From bad breath to burnout, your tongue can be surprisingly telling of your general health. Here’s what to look out for and how to “read” your tongue
I’ve weirded out most of my friends, family and colleagues with glimpses of my “leopard print” tongue on many occasions – roughly every few months I experience a case of what we’ve collectively put down as geographic tongue. It basically makes the surface of my tongue look like a map of the Greek islands, only far less dreamy. It manifests as sore red patches surrounded by white borders, and despite the fact that my GP, doctor and nurse parents and medical friends are still a bit baffled by it, and the causes of geographic tongue remain largely unknown, the condition is thought to be linked to psoriasis , which runs in my family, and potentially vitamin B deficiency , which I’ve had in the past. The islands pop up almost like clockwork when I’m feeling run down, stressed, have been unwell or have possibly had more than my usual fill of spicy food and booze (my partner’s parents own a pub with a Thai restaurant attached so make of that what you will).
As it turns out, my tongue and I probably aren’t such freaks of nature after all- the tongue has been seen as reflective of our overall health in both Chinese and Ayurvedic medicine for centuries, and the rise of tongue scraping, as popularised by wellness figures such as Jasmine Hemsley, encourages us to check in with our tongues regularly and clean it daily to avoid bad bacteria buildup. Methods of tongue scraping and cleaning vary, but Jasmine has her very own device to do the job- the new East by West Tongue Tingler , £10. It launched last week, is made of antibacterial copper and is designed to be scraped over the tongue to remove that oh so common white/ yellow/ brown fuzz (apologies) that your toothbrush doesn’t touch, in theory improving your digestion and ability to taste according to Ayurvedic principles.
Jasmine reveals that tongue scraping was on the first Ayurvedic rituals she added to her routine after learning Vedic meditation eight years ago, and that she’d now almost rather be without her toothbrush than her tongue scraper (we’re not sure we’d go that far, but she’s onto something with the regular tongue hygiene regime as we’ll explore). Hemsley highlights that children in India are taught to scrape their tongues alongside other oral health habits from a young age, and dentists agree that cleaning the tongue is particularly key to avoiding dental health problems down the line, not to mention sour breath, as Dr Uchenna Okoye , cosmetic dentist at London Smiling explains:
“Scraping your tongue not also reduced your risk of bad breath, but tongue scraping removes the bacteria that often leaps up to gums and causes serious damage.”
How to scrape your tongue
You can use a U shaped stainless steel, plastic or copper device such as Hemsley’s (they start at around £2, but Jasmine’s highly Instagrammable version will set you back a bit more…), and the metal variety can last a lifetime. Otherwise, many electric toothbrushes now come complete with tongue cleaning attachment heads, and failing that, you can have a go using a toothbrush, although that can result in brushing your tongue coating around your mouth rather than scraping it off thoroughly. If you are using a scraper, here’s Jasmine’s ritual:
“To use, take the two ends of the tongue scraper in each hand, stick out your tongue, and guide the arch of the tongue scraper to the back of the tongue. Gently scrape forward and down several times, rinsing the white mucus off the scraper in between. Rinse the mouth once you are done, then wash the scraper with hot water after use and store in a clean, dry place (I have a little hook by my bathroom mirror that I hang it on ready for action).”
Scraping with toothpaste can also provide bacteria and bad breath fighting clout- as dentist and bacteriologist Dr Harold Katz highlights:
“It’s important to brush the tongue when brushing your teeth, because most of the bacterial growth in a person’s mouth is at the back of the tongue. To clean your tongue, put a little bit of toothpaste on your tongue scraper or toothbrush and gently run it over the surface of your tongue. Allow the gel or paste to sit on the surface of the tongue, as this allows the oxygenating compounds of the toothpaste to penetrate below the surface of your tongue and destroy the bacteria breeding below it.”
Taking care of your tongue doesn’t stop with scraping according to ancient Eastern medicine either- tongue health is closely monitored in Traditional Chinese Medicine (TCM), with a tongue diagnosis being used to analyse overall wellbeing. Chinese medical therapists and founders of Escapada Emilia Herting and Maeve O’Sullivan give us the lowdown as to what a TCM tongue session might involve.
