Tongue disease, which includes oral thrush, geographic tongue, glossitis, or black hairy tongue, can change the color of the tongue, making it appear white, black, or yellowish. Blisters, sores, or lumps may also appear.
Depending on the cause, tongue diseases can be accompanied by other symptoms, which may include fever, bleeding in the mouth, or pain or discomfort when speaking, chewing, or swallowing.
If changes in the tongue suggest a possible disease, it’s important to consult a primary care provider or dentist. They can determine the cause and begin the most appropriate treatment.
Main types
The main diseases that can appear on the tongue are:
1. Geographic tongue
Geographic tongue is a benign change that causes well-defined, raised red patches with white borders and a rough surface on the tongue.
This condition may be caused by stress, hormonal disorders, uncontrolled diabetes, tongue fissures, allergies, and hereditary factors.
How to treat: Geographic tongue does not cause other health problems, therefore treatment is usually unnecessary. Symptoms such as pain or burning can be relieved with analgesic sprays and by avoiding acidic or heavily seasoned foods.
2. Canker sores
Canker sores are inflammation of the lining of the mouth. They can also affect the tongue, causing reddish ulcers with a yellowish center.
Canker sores may develop due to eating very acidic foods, allergic reactions, reduced immunity, use of antibiotics and corticosteroids, low levels of vitamins B and C, or sexually transmitted infections (STIs).
How to treat: A primary care provider or dentist should be consulted and may recommend 1% triamcinolone-based pastes or ointments, which reduce irritation and help canker sores heal, or medications to treat the condition that led to the canker sores.
In addition, laser therapy and chemical cauterization may be recommended when there are many lesions on the tongue or other parts of the mouth, and can provide immediate relief of pain and irritation in the affected area.
3. Black hairy tongue
Black hairy tongue is a condition in which keratin builds up on the tongue papillae. This makes the top of the tongue appear brown or black and can look like hair.
This condition can occur due to several factors, such as smoking, poor oral hygiene, excessive intake of tea or coffee, or bacterial or fungal infections.
In general, black hairy tongue does not cause symptoms. However, in some cases nausea, a metallic taste in the mouth, and bad breath may occur.
How to treat: If you notice a darker color on your tongue, it’s important to see a dentist or primary care provider to determine the cause and receive the right treatment, which may include antibiotics or antifungal medication.
In addition to medications, people with black hairy tongue should keep up with good oral hygiene habits and may use a tongue scraper.
4. Oral thrush
Oral thrush is an infection that affects the tongue and is mainly caused by the fungus Candida albicans. It can lead to whitish patches on the tongue and other parts of the mouth.
This infection is more common in people with weakened immunity due to chemotherapy, radiation therapy, use of immunosuppressants or corticosteroids, or HIV infection.
How to treat: A primary care provider or dentist should be consulted and may recommend swishing with nystatin solution and using antifungal medications.
It is also recommended to use dental products that contain disinfecting agents, such as chlorhexidine, as this can help eliminate the fungus and reduce tongue inflammation.
5. Pemphigus vulgaris
Pemphigus vulgaris is an autoimmune disease caused by an exaggerated reaction of the body’s defense cells. It is characterized by painful blisters on the tongue and inside the mouth that take a long time to heal.
The cause of pemphigus vulgaris is not completely understood, but some factors are known to influence its development, such as genetic predisposition, medication use, certain types of cancer, and infections.
How to treat: A primary care provider should be consulted to start treatment, which usually involves corticosteroids. If blisters on the tongue and the rest of the body are very extensive, immunosuppressant medications may be needed, or hospitalization may be required so corticosteroids can be given through an IV.
6. Tongue cancer
Tongue cancer is a type of tumor of the oral mucosa that most often affects the side of the tongue. It is more common in men over 50 who have smoked for many years.
Symptoms may include lumps and numbness on the tongue, trouble swallowing, hoarseness, and swollen lymph nodes in the neck, and it is mainly caused by HPV.
How to treat: When symptoms appear, it is important to consult an ear, nose, and throat (ENT) specialist or a primary care provider to investigate the cause through a physical exam and imaging tests, such as a CT scan.
After the diagnosis is confirmed, surgery to remove the tumor may be recommended. If surgery is not possible, chemotherapy and radiation therapy are usually recommended.
7. Burning mouth syndrome
Burning mouth syndrome causes a burning sensation on the tongue and other parts of the mouth without an identifiable cause. Other symptoms may include dry mouth or a bitter or metallic taste in the mouth.
This syndrome may be caused by hormonal changes, fungal, viral, or bacterial infection, problems with the salivary glands, mouth injuries, or conditions such as diabetes mellitus, hormonal disorders, and nutritional deficiencies.
How to treat: Treatment depends on the cause and aims to relieve symptoms, and may involve medications or lifestyle changes.
8. Transient lingual papillitis
Transient lingual papillitis is inflammation of the tongue papillae, causing small bumps on the tongue. The bumps may be single or multiple and can cause pain, burning, or tingling.
This condition may be caused by tongue irritation, poor nutrition, stress, or smoking, for example.
How to treat: Treatment is not always needed because it usually goes away in a few days. However, a dentist or primary care provider may recommend corticosteroids, such as triamcinolone acetonide, or mouth rinses to help relieve symptoms.
9. Glossitis
Glossitis is inflammation of the tongue that may occur due to burns or cuts on the tongue, nutritional deficiencies, dry mouth, canker sores, or allergies.
This inflammation can cause tongue swelling, pain, or difficulty swallowing, chewing, or speaking.
How to treat: Treatment varies depending on the cause of glossitis. A primary care provider or dentist may recommend anti-inflammatory medications or corticosteroids to help relieve symptoms.
10. Tongue coating
Tongue coating is a buildup of bacteria on the tongue that can leave the surface white, yellowish, brown, or gray. It may also cause a bitter taste in the mouth or bad breath.
This condition may be caused by poor oral hygiene, smoking, alcohol use, or conditions such as diabetes or liver problems.
How to treat: Good oral hygiene should be practiced, and a tongue cleaner should be used when brushing the teeth. It is also important to stop smoking and avoid excessive alcohol use.
If an underlying disease is present, treatment should be determined by a healthcare provider based on the cause.
11. Mpox
Mpox (formerly known as monkeypox) is an infection caused by a virus from the Orthopoxvirus genus. It can cause symptoms such as fever, chills, and blisters or sores on the tongue or inside the mouth.
These blisters or sores can also appear on other parts of the body, such as the palms of the hands or the genital area.
How to treat: A primary care provider or infectious disease specialist should be consulted and may recommend antivirals, such as tecovirimat. Medications may also be recommended to relieve symptoms, such as acetaminophen.
In addition, the provider should recommend isolation to help prevent transmission to other people.