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Tongue Discoloration and Other Changes


Bernard J. Hennessy

, DDS, Texas A&M University, College of Dentistry

Reviewed/Revised May 2022 | Modified Sep 2022
Topic Resources

The tongue's color and surface may change as the result of injury, poor oral hygiene, disease, or other factors. Some or most of the tongue may be involved. Many of the changes occur without producing pain or discomfort.

Tongue color changes

The tongue's papillae (tiny, rounded projections) may become discolored if a person smokes or chews tobacco, eats certain foods or vitamins, or has colored bacteria growing on the tongue.

Black discoloration on the top of the tongue may occur if a person takes bismuth preparations for an upset stomach. Brushing the tongue with a toothbrush or scraping it with a tongue scraper can remove such discoloration.

A small blue-black discoloration on the underside of the tongue may be a tattoo caused by a fragment of dental amalgam filling material, which contains silver, becoming stuck in the tongue.

A smooth red tongue and painful mouth may indicate general inflammation of the tongue (glossitis) or be caused by pellagra, a type of undernutrition caused by a deficiency of niacin Niacin Deficiency Niacin deficiency (causing pellagra) is uncommon in countries with low rates of food insecurity. Many people with niacin deficiency also have deficiencies of protein, riboflavin (a B vitamin)... read more Niacin Deficiency (vitamin B3) in the diet.

Tongue surface changes

In geographic tongue, some areas of the tongue are red and smooth (like ulcers), often surrounded by a white border. Other areas, appearing white or yellow and rough, may resemble psoriasis Psoriasis Psoriasis is a chronic, recurring disease that causes one or more raised, red patches that have silvery scales and a distinct border between the patch and normal skin. A problem with the immune... read more Psoriasis or be caused by psoriasis. The areas of discoloration often move around over a period of weeks to years. The condition is usually painless, and no treatment is needed. If people have symptoms, applying low doses of corticosteroids sometimes helps.

In fissured tongue, deep grooves are located on the tongue surface. The cause is unknown, but fissured tongue may occur with geographic tongue and some other disorders. Usually, there are no symptoms and no treatment is needed.

In "hairy" tongue, keratin (a normal body protein that is in hair, skin, and nails) accumulates on the normal projections on the top of the tongue (papillae) and gives it a hairy appearance. Hairy tongue may develop when food debris is trapped in the papillae when people do not clean their mouth adequately. The tongue may also appear hairy after a fever, after antibiotic treatment, or when peroxide mouthwash is used too often.

Discoloration and Surface Changes of the Tongue

Whitish patches on the tongue, similar to those sometimes found inside the cheeks, may be due to

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