Analysing your tongue, Chinese medicine style
“In Chinese Medicine, it is believed that the appearance of your tongue is a reflection of your inner health. Tongue diagnosis’ (where a practitioner asks to see your tongue) have been used for over two thousand years in TCM to identify diseases. Every person's tongue is unique with distinct characteristics, and the tongue is believed to be a microcosm of the entire body. By looking at the shape, colour, coating and texture you are often able to see any excess and deficiencies in the body."
“Practitioners will often refer to a tongue chart, whereby different areas of the tongue correspond to larger areas and organs of the body (in a similar way to reflexology). A tongue diagnosis wouldn’t be conducted in isolation, rather as part of a full overall health consultation, but the following are all considered when evaluating your wellbeing:
- If the tongue is puffy, with teeth marks it can indicate a lack of nutrients and moisture.
- A very thin tongue could indicate dehydration
- A red tongue may represent heat in the body, such as a fever or a hormonal imbalance that is leading to hot flushes or temperature changes.
- A purple tongue is a sign that the circulatory system is backed up, perhaps from a major injury or condition.
- A pale tongue is a sign of a vitamin or mineral deficiency or a lack of energy. This is common inanaemia sufferers or after a long-standing disease where the immune system might be weak.
- A thick coating is often considered reflective of poor gut health.
- A thin coating is normal, but a very thin or absent tongue coating can signal dehydration or that you need to be getting more fluids onboard.
- A yellow, grey or even black coating can signal infection or bacterial build-up.
- A thick white coating means there is ‘cold’ in the body, likely poor circulation or possibly a yeast infection.
- A bump on top of the tongue could be a warning of a bacterial or viral infection or of an allergic reaction to a food or medication.
- Canker sores pop up most often on the underside of the tongue, and can be identified by a round, red border and yellow or white centre.
- A white or grey sore with a hard surface that feels thick and raised from the tongue could be leukoplakia, a disorder of the mucous membranes most frequently caused by irritation from dentures, crowns, fillings or tobacco use.
- If you spot patchy lesions on the tongue that seem to change location from day to day, you may have a harmless but sometimes uncomfortable condition called geographic tongue.
- A tongue that bears grooves or wrinkles could be scrotal tongue, a harmless condition but this can make it difficult to keep the tongue properly clean.
“Always get sores or lumps on the tongue checked by a doctor, and if you’re experiencing any burning, pain, loss of sensation or inability to move the tongue properly, this should be looked at by a doctor as soon as possible.”
While you should always consult your GP above complementary therapy if you suspect that there’s a problem with your tongue, as Maeve and Emilia emphasise, much of the TCM tongue diagnosis is in line with medical thought too- the state of your tongue can point to larger health conditions. It could be that your tongue quirks are genetic or that your tongue simply needs a good clean, so do not panic, but the following can all show up on your tongue…
Going in at the deep end, oral thrush is an infection caused by the Candida fungus. If you’ve got it, you may notice white patches on your tongue and mouth, an unpleasant taste or a loss of taste, and occasionally pain and discomfort, particularly when eating and drinking. You could also experience smooth, red lumps or sores on your tongue. If any of the above sounds like you, get thee to the GP, as antifungal medicines are the only effective course of treatment and NHS Direct indicates that symptoms are likely to persist if you don’t seek out medication.
NHS Direct also reports that you’re more likely to suffer from oral thrush if you’ve recently taken a course of antibiotics, taken corticosteroid medication for asthma, wear dentures, have diabetes , have a dry mouth, smoke or have poor oral hygiene. A weakened immune system also makes contracting oral thrush more likely. Antifungal treatment should see oral thrush clear up within two weeks.
