At your annual physical, one of the first things your doctor may do is ask you to stick out your tongue, and with good reason. A healthy tongue has a warm, pinkish color, and anything different might indicate an underlying health condition.

Ryan Kauffman, M.D., an ear, nose and throat specialist at Piedmont, says most physicians follow a checklist when inspecting a patient’s tongue.

“We start with the worst case scenario and look for anything concerning, like ulcers, lesions, masses, and firmness,” he says. “Then we move on to evaluate signs of unusual coating, infection or fungus.”

Dr. Kauffman says it is amazing what can be learned simply by looking at a patient’s tongue.

“Without even asking, I can tell if a patient is well-hydrated, a smoker, a dipper, a tobacco user, uses a retainer, has an autoimmune disease, and the list goes on.”

Dr. Kauffman shares some of the most common tongue-related conditions and what they indicate.

Geographic tongue

• Geographic tongue gets its name from its map-like appearance on the tongue.
• While harmless, the condition is indicated by smooth, red patches on the tongue with slightly raised borders that resemble “islands.”
• Geographic tongue is not caused by cancer or infection.
• It affects about 1-3% of people and can show up at any age.
• It tends to affect middle-aged or older adults more often, and is more common in women than in men.
• The cause is unknown.

Hairy tongue

• Indicated by brown, black or even white discoloration of the tongue, along with a hairy appearance (caused by elongation of the filiform papillae).
• Hairy tongue is often caused by poor oral hygiene.
• It is usually accompanied by severe halitosis (bad breath).
• Contributing factors are heavy smoking, excessive coffee drinking and extensive use of antibiotics.
• Brushing twice daily, aggressive tongue scraping, and using mouthwash can both prevent and treat this condition.

Sore spots

• Mouth ulcers or canker sores can crop up on the tongue.
• Some people have a predisposition to getting sore spots.
• They often occur in conjunction with a cold or fever, after eating a lot of citrus fruits, or after accidentally biting your tongue.
• A normal canker sore will heal and disappear in a week to 10 days.
• Anything that lasts beyond two to four weeks and continues to get worse could be a sign of oral cancer and should be checked out by your doctor immediately.

White coating

• When the tongue looks white and pasty, it may be a sign of infection on the tongue, such as a bacterial infection or an autoimmune-related inflammatory disease.
• A common cause is thrush, an infection in the mouth caused by yeast.
• This condition may interfere with your taste buds, leaving most foods tasting bland.
• It is easily treated with an antifungal drug, and the tongue should return to its normal light pink coloring.

Severe dry mouth

• People who take blood pressure, diuretics, or allergy medications may suffer from an unpleasant side effect: uncomfortable tongue cracking.
• To overcome this condition, Dr. Kauffman recommends patients stay well hydrated, avoid caffeine, use Biotene mouthwash and toothpaste, and in extreme cases, use Biotene gel, all of which are sold over the counter.

Unusual growths

• Any growth on the tongue that causes soreness and does not dissipate over time may be cause for concern.
• Dr. Kauffman warns that there has been an increase in human papillomavirus (HPV) oropharynx cancers, so painful ulcerations that do not improve with time should be checked by a physician.
• Some types of oral HPV can cause cancers of the head and neck area, while others can cause warts in the mouth or throat.

If you have any concerns regarding a change in your tongue, make an appointment with your doctor. Some types of grooves or cracks are normal, and so is an occasional canker sore, but anything that does not go away or causes soreness beyond four weeks is cause for seeking professional advice. 

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