Our tongues are very sensitive, so we soon tend to notice when something is not quite right, says Dr Dr Melanie Wynne-Jones

Healthy tongue

Do you have a healthy tongue? © iStock

Our tongues contain flexible muscles that allow us to speak, chew, suck and swallow, and are covered in touch and taste receptors that act as guardians to our bodies, and enable us to enjoy or reject various foods.

Their surfaces have many papillae (tissue folds that look particularly large at the back) containing hundreds of taste buds which allow us to detect salt, sweet, bitter, acid and umami (savoury) flavours.

Coated tongue

This is usually caused by food debris trapped in the spaces between the papillae, and can lead to bacterial growth and bad breath (halitosis), or soreness (see below).

It’s made worse by mouth dryness – for example, in dehydration or if saliva is reduced by dry mouth or Sjogren’s syndrome, drugs such as those used for incontinence, or if we mouth-breathe (often while asleep).

The coating is usually whitish-grey, but if mouth hygiene is poor (for example, because of severe illness) it can lead to a ‘black, hairy tongue’.

You can remove coating by brushing your tongue every day with a toothbrush or tongue scraper (from your pharmacist). Pineapple or pineapple juice can help if it’s severe, but if it’s persistent, or you regularly have a dry mouth, this could damage your teeth, so see your GP or dentist.

Geographical tongue has irregular patches which frequently change. It’s due to flattening of different papillae, although the cause isn’t known.

Tongue soreness

A coated tongue may also be sore. This can be due to thrush (candida) which is more common in people with diabetes, poor immunity, anaemia, false teeth, poor hygiene or those who take antibiotics or steroids, including inhalers.

You’ll need a GP check, but it’s easily treated with antifungal drops or tablets.
Deficiencies of vitamins (B12 or folic acid) or minerals (iron or zinc) can produce soreness, a smooth red tongue, and/or taste abnormalities.

Don’t go straight into taking supplements – you’ll need tests first, to check levels in your blood, and whether there’s a serious underlying cause.

A ‘burning tongue’ that looks normal may be a form of neuralgia and improve with a small dose of antidepressants that block abnormal nerve signals.

Sore patches and lumps

Aphthous ulcers (greyish, shallow, often multiple) are more common in younger people,
and can last a couple of weeks.

Ulcers may also be triggered by stress, hormones, trauma (from tooth edges), foods (including nuts or fruit), or additives such as lauryl sulphate in toothpaste.

Take a painkiller or try using mouth lozenges (from your pharmacy). Some skin diseases, such as lichen planus, and medicines (such as nicorandil for heart disease, and non-steroidal anti-inflammatory drugs, such as ibuprofen) can cause ulcers, too.

Sore white or red patches (on the tongue or anywhere in the mouth) may be a sign of an immune system disorder, abnormal cell changes or, rarely, mouth cancer, which affects around 7,000 UK adults a year.

Any abnormal patch, ulcer, lump, bleeding or discolouration that lasts more than a couple of weeks should be shown to your GP.

It probably won’t be cancer, but she can refer you for an urgent biopsy (tissue sample).

5 tips for tongue health

1 Drink plenty of fluids. Avoid sugary or acidic drinks that can cause tooth decay.

2 Keep your mouth fresh by brushing teeth (and, if necessary, your tongue), twice daily. Floss teeth, too, but don’t rinse protective fluoride toothpaste away.

3 Don’t smoke – it’s a risk factor for mouth cancer and causes bad breath.

4 Drink alcohol within recommended limits – a high alcohol intake is also linked to mouth cancer.

5 Have regular dental checks – your dentist is trained to advise on mouth health, and to spot early signs of mouth cancer.