The tongue is not just vital for taste and helping with the digestion process by pushing food for chewing and swallowing. It’s also an excellent indicator of overall oral and systemic health. Various tongue abnormalities can signal underlying health issues, some of which can significantly impact your oral health. In this blog post, we’ll explore some common and not-so-common tongue abnormalities and what they may mean for your oral wellness.
Geographic tongue, also known as benign migratory glossitis, is characterized by smooth, red patches on the surface of the tongue, surrounded by white borders. These patches can change location, pattern, and size daily. While the cause is unknown, it has been linked to environmental factors, stress, and genetics. This condition is usually harmless, but it can sometimes cause discomfort or sensitivity to certain substances.
Black Hairy Tongue
Despite its alarming appearance, a black hairy tongue is typically a benign condition. It occurs when the tiny bumps on the tongue’s surface, called papillae, grow longer than normal and bacteria or yeast accumulate on them. This can cause the tongue to appear black and hairy. Poor oral hygiene, tobacco use, excessive coffee or tea drinking, and antibiotic use can contribute to this condition. Maintaining good oral hygiene and reducing or eliminating contributing factors usually clears it up.
Oral thrush, or oral candidiasis, is a yeast infection that leads to the development of white patches on the tongue and inside the mouth. Caused by an overgrowth of the Candida fungus, it’s common in denture wearers, infants, and individuals with weakened immune systems or those taking antibiotics. Treatment includes antifungal medications and good oral hygiene practices.
Oral Lichen Planus
This chronic condition causes a network of raised white lines on the tongue that may look like lace. Although the exact cause of oral lichen planus is unknown, it is often associated with an immune response or viral infections. It can cause discomfort, burning sensations, or sensitivity to hot and spicy foods. Treatment focuses on alleviating symptoms and may include corticosteroids or other medications.
A fissured tongue has deep grooves or fissures on its surface, which can be present at birth or develop with age. While these grooves are generally harmless, they can harbor food particles and bacteria, leading to inflammation or infection if not cleaned properly. Brushing the tongue or using a tongue scraper can help maintain cleanliness and prevent issues.
Leukoplakia results in white patches on the tongue and the inside of the mouth. It can be a reaction to irritation, such as rough teeth, dentures, or tobacco use. While leukoplakia is usually benign, it can sometimes be a precursor to cancer, so it’s essential to have it checked by a dentist.
Macroglossia is the term for an enlarged tongue and can be a sign of conditions like Down syndrome, hypothyroidism, or amyloidosis. It can lead to problems with eating, speaking, and breathing. Treatment for macroglossia depends on the underlying condition and may involve surgery, orthodontic or dental work, and speech therapy.
Although less common, tongue cancer can present as a lump or sore on the tongue that doesn’t heal. Other symptoms include pain, difficulty swallowing, or a feeling of something stuck in the throat. It’s most frequently associated with tobacco and alcohol use. Early detection and treatment are crucial for a better prognosis.
How the Tongue Affects Oral Health
The tongue plays a multifaceted role in maintaining oral health and contributes to various dental conditions due to its anatomical position and physiological functions. Understanding the interplay between the tongue and oral health is crucial for prevention and early detection of oral diseases.
Bacteria and Plaque Accumulation
The tongue’s surface is covered with tiny bumps called papillae, which can harbor bacteria and food particles. If not cleaned regularly, this accumulation can lead to plaque buildup and contribute to bad breath (halitosis), tooth decay, and gum disease. The posterior region of the tongue, which is more difficult to clean, often harbors a higher concentration of bacteria.
pH and Saliva Production
Saliva production is partially controlled by the tongue’s movement and its ability to stimulate the salivary glands during speech and mastication. Saliva neutralizes the acidic pH in the mouth, which otherwise would contribute to enamel erosion and tooth decay. It also aids in rinsing away food particles and bacteria, diminishing the risk of cavities and periodontal problems.
Taste and Nutrition
The tongue’s taste buds incentivize us to consume a variety of foods, but certain dietary choices influenced by taste preference can affect oral health. A diet high in sugar and acid, for example, can increase the risk of tooth decay and enamel erosion. Conversely, the tongue may help in selecting nutritious foods that protect against dental disease, such as crunchy fruits and vegetables that can help clean teeth surfaces.
Oral Hygiene Challenges
Certain tongue conditions can make maintaining oral hygiene more challenging. For instance, a fissured tongue may trap more bacteria and food than usual, requiring extra effort in cleaning. Likewise, conditions like macroglossia can result in a tongue too large for the mouth, making it difficult to effectively clean all dental surfaces, potentially leading to increased plaque and tartar formation.
Speech and Malocclusion
The tongue is intimately involved in speech production, and abnormal tongue postures or movements can lead to or exacerbate orthodontic issues. For example, a condition known as “tongue thrusting,” where the tongue presses too firmly against the teeth when swallowing or speaking, can lead to an open bite or other dental misalignments. This can have a cascade effect on dental health, increasing the difficulty of cleaning between misaligned teeth and potentially causing periodontal issues.
Wound Healing and Infection
The tongue’s rich vascular supply typically promotes rapid healing of minor injuries. However, persistent trauma to the tongue, such as that caused by teeth grinding (bruxism) or ill-fitting dentures, can lead to chronic inflammation, ulceration, and infection, which may spread to other oral tissues.
Detection of Systemic Health Issues
The tongue can also reflect signs of systemic health problems, like anemia (through paleness), dehydration (through dryness), and even more serious conditions like diabetes (evidenced by fungal infections like thrush) or vitamin deficiencies.
How to Maintain a Healthy Tongue
- Practice Good Oral Hygiene: Brush your teeth twice a day, floss daily, and clean your tongue with a scraper or toothbrush.
- Stay Hydrated: Drinking water helps keep your mouth clean and prevents bacteria from growing.
- Avoid Tobacco and Limit Alcohol: These substances can contribute to tongue abnormalities and oral health problems.
- Eat a Balanced Diet: A healthy diet rich in vitamins and minerals can keep your tongue and teeth healthy.
- Regular Dental Checkups: Visit your dentist at least twice a year for a checkup and professional cleaning.
Your tongue can tell a lot about your oral and overall health. Paying attention to changes and practicing good oral hygiene can help prevent more serious health issues. If you notice any abnormalities, don’t hesitate to contact your dentist or healthcare provider to get it checked out. Remember, early detection and treatment are the keys to maintaining good oral health and preventing further complications.
Dr. Gerald Sisko graduated from Ohio State University College of Dentistry in 1987. He is an active member of the American Dental Association, the Ohio Dental Association, and the Akron Dental Society where he is currently holding a council position. He has had the honor and distinction of being awarded “TOP DENTIST” in Akron and Cleveland as well as Northeast Ohio for the last several consecutive years.