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Updated 27 March 2014

Is your tongue black and hairy?

Sticking out your tongue could reveal more than you bargained for. What's your tongue telling you?

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You may not have realised just how important your tongue is: it not only helps you to speak, eat, chew and swallow food, but may also reveal the state of your health. Eastern medicine practitioners believe that the tongue reflects diseases that may be present in the body.

A healthy tongue is slightly pink in colour, moist and fairly smooth. Changes in the look and feel of your tongue could be related to the tongue itself or to another health problem. While some tongue changes are harmless, others could be of serious concern.

What could your tongue be telling you? Here are some of the most common tongue problems.

Black, hairy tongue
A black-coated tongue is the result of an overgrowth of oral bacteria and yeast, which attach to the papillae (the tiny projections of the tongue) and cause discolouration. Growth of the papillae may also make the tongue appear hairy.

Some of the causes of black tongue include:

  • poor oral hygiene
  • regular use of mouthwashes
  • changes in the normal bacteria in the mouth after being on antibiotic treatment
  • tobacco use
  • drinking too much coffee and/or tea

Fortunately, this is a harmless condition that can be cleared up by brushing your tongue and rinsing your mouth with diluted hydrogen peroxide. If the problem persists, consult your dentist or doctor.

White tongue
A white-coated tongue or white spots on your tongue can be caused by dehydration, excessive mouth breathing, oral thrush, leukoplakia (a condition in which the cells of the mouth grows excessively) and oral lichen planus (a network of raised white lines on the tongue).

To prevent or improve the appearance of a white tongue, brush your teeth regularly, drink lots of water and increase your intake of dietary fibre.

Geographic tongue
Geographic tongue gives the tongue a map-like appearance. This occurs when parts of the tongue are missing the layer of papillae. Irregularly shaped, smooth, red patches, which resemble a rash, form on parts of the tongue.

The patches can change in size and site daily and may come and go over time. The condition tends to run in families and is harmless.

Common symptoms include tongue discomfort, soreness or a burning sensation that may worsen when eating hot, spicy or acidic foods.

Fissured tongue
Fissured tongue is also known as 'scrotal tongue' or 'lingua plicata'. One or more shallow or deep grooves form on the surface and extend to the edges of the tongue.

The size and depth of the grooves may vary and may be interconnected when large and deep. The condition isn't painful unless food gets trapped in the grooves.

Fissured tongue may be inherited or may occur as a result of an underlying condition. It's sometimes seen in Melkersson-Rosenthal syndrome and Down syndrome, and often associated with geographic tongue and psoriasis.

No specific treatment is necessary. Brush the top surface of your tongue to remove any food that may cause irritation and infection when stuck between the grooves.

Smooth, pale tongue
A pale tongue could be a sign of a nutritional deficiency. It's mainly caused by a dietary lack of vitamin B12 and may also be the result of iron-deficiency anaemia.

Red tongue or strawberry tongue
If your tongue is red (pink to magenta), it may be a sign of a folic acid, vitamin B12 and/or vitamin B3 deficiency.

Scarlett fever may also cause strawberry tongue (enlarged, red taste buds dotting on the surface). If you have a high fever as well as a red tongue, contact your doctor immediately.

Kawasaki disease, which is usually seen in children under the age of five, affects the blood vessels in the body and can also cause strawberry tongue.

Canker sores on the tongue
A viral ulcer, or "canker sore", may appear on the tongue. This can be painful, but will go away in time. The sore can appear for no reason. However, some doctors believe they're triggered by stress and fatigue.

Taste abnormalities
Damage to the taste buds, nerve problems, side effects of medication, infection or other conditions may cause taste problems.

Difficulty moving the tongue
Tongue-movement problems are caused by nerve damage. Ankyloglossia, a disorder in which the band of tissue that attaches the tongue to the floor of the mouth is too short, can also cause tongue-movement problems.

Speech difficulties or difficulty moving food during chewing and swallowing can be the result of tongue-movement problems.

