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You might not spend much time looking at your tongue, but doctors say you can see that it may reveal a surprising amount about what’s happening with your health.
“The tongue is a beautiful organ that provides a uniquely accessible window to the otherwise hidden inner workings of the human body,” Dr. Peter C. Belafsky, director of the Center for Voice and Swallowing at the University of California, Davis Health, told HuffPost. “We often think of the tongue as the organ that allows us to speak, kiss, taste and swallow. But to physicians, it can provide the first clues to nutritional deficiency, neurologic and autoimmune disorders and even cancer.”
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The reassuring news is that most tongue changes aren’t extremely serious.
“Many changes in your tongue’s appearance are harmless and can be caused by something as simple as what you’ve eaten or a minor infection,” said Dr. Nora Tossounian, medical director for Hackensack Meridian Health’s signature executive health program. “However, your tongue can offer valuable clues about your overall health.”
That’s why it’s worth paying attention to things like the texture, color and size of your tongue over time. Below, doctors share the symptoms and changes they always take seriously and why you shouldn’t ignore them either.
1. A Sore Or Ulcer That Hasn’t Healed In 2-3 Weeks
“A sore or ulcer on the tongue that hasn’t healed in two to three weeks, especially on the side or underside, is the sign I never wave off,” said Dr. John Cramer, an associate professor in the Department of Otolaryngology at the Wayne State School of Medicine. “That’s the classic look of an oral tongue cancer. What makes it dangerous is that it’s often painless early and firm to the touch, so people assume it’s a bite or a canker sore and wait.”
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Although it’s tempting to dismiss this kind of small spot, you should seek medical attention if it doesn’t show signs of healing.
“Most tongue sores are caused by something simple, like accidentally biting the tongue or irritation from a sharp tooth,” said Dr. Hamid Djalilian, an otolaryngologist with UCI Health. “I would never ignore a sore that is still there after two weeks, especially if it feels firm, bleeds easily or seems to be getting larger. A persistent sore beyond three weeks can sometimes be an early sign of oral cancer and should be checked by a dentist or ENT specialist and biopsied.”
Dr. Brad deSilva, an otolaryngologist at the Ohio State University Wexner Medical Center, noted that your primary care provider or dentist can refer you to an oral pathologist or otolaryngologist if more specialized attention is needed.
“If they have a lesion growing outward from the tongue or an ulceration, the patient may require a biopsy or surgical excision,” he said.
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Beyond oral cancer, lesions and ulcers could also indicate other issues, such as a chronic viral infection, fungal infection or a systemic issue.
“Of course we are most worried about a cancer, but this could also occur with an infectious disease or an autoimmune or inflammatory condition or a nutritional deficit,” said Dr. Brianna Crawley, a professor of laryngology at UC Davis Health. “Sometimes a wound of the tongue is not visible from the front of the mouth but can cause significant pain further back in the oropharynx and should similarly be investigated.”
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2. A Tongue That’s Enlarging
“A tongue that is larger than normal, a condition known as macroglossia, can be a sign of an underlying health issue,” Tossounian said. “This can include hypothyroidism, allergies to food or medication or amyloidosis ― a rare disorder where abnormal proteins build up in organs.”
A swollen or enlarged tongue is easier to spot than other more subtle changes.
“A tongue that’s enlarging, with scalloped edges where it presses against the teeth, can point to a thyroid problem or, less commonly, a protein-deposit disease called amyloidosis,” Cramer said.
Tongue enlargement may indicate other issues as well.
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“It could also occur with a tumor or alteration in vascular drainage or could be due to damage to the innervation of the tongue,” Crawley said. “These three can involve only the left or right side of the tongue.”
If the swelling occurs suddenly, it’s a more urgent situation.
“Sudden swelling of the tongue can become dangerous very quickly as it can block your breathing,” Djalilian said. “If someone is also having trouble breathing, swallowing or speaking, they should call 9-1-1 immediately. This may be caused by a serious allergic reaction or a rapidly spreading infection that could block the airway.”
3. A Lump, Firmness Or Thickening On One Side
“A new lump, thickened area or firm spot on one side of the tongue should always be evaluated,” Djalilian said. “I would be even more concerned if it came with numbness, bleeding, trouble moving the tongue, pain with swallowing or a lump in the neck that is persistent beyond three weeks. These symptoms can sometimes point to a growth involving the tongue or nearby tissues.”
If the bump or thickening is unrelated to any accidental bites or other trauma to the tongue, pay attention. Bleeding or numbness should have a cause.
“Patients at risk for tongue cancer are those who have risk factors associated with tobacco use ― both smoking and smokeless tobacco, i.e. ‘dip’ ― and alcohol use,” said Dr. Collin F. Mulcahy, an otolaryngologist and head and neck surgeon at Houston Methodist Cypress Hospital. “However, other risk factors include chronic irritation of the tongue from an adjacent dental issue, such as a sharp tooth, bridge or crown. In rare circumstances, patients without these risk factors can develop tongue cancer. This is thought to be related to a genetic predisposition.”
4. Red Or White Patches That Don’t Go Away
“A red, white or mixed red-and-white patch on the side of the tongue is worth paying attention to if it lasts more than three weeks,” Djalilian said. “It may be caused by irritation or infection, but in some cases, it can represent a precancerous change, which may need to be biopsied. This is especially concerning if the area feels thick, rough or hard.”