We’ve all had one, and mouth ulcers are for the most part harmless and indicative of physical trauma- i.e, you’ve bit your tongue. They can also crop up when you’re stressed, tired, have eaten certain ‘trigger’ foods (holler chilli), have stopped smoking (stick with it) or during times of hormonal change such as your period, during pregnancy or postpartum. They’re generally small and round and mostly heal by themselves- you can take painkillers if they’re sore, and antimicrobial mouthwash can help. If they hang around for three weeks or longer, see your GP.
NHS Direct also underlines some less common triggers of mouth ulcers:
- “A long-term condition – such as inflammatory bowel disease (IBD), coeliac disease orBehçet's disease.
- Avitamin B12or iron deficiency.
- Certain medications – including some NSAIDs, beta-blockers or nicorandil, can make you more prone to mouth ulcers.
- Hand, foot and mouth disease.
- A long-lasting mouth ulcer is sometimes a sign of mouth cancer. It's best to get it checked.”
My particular mouth issue, as previously mentioned, no one’s quite sure why these map-like patterns can appear on the tongue, but rest assured that’s not infectious and unlikely to be serious. They can be sore and tender (mine certainly are), and acidic and spicy foods, alcohol and smoking are likely to make the painy bits more tender. There’s no treatment per se, but avoiding SLS in toothpastes can help, as can numbing mouthwashes and sprays. If your geographic tongue is recurrent, the NHS advises visiting your doctor, who may run blood tests to rule out anaemia or a zinc deficiency in particular and prescribe a steroid mouthwash if it’s causing severe pain.
Although this itchy rash can occur on all parts of your body, it can appears on the tongue in the form of a white, lacy pattern, or in patches. You mouth might sting too. It’s not contagious, but it can last for years in the mouth area in particular- the NHS recommends visiting your GP, who may provide a numbing or steroidal treatment to alleviate symptoms.
Another rather mysterious tongue issue, leukoplakia refers to white patches that can appear on the tongue, inside of the cheeks, gums and the roof of the mouth. The exact cause is unknown, although the condition is more common in smokers than non-smokers. The patches aren’t painful but they could be red or raised, and they can even be fuzzy, a condition labelled ‘hairy leukoplakia’ (*shudders*). NHS guidelines recommend visiting your GP if white patches are still present after two weeks, and making an immediate appointment if you suffer from a weakened immune system. Stopping smoking, eating a healthy, balanced diet, cutting down your alcohol intake and maintaining good oral hygiene can prevent the patches from appearing, or help them to get smaller and ‘heal’ faster’, but ultimately your GP may recommend a biopsy and surgical removal if there’s a risk of leukoplakia becoming cancerous (very rare, but get it checked out if you’ve had the patches for a fortnight or longer).
Teeth grinding (bruxism)
It can be difficult to identify if you grind your teeth in the night, because you’re generally out for the count, although everything from headaches to a bedfellow’s feedback/ complaints could alert you to the fact that you’re suffering from bruxism (as it’s known medically). Another indicator could be your tongue according to Dr Okoye:
“If you wake up with a visibly sore tongue, or can see indentations or impressions in your tongue, this is a major red flag that you’re stressing your jaw during your sleep. Bruxism occurs throughout the night in short bursts, but the damage potential is still high.”
If you’re worried that you’re grinding your teeth, read our dentist’s guide to bruxism and book an appointment with your dentist for a clearer picture of what’s going on in your mouth.
This simply refers to a swelling of the tongue, and can occur for a myriad of causes, from allergic reactions to severe cases of anaemia. If accompanied by breathing issues, call 999 immediately.
Not meaning to alarm with tales of ye olde historical style STIs, but actually, “Cupid’s disease” as it was once known, is now on the rise (the invention of penicillin saw syphilis cases tumble from the 1940s onwards). Public Health England warned in June that cases of syphilis in the UK have increased by 20 per cent since 2016, and if you’re wondering what your tongue’s doing with any of this, early symptoms can include a painless sore on your tongue, progressing to white patches in the mouth, alongside other possible markers as indicated by the NHS . If you’ve had unprotected sex and are in any doubt at all, visit your local STI clinic or GP for a checkup. Better safe than sorry.