Tongue problems
- We each probably have about 10 000 tastebuds on our
tongues
- Tastebuds on the tongue can detect
only four tastes – sweetness
and saltiness at its tip and centre, acidity at the
sides and bitterness at the back. Sense of smell helps
to increase our range of tastes, which is why we lose
our sense of taste when we have a cold
- The tongue is one of the most touch-sensitive organs
in the body; for example, it can detect tiny hairs
that our fingers are unable to feel
- Without our tongues, we would not be able to chew,
swallow, taste or talk
- The tongue doubles in length,
width and thickness between birth and adolescence
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In the olden days doctors were very keen on asking patients
to put out their tongue, and made all sorts of diagnoses
from its appearance. It is true that some conditions can
alter the appearance of the tongue (for example, a smooth,
red, sore tongue may be a sign of anaemia), but the appearance
of the tongue normally varies a lot between individuals.
‘Bald’ tongue
The
tiny projections that cover the surface of the tongue are
called ‘papillae’. If you
could examine them under a microscope you would see that
the papillae are tiny folds of the surface of the tongue.
Each is surrounded by a trench, rather like a castle surrounded
by a moat. In each trench, there are several clusters of
cells sensitive to various tastes; these are the actual
taste buds. If we did not have any papillae, the tongue
would be very smooth and slippery, and not very efficient
at moving food round the mouth. Some animals (such as cats)
have very prominent papillae, which is why their tongues
feel so rasping.
There are two different sorts of papillae
on the tongue – flat
ones and slender ones. The slender type are paler in colour.
The flat type are bright red in colour and slightly shiny.
Bald sides of the tongue. It is normal
for the sides of the tongue to look balder than the middle.
The main surface of the tongue is covered by the pale, slender
papillae. The flat, shiny papillae cover the sides and tip
of the tongue (with a few scattered on the main surface of
the tongue, looking like small red spots). Therefore it is
normal for the edges of the tongue to look flatter and more
shiny.
Patchy tongue
About
2% of people have a patchy appearance of the tongue, called ‘geographic
tongue’. This sometimes runs
in families. The patches are red areas with a distinct margin,
and in these areas the slender papillae are reduced. It looks
a bit like a map, which is how it got the name ‘geographic’.
In some people, the papillae are lost only from the sides
of the tongue, or the sides and tip. The papillae usually
grow again but this can take a long time and, meanwhile,
a new patch may be occurring on another part of the tongue.
Geographic tongue is not a sign of disease – it is
normal and nothing to worry about.
Furred tongue
Instead
of looking pink, your tongue may seem to have a greyish-white
coating. This is not a sign of disease. It is more common
in heavy smokers, people who breathe through their mouth
rather than their nose (look at the section on snoring and
people who eat mainly soft foods (perhaps because they do
not want to wear their false teeth). Debris, bacteria and
dead cells collect between the papillae and build up into
a coating. Eating more high-fibre foods such as vegetables
can help or you can discuss it with your dentist, who may
suggest that you obtain a tongue scraper (look at the section
on bad breath.
Very occasionally, the tongue appears to be black and hairy.
This is caused by the papillae of the tongue growing longer
than usual and becoming brown in colour. No one knows exactly
why this occurs, but it may be made worse by taking antibiotics,
using antiseptic mouthwashes, smoking and poor oral hygiene.
Try using a tongue scraper and, if it persists, ask your
dentist for advice.
White patches
There
are two main causes of white patches.
- White patches on the tongue and inside of the cheeks
may be caused by thrush, a fungal infection that is common
in babies and also in adults who have been taking antibiotics
or have been unwell. These patches can be scraped off to
leave red, sore areas underneath, and can be improved by
special lozenges from your doctor.
- White patches that are not sore, cannot be scraped away
and do not go away on their own (leukoplakia) are sometimes
an early warning sign that the area could become cancerous
in the future. These patches should be checked by your
doctor so they can be dealt with before they develop further.
