A dentist is urging people to pay attention to their tongue, as changes can signal infections or low iron and vitamin levels that should be checked. Dr Nilesh Parmar, clinical director of Parmar Dental Group in Essex, who also works with Emergensee, a network of private emergency dental practices, said dentists examine the tongue during routine check-ups because it can reveal a lot, from an infection to low iron or vitamin B12.
Most changes are harmless and clear up on their own, but anything new that does not settle is worth getting checked. Persistent ulcers, unexplained lumps, or red or white patches should also be assessed by a dentist, particularly if they persist for three weeks.
Why the Tongue Changes
The tongue is covered in tiny projections called papillae. According to the British and Irish Society for Oral Medicine, every tongue carries a coating of mucus, cells, bacteria and other debris, which the tongue's movement and saliva normally clear away. A 2016 review in The Open Dentistry Journal links a smooth tongue, where the tiny bumps on its surface have been lost, with conditions including iron and vitamin B12 deficiency.
Dr Parmar has shared some common issues, what they might be and what you need to do about them.
Common Tongue Conditions and What They Mean
A white coating is not usually serious, according to the NHS, which suggests brushing your tongue or using a scraper to help improve it. A dry mouth makes a coating more likely, according to the British and Irish Society for Oral Medicine, and the NHS lists breathing through your mouth at night, which can happen with a blocked nose, among the main causes of a dry mouth. A white tongue can also be a sign of oral thrush, or of leukoplakia, white patches that cannot be rubbed or scraped away.
Hairy tongue happens when the papillae grow longer than usual, and it can look yellow, dark brown or black. The British and Irish Society for Oral Medicine lists smoking, drinking a lot of tea or coffee, a dry mouth, poor oral hygiene and some medicines among the factors that make it more likely, and says it is harmless and not linked to mouth cancer. Dr Parmar explained: "A black or brown furry tongue looks worrying, but it's usually harmless. The tiny bumps on the tongue grow longer and pick up staining from tea, coffee, smoking and some medicines. Gently cleaning your tongue each day and drinking more water can help."
Geographic tongue is a common, harmless condition that causes smooth red patches with pale or white edges, which can look like the outline of a map, according to the Oral Health Foundation. It happens when the surface of the tongue sheds and renews itself unevenly, the patches can change shape or move over time, and it cannot be passed on. Some people notice soreness or burning, particularly with acidic, hot or spicy food.
The NHS lists a sore or red tongue among the symptoms of vitamin B12 or folate deficiency anaemia, and a sore tongue among the less common symptoms of iron deficiency anaemia. It says B12 or folate deficiency anaemia should be diagnosed and treated as soon as possible, as some of the problems it causes can be irreversible if left untreated. Dr Parmar said: "A sore, red or unusually smooth tongue can be a sign of low iron, vitamin B12 or folate. If it doesn't settle, see your GP, especially if you're also tired or short of breath. A blood test is better than treating it with supplements yourself, as the reason your levels are low also needs to be found."
When to Get Your Tongue Checked
Scarlet fever occurs most often in winter and spring, according to the UK Health Security Agency. The NHS says it can start with flu-like symptoms such as a high temperature and a sore throat, followed by a rash that feels rough, like sandpaper. A white coating appears on the tongue and then peels, leaving it red, swollen and covered in little bumps, known as "strawberry tongue". It is less common in adults than in children. The NHS advises seeing a GP if you have symptoms, and checking with the surgery before you go in, as scarlet fever spreads very easily. It is treated with antibiotics.
The NHS says mouth ulcers should clear up on their own within a week or two, and advises seeing a dentist or GP about one that lasts longer than 3 weeks. It also advises getting a red or white patch in the mouth, a lump, or pain that is not going away checked by a GP or dentist. It says to call 999 if your lips, mouth, throat or tongue suddenly become swollen, as this can be a sign of a serious allergic reaction.
