Tongue Problems

Medically Reviewed by Jabeen Begum, MD on May 05, 2023
7 min read

The tongue is a muscular organ in the mouth. It's covered with moist, pink tissue called mucosa. Tiny bumps called papillae give the tongue its rough texture. Thousands of taste buds cover the surfaces of the papillae. Taste buds are collections of nerve-like cells that connect to nerves running into the brain.

It's anchored to the mouth by webs of tough tissue and mucosa. The tether holding down the front of the tongue is called the frenum. In the back of the mouth, the tongue is anchored into the hyoid bone. The tongue is vital for chewing and swallowing food, as well as for speech.

The four common tastes are sweet, sour, bitter, and salty. A fifth taste, called umami, results from tasting glutamate (present in some foods and in MSG). The tongue has many nerves that help detect and transmit taste signals to the brain. Because of this, all parts of the tongue can detect these four common tastes. The commonly described “taste map” of the tongue doesn't really exist.

Tongue problems include a variety of symptoms, from pain to changes in color and texture, that can have many different causes.

Though often hailed as "the strongest muscle in the body," the tongue is made up of a group of muscles that allow us to taste food, swallow, and talk. A healthy tongue is pink and covered with papillae.

Because you use your tongue all the time, tongue problems can be frustrating and uncomfortable.

Different causes of tongue problems have different symptoms. You might have:

  • Pain
  • Burning sensation
  • Lumps
  • Sores
  • Discoloration, ranging from white to black
  • Texture changes

There are a variety of causes for common tongue symptoms. The majority of tongue problems aren’t serious, and most can be resolved quickly.

In some instances, though, a discolored or painful tongue can indicate more serious conditions, including vitamin deficiencies, AIDS, or oral cancer. For this reason, it is important to seek medical advice if you have any ongoing problems with your tongue.

Causes of sore tongue or tongue bumps

Many things can make your tongue become sore or cause painful bumps to form, including:

  • Trauma. Accidentally biting your tongue or scalding it on something hot can leave you with a sore tongue until the damage heals. Grinding or clenching the teeth can also irritate the sides of the tongue and cause it to become painful.
  • Smoking. Smoking excessively can irritate your tongue and make it sore.
  • Canker sores. Many people will get these mouth ulcers on the tongue at some point. The cause is unknown, although they can be worse during periods of heightened stress.
  • Burning tongue syndrome. Some postmenopausal women develop this syndrome, which makes the tongue feel as if it has been burned.
  • Enlarged papillae. If one or more of your taste buds becomes inflamed or irritated, it can swell and form a painful bump on your tongue.
  • Other medical problems. Medical conditions, including diabetes and anemia, can have a sore tongue as a symptom.
  • Oral cancer. Though most sore tongues aren’t anything to worry about, you should consult a doctor if you have a lump or sore on your tongue that doesn't go away within a week or two. Many oral cancers don't hurt in the early stages, so don't assume a lack of pain means nothing is wrong.

Causes of white tongue

There are a number of things that can cause a whitish coating or white spots to develop on the tongue, including:

  • Leukoplakia. This condition causes cells in the mouth to grow excessively. That, in turn, leads to the formation of white patches inside the mouth, including on the tongue. Although not dangerous on its own, leukoplakia can be a precursor to cancer. So it is important for your dentist to determine the cause of white patches on your tongue. Leukoplakia can develop when the tongue has been irritated, and it is often found in people who use tobacco products.
  • Oral thrush. Also known as candidiasis, oral thrush is a yeast infection that develops inside the mouth. The condition brings on white patches that are often cottage cheese-like in consistency on the surfaces of the mouth and tongue. Oral thrush is most commonly seen in infants and older people, especially denture wearers, or in people with weakened immune systems. People with diabetes and people taking inhaled steroids for asthma or lung disease can also get thrush. Oral thrush is more likely to happen after the use of antibiotics, which may kill the "good" bacteria in the mouth. Eating plain yogurt with live and active cultures may help restore the proper fauna in your mouth. Additionally, medications may be used to combat the infection.
  • Oral lichen planus. A network of raised white lines on your tongue with a lace-like appearance can be a sign of this condition. Doctors often can't pinpoint its cause, but it usually gets better on its own. You can do some things that might help: Practice proper dental hygiene, avoid tobacco, and cut back on foods that irritate your mouth.