Swollen or enlarged tongue
Strep infection, Down's syndrome, leukaemia, cancer and hypothyrodism are all conditions that may cause swollen tongue.

A swollen tongue can also be the side effect of a hangover or an allergic reaction to food or medication.

Burning-mouth syndrome
Burning-mouth syndrome causes chronic burning pain in the mouth and can affect the tongue, gums, lips, inside of the cheeks or roof of the mouth.

The cause is sometimes difficult to determine. It may be caused by an underlying medical condition, in which case it's called secondary burning.

Conditions that may cause secondary burning include:

  • dry mouth
  • psychological factors
  • other oral conditions
  • nutritional deficiencies
  • dentures
  • nerve damage
  • allergies and other adverse reactions to food
  • reflux of stomach acid
  • certain medications
  • oral habits
  • diabetes
  • an underactive thyroid
  • hormonal imbalances
  • excessive mouth irritation

Burning-mouth syndrome is an uncommon condition that affects more women than men. Treatment will depend on the particular signs and symptoms as well as the underlying condition(s).

Keeping your tongue healthy
One of the breeding grounds of the bacteria that attack our teeth and gums is the surface of the tongue.

What's more, studies have shown that the bacteria in our mouths are associated with heart disease. Bacteria in the mouth can enter the bloodstream, and promote blood clots and damage to the heart-muscle tissue.

Cleaning your tongue can help remove food debris, and reduce bacteria build-up and bad breath. It may also improve taste and stimulate the secretion of digestive enzymes. Tongue cleaning dates back to ancient times in India and China where the action was recommended as part of a daily hygiene routine to remove toxic debris.

A tongue cleaner doesn't have to be an expensive gadget. Your tongue cleaner is probably already part of your oral-hygiene kit in the form of a toothbrush and floss.

How to clean your tongue with a toothbrush
Brush the entire surface of your tongue with a clean toothbrush. Apply light pressure from the back of the tongue to the front.

Most of the bacteria are at the back of the tongue, which may cause a gag reflux in the beginning.

Tongue cleaning with dental floss
Take a good length of floss and wrap each end around your middle fingers.

Apply downward pressure with your index fingers, stick out your tongue and drag the floss from the back to the front several times.

Rinse the floss in between scrapings.

Tongue scrapers
Tongue scrapers are the most effective in cleaning the entire surface of the tongue, especially the back.

Place the tongue scraper as far back as you can without gagging. Place it at the surface of the tongue and make slow, sweeping strokes from back to front. Start at either side (left/right) and work your way to the other.

Depending on the type of tongue cleaner you're using, you might need to make several strokes across the tongue. Don't leave any gaps when scraping.

It's not necessary to scrape hard as pressing harder doesn't remove more bacteria. Simply press hard enough so that the tongue cleaner makes contact with the surface of your tongue.

(Leandra Engelbrecht, Health24, updated August 2010)

Oral Health Centre

Sources:
- How your tongue can reveal your health. www.womanknows.com
- What your tongue says about your health. Nine tongue signs to watch out for. www.sixwise.com
- Fissured tongue. www.dermnetnz.com
- Tongue problems overview. http://healthy.nytimes.com
- Tongue problems: causes, symptoms and treatment. www.medicinenet.com
- Burning mouth syndrome. Geographic tongue. Yellow tongue. Black hairy tongue. White tongue. www.mayoclinic.com
- How the colour of your tongue reveals your health. Naomi Coleman. www.dailymail.co.uk
- Do you have a white tongue or geographic tongue? Discover how to correctly clean your tongue to make white tongue disappear. Dr Harold Katz. www.therabreath.com
- Tongue cleaning. www.dentalgentlecare.com
- Tongue cleaning as bad breath cure for better oral health. http://worlddental.org
- Tongue scraping, improve your oral health. Brian J Gray. www.1stdentalhygiene.com
- Tongue cleaner. www.wikipedia.org

 
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