How your tongue can hold health secrets

The tongue often times gives clues to a person's general health. It's one of the first ways to know that something is wrong.

Most tongue changes noticed by patients are normal and not a cause for concern.

However, many diseases affect the tongue, such as:

  • Cancer: squamous cell carcinoma, melanoma
  • Anemia
  • Vitamin and mineral deficiencies
  • Infectious diseases: HIV, herpes, genital warts, varicella zoster
  • Autoimmune disorders
  • Gastrointestinal disease

    Common issues affecting the tongue:

    Canker sores: one of the most common causes of sores in the mouth

  • More common in adolescence and young adulthood
  • Becomes less frequent in adulthood
  • Not contagious
  • If recurrent sores occur, this may be a sign of underlying disease

    Tongue Fissures:

  • Grooves in the tongue
  • can lead to a build-up of bacteria and bad breath

    Tongue discoloration (example, Black Hairy Tongue):

  • Caused by foods we eat
  • Tobacco
  • Antibiotics
  • Pepto Bismal
  • Dehydration
  • Treatment: good oral hygiene, cleaning of the tongue with scraper or toothbrush

    Tongue changes that should not be ignored:

    Thrush: Thick white coating or white plaques on the tongue which may be associated with burning. Caused by a build-up of yeast in the mouth

  • Compromised immune system from HIV/AIDS or other illnesses
  • Certain medications, such as oral steroids, steroid inhalers for asthma, antibiotics
  • Cancer and its treatment
  • Diabetes: when it is poorly controlled or a person doesn't know they have it, there can be an overabundance of sugar in the saliva which can cause the overgrowth of yeast on
  • Older adults are more prone to thrush than young adults

    Tongue Mass:

  • Tumors
  • HPV infection
  • Cancer
  • Most common: squamous cell carcinoma
  • Risk factors: smoking, chewing tobacco, heavy alcohol consumption
  • Pigmented lesion: melanoma


  • Inflammatory bowel disease: Crohn's Disease, ulcerative colitis
  • Celiac disease
  • Behcet's Disease
  • Infectious disease: Herpes, syphilis

    Glossitis: acute or chronic inflammation of the tongue; can be a primary tongue disorder or a symptom of another disorder

  • Allergic response to food, toothpaste, mouthwash, breath fresheners
  • Spicy foods, hot foods or beverages, tobacco, alcohol
  • Certain vitamin and mineral deficiencies: iron deficiency, vitamin B deficiencies
  • Mechanical irritation from injury, dental appliances
  • Bacterial or viral infections: herpes simplex, syphilis, HIV
  • Skin disorders, such as psoriasis


  • Beefy red appearance of the tongue
  • Soreness of the tongue
  • Smooth appearance
  • Difficulty with eating or speaking

    Benign Migratory Glossitis (also known as Geographic Tongue):

  • Benign condition of unknown cause
  • Bald patches on the tongue surrounded by a white border
  • The patches can change in appearance over the course of the day
  • Can cause tongue discomfort
  • No treatment available
  • Needs to be distinguished from: thrush, herpes, psoriasis, drug reaction

    Who should you go to if you have noticed changes on your tongue:

  • Dentist
  • ENT physician
  • Primary care physician

    Abnormalities in tongue appearance should be evaluated by one of these clinicians and never ignored!

    Examples of tongue issues:

  • Geographic tongue
  • Thrush
  • Canker sore
  • Squamous cell carcinoma
  • Anemia

    About /*Dr. Leah Millheiser*/:
    Dr. Millheiser oversees the Female Sexual Medicine Program, which is available to women of all ages in the discreet surroundings of our Stanford Hospital office. This clinic provides treatment for the following disorders: decreased libido; decreased arousal; anorgasmia; dyspareunia and vaginismus. We take a multidisciplinary approach to female sexual medicine, working in conjunction with a licensed sex therapist, pelvic floor physical therapist, as well as alternative health practitioners.

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