my tongue began getting this really sticky film and yellowish color.I have to constantly brush my tonge,Ive also had cracks around my piercing.I'm worried I might have an infection,could you please help me?

Posted by Stephany on 16/12/2009 at 10:08:00 pm

I got my tounge pierced a week ago and I got this like bold spot on the side of the tounge pierce, it is not on the hole but is like next to it... Is it infected? =[

Posted by Worried on 14/12/2009 at 06:43:00 pm

I have small but wide cracks on my tongue and a big white blister. What could this be????? it's sore...)-: