How does acid reflux affect the tongue?

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It is not common for acid reflux to affect the appearance of the tongue, especially if it is infrequent. However, frequent acid reflux, or GERD, often causes oral symptoms. The medical name for this is laryngopharyngeal reflux, which occurs when acid reaches the throat. Some common examples include:

• persistent sore throat
• burning in the throat or mouth
• bad breath

A less common symptom of GERD is damage to the tongue. This occurs when acid reaching the mouth damages tissues in the mouth over time. It can also erode the teeth. An individual 2016 study from India found that in people with GERD:

• 44% had dental erosion
• 25.5% had severe gum disease (periodontitis)
• 9.9% had mild gum disease

Less common symptoms included red lesions on the gums, roof of the mouth, and tongue. However, as this is a single study, more research is necessary to confirm the results.

Some systems of medicine consider tongue changes to be a method for diagnosing diseases elsewhere in the body. For example, a 2020 case control observational study based on the principles of Traditional Chinese Medicine (TCM) found that people with GERD had more “fur” on certain parts of their tongue than those without the disease.

The researchers stated that this could indicate the presence and severity of GERD, but they also call for larger trials to confirm this, as their study included only 67 participants.

Yes, it is possible for frequent or severe acid reflux to cause sore patches, or lesions, in the mouth. These can occur on the gums, tongue, or palate.

However, this is an uncommon symptom, and can occur for other reasons. More common conditions that cause mouth sores include canker sores and cold sores.

There is not much research on the connection between acid reflux and dry mouth. However, a 2018 study suggests that swallowing saliva may help neutralize stomach acid. It is possible that people who do not produce enough saliva may have a more acidic stomach, worsening their reflux.

The study found that treating dry mouth also reduced acid reflux. However, more research would have to find similar conclusions to support this as an effective treatment.

In addition to feeling as though the mouth is dry, signs of a dry mouth include:

• excessive thirst
• bad breath
• dry gums or tongue

People with acid reflux may experience changes in their sense of taste. A sour or bitter taste is common, but it may also taste metallic to some.

Other changes to taste and smell are also possible. A 2017 study found that many participants with GERD reported they were less sensitive to sweet, salty, and bitter tastes and smells than they were before they developed the illness. The researchers noted an association between these changes and the severity of symptoms.

Research so far has not shown a strong connection between acid reflux and a white coating on the tongue. A 2020 study drawing on TCM found that people with GERD had more “fur” on certain parts of the tongue, but this did not coat the whole tongue. Additionally, this was a small study, so may not apply to a larger population.

However, there is an association between some drugs that doctors use to treat GERD and yeast overgrowth, which can cause a white tongue. A 2017 review noted that in some studies, people taking drugs known as H2 antagonists had higher rates of Candida albicans (a type of yeast) in their digestive tracts, particularly in the esophagus.

Scientists believe that suppressing stomach acid production may allow species of yeast that typically grow at harmless levels, such as C. albicans, to become opportunistic. Doctors can address this through antifungal drugs as well as measures that protect the microbiome. These measures may include:

• taking prebiotics, which are substances that feed beneficial bacteria
• taking probiotics, which involves taking live bacterial cultures
• getting adequate nutrition

People with suppressed immune systems, such as those receiving chemotherapy or who have HIV or AIDs, are at a higher risk of opportunistic infections such as C. albicans than the rest of the population.

Tongue changes can happen for a number of reasons that may or may not be related to acid reflux and GERD. Some other explanations include:

• Canker sores: Canker sores are small ulcers that can appear on the tongue, lips, or near the gums. They usually go away on their own, but mouth rinses and numbing solutions can help with the pain.
• Oral thrush: This infection occurs when yeast overgrows in the mouth, causing the tongue to turn white or yellow with a thick residue on top. Brushing the residue with a toothbrush may be painful. Medications, especially antibiotics, sometimes trigger thrush. Antifungal drugs can treat it.
• Black hairy tongue syndrome: This benign condition causes a discolored gray, black, or white furry tongue. Smoking, low oral hygiene, and certain medications are associated with it.
• Burning mouth syndrome (BMS): BMS causes a burning sensation in the mouth, sometimes along with dry mouth. Primary BMS means that there is not an underlying disease, but a person may have nerve damage. Secondary BMS is when another condition, such as an allergy to toothpaste, causes the burning.

Anyone who notices persistent changes to the surface of their tongue should speak with a doctor or dentist. There are many things that can cause this, ranging from minor conditions to more serious ones.

Consulting a doctor or dentist promptly will allow them to rule out serious conditions, make a diagnosis, and recommend treatments. If the changes are caused by GERD, they can help with managing the condition and reducing the impact it has on the mouth and teeth.

In rare cases, changes to the tongue’s surface can be signs of tongue cancer. The symptoms can include:

• a red or white patch on the tongue that will not go away
• a persistent sore spot or ulcer on the tongue
• unexplained bleeding on the tongue
• numbness in the mouth
• pain when swallowing
• a persistent sore throat

Tell a doctor about these symptoms, particularly if GERD treatment is not helping them.

Occasional acid reflux will not typically alter the tongue’s appearance, but it can if people have frequent acid reflux, or GERD. People may experience soreness, redness, swelling, inflammation, or changes to their sense of smell or taste.

Managing GERD with medications or lifestyle changes can reduce the symptoms. However, it is also worth noting that tongue changes can happen for other reasons. It is important to speak with a doctor or dentist about changes to the tongue so that they can confirm the cause.