The tongue says a lot about your health

Donya Betancourt
Pediatitian/drdonya@hotmail.com

The importance of the tongue has long been recognized by physicians. Scrutiny of the tongue can provide information about a patient's state of health, consequently the oral examination has assumed a central role in clinical and dermatologic examinations.

The tongue can have a variety of signs that may be noticed by patients or their doctors. A "furry" tongue and a "black, hairy" tongue are examples of such incidental, benign (not serious) conditions. Both of these conditions are due to hyperplasia (cell enlargement) of the papillae (the small buds you see on the tongue), with the tongue becoming darker and enlarged, giving the appearance of "fur," usually on the front and top of the tongue.

With the "black, hairy" tongue, bacteria trapped between the papillae produce a substance called porphyrins, which impart a dark brown to black color.

These conditions are typically not symptoms, but interestingly, they may provide an unspoken history about a patient as they are seen more commonly seen in smokers, mouth breathers, patients with poor oral hygiene or who have a soft diet with little fiber, or in patients who have recently had a fever.

Brushing the tongue two to three times a day with five to 15 strokes using a soft-bristled toothbrush and regular flossing can reduce the problem.

A fissured tongue is another variant occasionally noted in patients. A central fissure or multiple lateral fissures on the top of the tongue are common in older people, but can also indicate certain genetic disorders.

Also sometimes seen is a smooth tongue with a deep red glossy appearance. This may be noted in patients complaining of glossodynia (tongue pain) due to atrophying of the papillae. This is often associated with an underlying nutritional deficiency or malabsorption (insufficient absorption of foods) syndrome.

Disorders such as pernicious anemia (vitamin B12 deficiency) or gluten-sensitive enteropathy should be actively checked and corrected.

Aging can produce other changes to the tongue apart from increased fissuring, and sublingual varices (veins) are commonly found in older patients. These appear as soft blue-black blebs on the ventral (under) or lateral (side) part of the tongue.

Another "architectural" abnormality of the tongue is sometimes seen in a square-shaped thin patch in the back-middle part of the tongue.

Lately, this patch has been associated with chronic candidiasis (thrush), and if it is associated with corresponding palatal (top floor of mouth) inflammation, it may actually be suggestive of a compromised immune system.

Two other tongue disorders described as "oral hairy leukoplakia" refer to white and black vertical corrugations found on the lateral border of the tongue that cannot be wiped off with gauze.

Originally thought to be exclusive to HIV-positive patients, they are now known to also be associated with the Epstein-Barr virus and can be seen in other immuno-compromised states, not limited to the HIV-positive population.

Herpetic glossitis is also exclusive to immuno-compromised patients. It is caused by a chronic herpetic infection of the dorsal (top) part of the tongue and characteristically demonstrates linear and map-like striations on the tongue. This is a painful condition and requires aggressive antiviral treatment.

The geographic tongue (tongue map) is perhaps one of the most challenging tongue disorders, despite its benign nature.

As with many of the other diagnostic terms, the geographic tongue takes its name from the changing shape of both the hyperkeratotic (cell hypertrophy) white-raised plaques and the atrophic (flat) red areas on the tongue.

The plaques have a map-like configuration, hence the nomenclature, and may vary from day to day or even hourly. This is an innocent condition, but can be a frustrating disorder for both patient and physician, as patients may be significantly symptomatic and treatment is typically suboptimal, although antifungal agents may be prescribed.

So your tongue can tell your doctor a lot about your state of health, but as you read few of these tongue abnormalities are serious. So let your doctor do a tongue exam and keep a peaceful mind knowing there is likely nothing seriously wrong.