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Tongues are an essential muscle. They help people speak and chew and taste food. However, sometimes a tongue’s appearance can change. They can develop bumps, change color, or become hairy in appearance.

A healthy tongue is usually pink, and papillae, which are minusclue bumps, cover the surface.

In this article, we discuss conditions that may change the appearance of a tongue and how to treat them.

A white tongue can occur due to a variety of medical conditions:

1. Lichen planus

This is an autoimmune inflammatory condition that occurs when the immune system attacks the cells of the skin.

Symptoms

Lichen planus often presents a white, lacy pattern on the tongue or as scattered ulcerations.

Treatment

Treatment typically includes topical steroids if ulcers are present.

2. Oral hairy leukoplakia

According to Johns Hopkins Medicine, this is a condition that occurs due to the Epstein-Barr virus.

Symptoms

White patches appear on the tongue, and some patches can look hairy.

It typically occurs in those with a weakened immune system, such as those with HIV.

Treatment

This condition does not require treatment. However, a healthcare professional may advise on ways to boost the immune system.

3. Leukoplakia

Leukoplakia is a premalignant condition. According to a 2020 article, this means that a person with leukoplakia is at higher risk of developing oral cancer.

Between 1–9% of people with leukoplakia will develop oral cancer.

The article also indicates that any kind of tobacco use is the most common factor that increases the risk of developing leukoplakia.

Symptoms

People with leukoplakia may notice white patches on their tongue that they are unable to scrape off.

According to the 2020 article, homogenous leukoplakia presents a series of uniformly white patches with no other symptoms.

Non-homogenous leukoplakia is irregular and flat and may appear as mixed red and white patches on the tongue.

Non-homogenous leukoplakia is more likely to turn malignant, developing into oral cancer.

Treatment

Medical professionals can diagnose leukoplakia by doing a biopsy of the tongue.

If a medical professional diagnoses leukoplakia, they will remove the patches with surgery.

4. Oral thrush

Oral thrush typically occurs when the natural flora inside the mouth changes. According to the Centers for Disease Control and Prevention (CDC), this causes the fungus Candida that normally live in the mouth to multiply, causing an infection.

Symptoms include:

  • white patches
  • smooth and red shiny patches
  • a sore mouth
  • sore splits on each side of the mouth
  • diamond-shaped inflammation at the back of the tongue, otherwise known as median rhomboid glossitis

Treatment

Treatment includes topical antifungal products and mouthwashes.

A red tongue typically occurs due to an underlying medical condition or vitamin deficiency.

According to an older 2010 article, a beefy-red tongue can occur if a person is deficient in:

Examples of medical conditions that can cause the tongue to turn red include:

Treatment

Treatment includes replacing any missing nutrients or treating the underlying medical condition.

Geographic tongue is a condition where the tongue becomes inflamed, causing it to lose some of its papillae.

People with geographic tongue will notice red, round patches outlined with white. The tongue can look like the surface of a map.

Cause

According to a 2016 article in the Journal of Dentistry of Tehran University of Medical Sciences, researchers are not sure what causes geographic tongue.

Factors that may increase a person’s risk of developing geographic tongue include:

  • emotional stress
  • allergies
  • bacterial or fungal infections
  • vitamin deficiency
  • immune disorders

Symptoms

Most people do not experience any symptoms. However, symptoms can include:

  • pain
  • burning sensation
  • sensitivity to hot, spicy, and sour food
  • taste loss

Treatment

According to DermNet, geographic tongue usually resolves naturally over time.

As geographic tongue is usually asymptomatic, there is no need for treatment, according to a 2020 article.

However, the article adds that if a person does have symptoms, the best way to treat them and stop them from worsening is to maintain good oral hygiene. Avoiding the following can also help:

  • alcohol
  • hot, spicy, and sour foods
  • acidic fruit and drinks

A medical professional may prescribe corticosteroids, antihistamines, and other medication to manage symptoms.

Tongue-tie, or ankyloglossia, is a condition where a person has a short lingual frenum that prevents the tongue from moving normally. The lingual frenum is the piece of tissue that connects the tongue to the floor of the mouth.

Cause

A 2020 article indicates that there is a genetic cause of tongue-tie.

A mutation of the gene TBX22 causes the body to develop the extra tissue that prevents normal tongue movement.

Symptoms

People with tongue-tie may experience:

  • difficulty breastfeeding as an infant
  • difficulty in pronouncing certain letters
  • difficulty licking
  • difficulty playing wind instruments

Treatment

According to the article, medical professionals may not treat the condition.

If a person is not experiencing any symptoms, the medical professional may decide it is not worth referring the person for surgery.

If a person does require treatment, a medical professional will cut through the tissue, which frees the tongue.

According to one source, black hairy tongue, or lingua villosa nigra, is a harmless condition in which the filiform papillae become enlarged and discolored, resembling hairs.

According to The American Academy of Oral Medicine (AAOM), people may experience lingua villosa nigra due to a buildup of keratin, which is a protein that forms hair.

The keratin builds up because there is not enough abrasion or stimulation to the tongue.

Some factors that may increase the chances of lingua villosa nigra include:

  • poor oral hygiene
  • using antibiotics for an extended period
  • radiation treatment of the head and neck
  • drinking lots of caffeine products such as tea and coffee
  • smoking
  • having an exclusively soft food diet

Symptoms

The main symptom of lingua villosa nigra is the lengthening of papillae. They can grow up to 18mm in length.

Because the papillae grow so long, food and other bacteria can get trapped in it, which, according to the AAOM, can change the color of the papillae.

People may also experience:

  • a burning sensation of the tongue
  • gagging or tickling sensation while swallowing
  • bad breath, or halitosis

Treatment

If the symptoms persist, a dentist may recommend:

  • discontinuing or changing any responsible medication
  • avoiding excessive alcohol intake
  • avoiding smoking
  • using antiseptic mouthwash
  • applying a topical antifungal agent
  • using a topical retinoid

However, a person can treat this condition at home.

The AAOM suggest practicing good oral hygiene.

This may include scraping the tongue with a tongue scraper, a special tool made for cleaning the tongue.

A person can buy tongue scrapers online here.

Although people may follow a personalized oral care routine designed by their dentist or another medical professional, the American Dental Association recommend people follow these steps for healthy mouth and teeth:

  • brushing teeth twice a day with a toothpaste containing fluoride
  • cleaning between teeth daily with floss
  • eating a healthful diet that is low in sugary drinks and food
  • seeing a dentist regularly for check-ups

It is important to see a doctor or dentist if a person notices anything unusual about their tongue, and home remedies, such as maintaining good oral hygiene, do not improve symptoms and appearance.

A healthcare professional can diagnose a person’s condition and investigate whether they have any underlying conditions that need treatment.

Many different conditions and factors can cause a change in the tongue’s appearance.

Anyone worried about their tongue’s appearance or any other symptoms could talk to their doctor for advice.