Causes of red or strawberry tongue

There are multiple factors that can cause a normally pink tongue to turn red. In some instances, the tongue may even take on the appearance of a strawberry with enlarged, red taste buds dotting the surface. Possible causes include:

  • Vitamin deficiencies. Deficiencies of folic acid and vitamin B12 may cause your tongue to take on a reddish appearance.
  • Geographic tongue. This condition, also known as benign migratory glossitis, is named for the map-like pattern of reddish spots that develop on the surface of the tongue. At times, these patches have a white border around them and their location on the tongue may shift over time. Though usually harmless, you should check with your dentist to investigate red patches that last longer than 2 weeks. Once the dentist has determined that the redness is a result of geographic tongue, no further treatment is necessary. If the condition makes your tongue sore or uncomfortable, you may be prescribed topical medications to ease discomfort.
  • Scarlet fever. People who get this infection may develop a strawberry tongue. Be sure to contact a doctor immediately if you have a high fever and red tongue. Antibiotic treatment is necessary for scarlet fever.
  • Kawasaki syndrome. This disease, usually seen in children under the age of 5, affects the blood vessels in the body and can cause strawberry tongue. During the severe phase of illness, children often run an extremely high fever and may also have redness and swelling in the hands and feet.

Causes of black hairy tongue

Though troubling in appearance, a black, hairy tongue is typically nothing serious. It comes from an overgrowth of bacteria, dead cells, and other debris that get trapped on your tongue. Several things can cause it:

  • Overgrown papillae. The small bumps on the surface of your tongue grow throughout your lifetime. In some people, the papillae become excessively long, rather than being worn down by daily activities. That makes them more likely to harbor bacteria. When these bacteria grow, they may look dark or black and the overgrown papillae appear hair-like.
  • Medical treatments. People who are taking antibiotics or receiving chemotherapy may be more likely to have a black hairy tongue.
  • Poor oral care. This condition isn’t common and is most likely to happen in people who don’t have good dental hygiene.

Other causes of tongue issues include:

  • Macroglossia (big tongue). This can be broken down into various categories based on the cause. These include congenital, inflammatory, traumatic, cancerous, and metabolic causes. Thyroid disease, lymphangiomas, and abnormalities at birth are among some of the causes of an enlarged tongue.
  • Atrophic glossitis (bald tongue). The tongue loses its bumpy texture, becoming smooth. Sometimes this is due to anemia or a B vitamin deficiency.
  • Herpes stomatitis. The herpes virus can uncommonly cause cold sores on the tongue. Herpes virus cold sores are usually on the lip.

Your doctor can usually tell what’s wrong with your tongue by looking at it. They may want to test you for medical conditions that can cause tongue symptoms, like diabetes or a vitamin deficiency.

If you have a mouth tumor, you may have a biopsy to check for cancer.

Treatments for tongue problems vary depending on their cause. Some problems go away by themselves. If you have an underlying health condition, treating that can improve your symptoms.

Your doctor may suggest a medicated rinse or gel. If you have oral thrush, you may need antifungal medication.

If you have sores or other conditions that cause pain, it may help to avoid spicy or acidic foods.

Cancer treatment can range from surgery to radiation and chemotherapy or drug therapy.

Because some tongue problems can be linked to poor oral health, it’s important to take care of your mouth and teeth. Brush and floss regularly and use a tongue scraper to remove bacteria and other particles. If you smoke, talk to your doctor about quitting.