Though often hailed as "the strongest muscle in the body," the tongue is actually made up of a group of muscles that allow us to taste food, swallow, and talk. A healthy tongue is pink and covered with small nodules called papillae.

Because you use your tongue constantly, it can be frustrating and uncomfortable when you experience tongue problems, including discoloration and soreness. There are a variety of causes for a number of common tongue symptoms. Fortunately, the majority of tongue problems are not serious and most can be resolved quickly.

In some instances, however, a discolored or painful tongue can indicate more serious conditions, including vitamin deficiencies, AIDS, or oral cancer. For this reason, it is important to seek medical advice if you experience any ongoing problems with your tongue.

What causes white tongue?

There are a number of things that can cause a whitish coating or white spots to develop on the tongue, including the following:

• Leukoplakia. This condition causes cells in the mouth to grow excessively. That, in turn, leads to the formation of white patches inside the mouth, including on the tongue. Although not dangerous on its own, leukoplakia can be a precursor to cancer. So it is important for your dentist to determine the cause of the white patches on your tongue. Leukoplakia can develop when your tongue has been irritated and is often found in people who use tobacco products.
• Oral thrush. Also known as candidiasis, oral thrush is a yeast infection that develops inside the mouth. The condition results in the formation of white patches that are often cottage cheese-like in consistency on the surfaces of the mouth and tongue. Oral thrush is most commonly seen in infants and the elderly, especially denture wearers, or in people with compromised immune systems. People with diabetes and people taking inhaled steroids for asthma or lung disease also can get thrush. Oral thrush is more likely to occur after the use of antibiotics, which may kill the "good" bacteria in the mouth. Eating plain yogurt with live and active cultures may help restore the proper fauna in your mouth. Additionally, medications may be used to combat the infection.
• Oral lichen planus. If you have a network of raised white lines on your tongue that has a lace-like appearance, you may be suffering from oral lichen planus. Doctors are often unable to determine the cause of this condition, which often resolves on its own. Practicing proper dental hygiene, avoiding tobacco, and limiting your consumption of foods that cause irritation to your mouth may helpful.

What causes red tongue or strawberry tongue?

There are multiple factors that can cause a normally pink tongue to turn red. In some instances, the tongue may even take on the appearance of a strawberry with enlarged, red taste buds dotting the surface. Possible causes include:

• Vitamin deficiencies. Deficiencies of folic acid and vitamin B-12 may cause your tongue to take on a reddish appearance.
• Geographic tongue. This condition, also known as benign migratory glossitis, is named for the map-like pattern of reddish spots that develop on the surface of the tongue. At times, these patches have a white border around them, and their location on the tongue may shift over time. Though usually harmless, you should check with your doctor to investigate red patches that last longer than two weeks. Once your doctor has determined that the redness is a result of geographic tongue, no further treatment is necessary. If the condition makes your tongue sore or uncomfortable, you may be prescribed topical medications to alleviate discomfort.
• Scarlet fever. People suffering from this streptococcal infection may develop a strawberry tongue. Be sure to contact a doctor immediately if you have a high fever and red tongue. Antibiotic treatment is necessary for scarlet fever.
• Kawasaki syndrome. This disease, usually seen in children under the age of five, affects the blood vessels in the body and can cause strawberry tongue. During the acute phase of illness, children often run an extremely high fever and may also have redness and swelling in the hands and feet.

What causes black hairy tongue?

Though incredibly disconcerting in appearance, a black, hairy tongue is typically nothing serious. The small bumps on the surface of your tongue, called papillae, grow throughout your lifetime. In some people, the papillae become excessively long, rather than being worn down by daily activities. That makes them more likely to harbor bacteria. When these bacteria grow, they may look dark or black and the overgrown papillae appear hair-like.

This condition is not particularly common and is most likely to occur in people who do not practice good dental hygiene. People who are on antibiotics or receiving chemotherapy and people with diabetes may be more likely to have a black hairy tongue.

What causes a sore tongue and tongue bumps?

There are many things that can make your tongue sore or cause painful tongue bumps to form, including:

• Trauma. Accidentally biting your tongue or scalding it on something straight out of the oven can result in a sore tongue until the damage heals. Grinding or clenching the teeth can also irritate the sides of the tongue and cause it to become painful.
• Smoking. Smoking excessively can irritate your tongue and make it sore.
• Canker sores. Many people will develop these mouth ulcers on the tongue at some point in their life. The cause is unknown, although they can be worse during periods of heightened stress.
• Burning tongue syndrome. Some post-menopausal women develop this syndrome, which makes the tongue feel as if it has been burned.
• Enlarged papillae. If one or more of your taste buds becomes inflamed or irritated, it can swell and form a painful bump on your tongue.
• Certain medical conditions. Medical conditions, including diabetes and anemia, can have a sore tongue as a symptom.
• Oral cancer. Though most sore tongues are nothing to worry about, you should consult a doctor if you have a lump or sore on your tongue that doesn't go away within a week or two. Many oral cancers don't hurt in the early stages, so don't assume a lack of pain means nothing is wrong.

WebMD Medical Reference

Sources:

University of Maryland Medical Center: "Tongue Problems."

University of Maryland Medical Center: "Oral Cancer."

American Dental Association: "Common Mouth Sores."

Familydoctor.org: "Mouth Problems."

Columbia University College of Dental Medicine: "Black hairy tongue."

Familydoctor.org: "Canker sores: What are they and what can you do about them."

Columbia University College of Dental Medicine: "Painful papillae of the tongue."

Reviewed by Matthew Hoffman, MD, on July 10, 2008

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Last Editorial Review: 8/6/2008

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