A healthy tongue is typically pink in color, though it may vary slightly in dark and light shades. An unhealthy tongue, however, may be white, red, black, or yellow and may also be swollen and tender.
When it comes to your health, you may be used to looking out for differences in your energy levels, your skin, and blood pressure. One often overlooked window into your health includes your tongue.
While your dentist will look at your tongue for any clues pertaining to oral cancer, there’s other changes you can be on the lookout for yourself.
Generally speaking, any significant changes in color or the development of pain and lumps may indicate a health problem. However, there’s a wide range of possible changes to your tongue, all with different outcomes.
First, it’s important to gain a sense of what’s normal for a tongue.
A healthy tongue is typically pink in color, but it can still vary slightly in dark and light shades. Your tongue also has small nodules on the top and bottom. These are called papillae.
One of the first noticeable symptoms of an unhealthy tongue is a significant change in color from the normal pink shade you’re used to seeing.
Other signs of concern can include pain when eating, drinking, and swallowing, as well as new lumps and bumps.
Below are possible causes of tongue abnormalities based on color. This list only serves as a guide. Be sure to see your doctor right away if you notice any of these changes.
White tongue
Thick, white patches or lines on the tongue are one of the most common issues that can affect an otherwise healthy tongue. Some causes are harmless, while others need medication and careful attention.
Oral thrush
One possible cause is oral thrush. The Candida albicans fungus causes it, creating thick, white to green cottage cheese–like patches on top of the tongue as well as the insides of your cheeks.
Oral thrush is most common in the following groups:
- infants and toddlers
- older adults
- people with diabetes
- people who use dentures
- people who use inhaled steroids for asthma and COPD
Oral lichen planus
Oral lichen planus consists of white lines across the top of the tongue. These may resemble lace. While it’s important to get a proper diagnosis for this condition, oral lichen planus itself usually goes away on its own without treatment.
Leukoplakia
Leukoplakia consists of thick white patches in the mouth and tongue. Unlike the fungus that causes oral thrush, leukoplakia occurs due to cell overgrowth in your mouth.
A dentist usually diagnoses leukoplakia. Some cases are benign, while others could lead to cancer.
Red tongue
The following conditions may cause your tongue to appear red or purple rather than pink in color:
Geographic tongue
Sometimes red patches with white borders on the tongue could be a sign of a condition called geographic tongue. The name refers to the maplike appearance of the tongue patches. It affects about 1 to 2.5 percent of people in all age groups.
This condition is usually harmless, though the patches may shift positions over time.
B vitamin deficiencies
A red tongue may also signal B vitamin deficiencies. This is particularly the case with folic acid (vitamin B-9) and cobalamin (vitamin B-12).
As these vitamin deficiencies are resolved, you’ll notice an improved appearance in your tongue.
Kawasaki disease
Kawasaki disease is a more serious condition that’s most common in children under 5 years of age. It causes a high fever along with a strawberry-like appearance in the tongue.
Not all cases are life threatening, but Kawasaki disease may increase the risk of heart complications if left untreated.
Scarlet fever
Scarlet fever, which coincides with strep throat, is another serious condition that requires prompt treatment. Like Kawasaki disease, scarlet fever can make the tongue look like it has strawberries on top of it.
Your tongue may also have large bumps.
Yellow tongue
An often less serious tongue color is yellow. Bacterial overgrowth primarily causes yellow tongue. Other causes may include:
- smoking
- chewing tobacco
- taking certain vitamins
- psoriasis
- jaundice, but this rare
Black and hairy
A black and hairy tongue may look concerning, but it’s usually harmless. Bacterial overgrowth on the tongue most commonly causes it. Your tongue may look dark yellow, brown, or black. Also, the papillae may multiply, giving off the “hairy” appearance.
This tongue condition may develop from:
- poor oral hygiene
- taking antibiotics
- diabetes
- chemotherapy treatments
Sore and bumpy
Have a doctor diagnose any new soreness or bumps on the tongue. Soreness and bumps may be even more concerning if you’re also experiencing pain.
Tongue soreness and bumps may result from:
- tobacco use, especially smoking
- mouth ulcers (canker sores)
- accidental tongue biting
- tongue burns from hot food and liquid
If soreness and bumps don’t go away within a couple of weeks, this could be a sign of oral cancer. See your doctor right away. Not all cases of oral cancer cause pain.
While no healthy tongue is identical to another, here’s a few images of what the “typical” tongue can look like, as well as images of conditions that can affect the tongue.
Treatment for each case of tongue discoloration varies on its underlying cause. Some causes require medications, such as:
- antibiotics for scarlet fever
- antifungals for oral thrush
- vitamin B-12 supplementation for deficiency
- folic acid (vitamin B-9) supplementation for deficiency
- anti-inflammatory drugs for Kawasaki disease
The following conditions don’t usually require treatment. Instead, you may resolve them by adopting better oral health practices:
- geographic tongue
- yellow tongue
- black, hairy tongue
- oral lichen planus
If your tongue changes are attributed to medications or vitamins, talk to your doctor about the possibility of finding an alternative. This may be helpful, especially if your tongue is bothering you.
Your primary care doctor will look at your tongue during your annual physical. At your dental cleanings, either the hygienist or dentist will take a look at your tongue as part of your exam.
Still, it’s important to keep track of any changes in your tongue throughout the year.
As a good rule of thumb, see your doctor if you notice any significant changes in the color of your tongue, especially if it lasts longer than 2 weeks.
Also call your doctor if you have pain, swelling, or lumps on the tongue. The earlier that any tongue issues — and their underlying causes — are diagnosed, the quicker you can receive treatment.
It’s also important to catch oral cancer as soon as possible. See your dentist twice a year, and let them know if you have a history of tobacco use. Tobacco use is a common cause or cancers of the mouth and throat.
While often inconspicuous, your tongue can tell a lot more about your health than you may realize.
If there are any unusual changes in color, such as white, yellow, or red, see your doctor right away.
Don’t let any pain, color changes, or new lumps go undiagnosed.
