The tongue normally appears moderately pink, smooth, and clearly defined with non-flattened papillae. A tiny white or clear coating may be present upon waking, and colors from foods or drinks can tint the tongue red or brown. Pathological plaques can vary from thick white to sticky black, and such signs should never be ignored. These tongue changes can signal a range of issues—from internal organ problems and metabolic disorders to respiratory conditions. This perspective comes from Ekaterina Kashukh, a medical sciences candidate and gastroenterologist at Gemotest Laboratory, speaking about tongue health.
Experts note that infectious illnesses frequently alter tongue color. For instance, scarlet fever, an acute infection of the oropharynx, often leaves a dense gray-white or yellowish coating on the tongue. In diphtheria, gray-white films may also appear. Candidiasis often presents with curled plaques that resist removal even with brushing.
If an individual has gastritis, stomach ulcers, or other digestive tract issues, the tongue may take on a grayish-white hue. Plaque tends to cluster toward the back of the tongue but can blanket its entire surface in some cases. In liver disease, disruptions in the metabolism of bile pigments—the breakdown products of blood proteins—can color soft tissues, including the tongue’s mucous membrane, with a distinctive yellow tint.— Ekaterina Kashukh explains.
Diabetes is another factor that can change tongue color. This chronic condition elevates blood glucose levels, and the tongue may become drier, occasionally accompanied by an orange-yellow, itchy rash on the surface.
After trauma or a severe burn, the tongue can appear bright red. In more severe cases or with iron deficiency anemia, the tongue may look very pale. Typically, such anemia is accompanied by symptoms like weakness, dizziness, reduced appetite, tinnitus, and excessive sweating.
Geographic tongue, also known as desquamative glossitis, is another described condition. It features bright red patches with a white border, accompanied by grooves and fissures that can migrate across the tongue. This phenomenon is documented by specialists, including the Gemotest gastroenterologist, who notes that the condition can shift from one area of the tongue to another.
The exact causes of geographic tongue remain uncertain. Some researchers have linked it to other skin and mucosal conditions such as psoriasis and lichen planus. It is also observed more often in people with a family history of this trait, and in those who have naturally deep grooves and thickened, enlarged tongues, a condition sometimes referred to as a folded tongue.
Additionally, aphthous ulcers can affect tongue color. These small sores are often covered with a gray or yellowish coating and tend to be painful. When aphthae appear, a dental consultation is advised for proper assessment and management.
In sum, changes in tongue color, coating, or texture warrant careful attention. While some signs may reflect benign conditions, others could indicate underlying health issues that merit medical evaluation. A dental or medical professional can provide a thorough examination and guidance on appropriate next steps based on the individual’s overall health profile and any accompanying symptoms.