White patches have a range of causes and can signal different conditions.
“Creamy white patches that wipe off and leave the tongue red or sore may be oral thrush, which is a yeast infection,” Djalilian said. “It is common after antibiotics or with the use of steroid inhalers.”
If this appears in other situations or keeps coming back, there could be other issues at play, however.
“Thrush, a white coating that wipes off, in an otherwise healthy adult who isn’t on antibiotics or inhalers, should prompt a look for something suppressing the immune system, like uncontrolled diabetes,” Cramer said. “A corrugated white plaque on the side of the tongue that won’t wipe off can be a marker of HIV.”
There are other serious conditions that manifest in this way as well.
“Especially in smokers, a white coating on the tongue that cannot be scraped off can be a sign of a more concerning issue, such as leukoplakia, which is a condition that can sometimes progress to oral cancer,” Tossounian noted.
Belafsky also pointed to the possibility of lichen planus, as well as leukoplakia, candida and cancer.
“These white plaques are often caused by chronic inflammation such as from poorly fitting mouth retainer or dentures, or from biting the tongue,” he added.
5. Changes In How The Tongue Moves
“We would definitely wish to address a change in how the tongue protrudes ― either if its motion is limited or it points to one side or the other instead of going straight out,” Crawley said. “This may be accompanied by dysarthria or changes in the way someone speaks.”
She highlighted potential nerve issues, which could cause the tongue to drift to one side, for instance.
“Motion can be impacted by a stroke or neurodegenerative disorder, a tumor including in the skull base or neck, or even as a result of a trauma, surgery or radiation,” Crawley said.
Dr. Neal Godse, an assistant professor at the University of Minnesota Medical School, pointed to the functions of the tongue in everyday life as potential indicators of a problem.
“Difficulty with moving the tongue, often noticed as slurred speech, can signify neurologic issues affecting the nerves and muscles of the tongue,” he said. “Ultimately the tongue is an important organ that helps us with sensation, eating and drinking and communication. If people notice persistent issues with these functions, it can signify local or body-wide problems that are worth investigating with their health care team.”
6. A Smooth, Shiny Or Unusually Red Tongue
“A smooth, sore, beefy-red tongue can be the first sign of a vitamin deficiency in B12, folate or iron,” Cramer said.
Belafsky noted that a pale tongue could similarly signal anemia or vitamin deficiency and shared other potential issues at play with a red tongue.
“A beefy, red tongue is a sign of inflammation, which may be caused by infection or occasionally autoimmune disease like Sjögren’s,” he said.
Low levels of vitamin B12 can have a range of effects on the body, including the tongue.
7. A Bright ‘Strawberry’ Tongue
“A bright-red, bumpy tongue along with fever, sore throat or a rash may occur with infections such as scarlet fever,” Djalilian said. “In children, it can also be seen with Kawasaki disease, especially when there are red eyes, swollen hands or feet, or a prolonged fever.”
He emphasized the importance of prompt evaluation in an emergency department in this case.
“Kawasaki disease is a rare but serious condition that primarily affects children and causes inflammation in the walls of arteries,” Tossounian said, adding that it can lead to “a bright red, bumpy tongue that resembles a strawberry.”
8. Twitching Or Trembling
“A tremulous tongue could be a sign of neurologic illness such as Parkinson’s or essential tremor,” Belafsky said. “Fasciculations ― involuntary muscle twitches of the tongue ― are one of the most ominous signs and could indicate motor neuron disease such as ALS or other neuromuscular disease.”
Cramer described what to look for.
“A tongue that looks wasted and is rippling or twitching can be an early sign of a motor neuron disease like ALS,” he said.
9. Numbness, Especially On One Side
“Development of numbness or taste change, especially when it is asymmetric or limited to one portion of the tongue, is something we would definitely wish to address,” Crawley said.
Tongue numbness can lead to difficulty speaking and may have a more serious underlying issue.
10. Persistent Pain Or Soreness
“I would never ignore persistent pain or soreness which may indicate neoplastic, infectious or inflammatory conditions,” said Dr. Maggie A. Kuhn, an associate professor in the department of otolaryngology at UC Davis Health.
Dr. Jon Mallen-St. Clair, an otolaryngologist-head and neck surgeon at Cedars-Sinai Medical Center, similarly urged prompt medical attention for a tongue that continues to hurt or hurts worse over time.
“One of the main concerning symptoms is persistent and/or progressive tongue pain,” he said. “This should be assessed by a medical professional. Associated ear pain is particularly concerning.”
In addition to changes in appearance, some tongue pain or discomfort can also be related to nutritional deficiencies.
“Some people also notice a burning tongue, tenderness, fatigue, weakness or tingling in the hands and feet,” Djalilian said. “Blood testing may be needed to look for anemia or vitamin deficiencies.”
While many changes to the tongue can be harmless, paying attention to this part of your body may help you know when to seek a professional opinion.
“Don’t just look at the top of your tongue,” Cramer advised. “Check the sides and underneath. Those are the most common places cancer shows up, and they’re exactly where a quick glance in the mirror misses. This is no longer a disease only of older smokers and drinkers.”
He noted that tongue cancer rates are rising “in younger people, disproportionately women, many of whom have never smoked” in recent years. That’s no reason to panic, however.
“The vast majority of tongue changes are nothing,” Cramer said. “The point isn’t fear. It’s knowing the handful of red flags and getting them looked at promptly.”
