Tongue Problems

WHEN TO SEE YOUR DOCTOR

* Discoloration or coating on the tongue—especially if it's white, curdlike or stringy—does not disappear with regular brushing.

* You develop a sore on the side of your tongue.

What Your Symptom Is Telling You

Open your mouth, stick out your tongue and say "A-a-a-h." When a doctor tells you to do that, he's just trying to get your tongue out of the way to see down your throat. You may do it in front of the bathroom mirror if you see something weird going on—and a lot of weird things can show up on the tongue.

The normal tongue is a healthy coral pink and is sandpaper rough, covered with fissures, grooves and small hairlike projections called papillae. The normal tongue is also a breeding ground for all sorts of gunky growths.

"It's an incubator for bacteria and fungus of all kinds," says J. Frank Collins, D.D.S., a dentist in private practice in Jacksonville, Florida. "The grooves can get filled up with plaque and food, and then bacteria set up housekeeping there."

Bacteria may build up because of poor hygiene. And for a variety of reasons, the bacterial balance may be tipped in favor of just one species, which then flourishes, Dr. Collins explains. That's when things get weird.

The papillae, for example, can grow from their original length of just a silly millimeter or two to as long as 20 millimeters (about 3Ž4 inch), making it look as though your tongue has sprouted a beard. As if that weren't bad enough, Dr. Collins says, the hairs and the debris between and below them become colored—white, black, green or red, depending on the particular bacterium and foodstuffs involved.

In contrast to the hairy look, the tongue also can be too smooth. That usually happens because of a nutrition deficiency. The small papillae don't fall off, Dr. Collins explains. Rather, the inflamed tongue tissue swells and engulfs them.

Sores can also show up on the tongue. They can be benign, like canker sores, or be caused by a bite. Or they can be a bit more serious, perhaps a fever blister. Sores on the sides of the tongue are of more significant concern. While they could be any of the above, they also could be oral cancer and need to be checked out by a doctor, Dr. Collins says.

And if the papillae are missing altogether in places, a person may have what is known as geographic tongue. It sounds exotic, but is no cause for concern, according to Louis M. Abbey, D.M.D., a professor of oral pathology at Virginia Commonwealth University/Medical College of Virginia School of Dentistry in Richmond. A person with geographic tongue has smooth red patches on the tongue that seem to change location from time to time. "You see this in 20 to 30 percent of the population," he says.

Geographic tongue is not those little brights spots interspersed with whitish areas that are part of a healthy, pink tongue.

Geographic tongue sort of resembles a topographical map, and if you have it, someone in your family also probably has it, because it's seen in families, although no one has ever proved it's hereditary.

Symptom Relief

If your tongue discoloration can't be tied easily to a bottle of wine, a glass of milk or a green jawbreaker, you may have acquired something that only a doctor can remedy. Here are your options.

Grab your toothbrush. Whenever you notice a discoloration or coat on your tongue, the first recourse is to use a toothbrush on it, Dr. Collins says. "If it doesn't come off with brushing, and it persists for a couple of days, then go see the dentist and ask what the problem is. If it does come off and your tongue returns to normal, just keep on brushing."

Change your prescription. Many drugs—such as Darvon and other analgesics or tetracycline and other antibiotics—change the balance of bacterial flora in the mouth, Dr. Collins says. That allows certain stronger strains to grow like dandelions in a spring lawn. If you're taking medications and your tongue changes color or begins to develop a growth, he recommends that you continue to brush your tongue regularly. And ask your doctor if you can discontinue the medication you're on or take something less likely to tint your tongue as a side effect.

Don't smoke. Tobacco use can aggravate or cause tongue problems, Dr. Abbey says. You've heard it before, but here it is again: Stop smoking.

B takes the skid off. A slick or smooth tongue usually is a sign of pernicious anemia, caused by a vitamin B₁₂ deficiency. "It's usually pernicious anemia, but that's not always the case," Dr. Collins says. "If it's not pernicious, chances are it's some other type of anemia, maybe iron deficiency. Or it's some other blood-borne problem." Your doctor will have to diagnose the cause of slick tongue. He may treat it with a vitamin B₁₂ shot or have you take a supplement. In the meantime make sure you eat plenty of foods high in B₁₂, like fish, low-fat yogurt and cottage cheese.

Make sure it makes its move. Geographic tongue may cause a burning sensation in your mouth. If necessary, talk to your doctor for possible treatments. Other than that, geographic tongue is of no real concern, Dr. Abbey says, "although you and your dentist should watch to make sure it doesn't turn into something else."

Diet drinks do it. Certain foods may cause discomfort or burning for people with geographic tongue, Dr. Collins says. "I've seen some people with it who are irritated by diet drinks or spearmint oil in chewing gums," he says. You'll have to experiment with eliminating different drinks or foods from your diet to see if it eases the soreness.

Don't blame it on your teeth. If you develop a sore (painful or not) on the side of your tongue, schedule a visit with the doctor. It could be a canker sore or cold sore. But for some reason, the sides are a favorite site for oral cancer, Dr. Collins advises. "You might think it's caused by scraping against a sharp tooth, but it doesn't have anything to do with a tooth," he says. "Teeth don't usually cause sores on your tongue."