Ulcers and lumps on the
tongue
Most people have ulcers on their tongue
from time to time. Usually they are very sore, but so small
that they are difficult to see. They are harmless, and
clear up in a day or two without any treatment. However,
you must not ignore a lump on the tongue or an ulcer that
doesn’t heal, even if it is
painless, because it could be a cancer. Get it checked by
your doctor if it is still there after 2 weeks. Cancer of
the tongue is unlikely under the age of 50.
Tongue piercing
Tongue
piercing is normally safe, but it is theoretically possible
that it could lead to infection with hepatitis B, hepatitis
C or HIV, and it can cause other health problems. So think
very carefully about the risks before having it done.
Obviously you must make sure that the person
doing the piercing is experienced and that the piercing
parlour is hygienic. This may be difficult, because there
are no official qualifications or training standards for
body piercers in the UK. Check the piercer uses clean needles
for each person, disposable gloves and antiseptics, and
has a ‘sharps’ box
(as in a doctor’s surgery) for disposing of each used
needle. The jewellery is not sterile, so ideally the piercer
should sterilize it in an ‘autoclave’ (as in
a doctor’s surgery). Usually, however, the jewellery
is wiped with antiseptic or boiled before insertion; this
lessens the risk of infection but not as absolutely as autoclaving.
Ask about all of this before you decide to have it done.
Bleeding. There
is a very slight risk of serious bleeding when you have the
piercing done. This is because the tongue contains lots of
blood vessels. Because you naturally swallow the blood, you
may not realize how much you are bleeding. Doctors at the
London Hospital, UK, have given the following advice to anyone
having a tongue piercing (British Dental Journal 2000;188:657 –8).
- Reduce the risk of swelling by sucking ice cubes hourly
for the rest of the day.
- If your tongue swells, making it difficult to swallow
or breathe, go to the nearest Accident and Emergency Department
straight away.
- Every 4 hours, and after eating, give
yourself a salt-water mouth bath to help prevent
infection. This means dissolving 1 teaspoonful of salt
in a glass of hot water, and immersing the site of
the piercing for at least 2 minutes. This is awkward
but possible – you
have to fill the glass fairly full.
- If the area round the jewellery becomes red and tender,
you may have an infection. Go to your doctor or an Accident
and Emergency Department.
- If part of the jewellery becomes dislodged and you may
have swallowed or inhaled it, go to your nearest Accident
and Emergency Department.
- If the piercing bleeds, press it firmly with a clean
cloth (for example, a clean handkerchief) for half an hour.
If it continues to bleed, go immediately to the Accident
and Emergency Department.
Other problems. Bleeding is the most serious,
but tongue piercing can cause other problems.
- The jewellery may damage your teeth and
gums. A study from Ohio State University found that almost
half the people wearing a tongue stud for more than 4
years had chipped teeth, and 35% had receding gums because
of the stud banging against the gum (Journal of Periodontology 2002;73:289 –97).
The longer the stud had been present, the worse the
damage.
- The pierced site could become infected, but this seems
to be fairly unusual in the tongue compared with other
parts of the body (maybe because of its good blood supply).
Resist the temptation to fiddle with the newly inserted
stud.
- Because different parts of the tongue are sensitive to
different tastes, some people find that a piercing affects
their sense of taste. It can also cause slight difficulty
in speaking clearly. If you need an operation, you will
be asked to remove the tongue jewellery, because it can
cause difficulties with the anaesthetic.
- Allergy is another problem, because the metal may not
be pure. You may think that you have pure gold or steel
jewellery, but it may contain substantial amounts of nickel,
which can cause a sensitivity. When scientists in Finland
tested body jewellery, they found that 11 of the 12 items
they tested exceeded the EU safety limits for nickel. Surgical
stainless steel with the mark 316L is of good quality and
is unlikely to cause sensitivities. Niobium is an expensive
metal, but is least likely to cause sensitivities.
- The piercing can allow bacteria
to enter the bloodstream. In a recent case in the
USA, the bacteria from a tongue piercing damaged
the valves of the heart.
