Abnormalities of the tongue surface

Smooth areas of the tongue may be related to injury (food burn) or a nutritional deficiency of iron, folate, or vitamin B12. A smooth tongue can also result from the use of dentures.

"Geographic tongue" (or benign migratory glossitis) is the most common tongue condition. It is found in up to 14% of the U.S. population. It is a benign condition that appears as bare or smooth areas on the dorsum of the tongue. It may be one area or several areas and may even vary from time to time. It is usually painless; however, the smooth areas may have sensitivity to spicy or acidic foods for some individuals. No treatment is recommended.

Fissured tongue is the second most common tongue condition and is characterized by a deepening of normal tongue fissures and is usually associated with aging. Some medical conditions are linked to fissured tongue and include Sjögren's syndrome, psoriasis, Down syndrome, and acromegaly. No treatment is required unless food debris and bacteria get trapped and cause inflammation of the tongue's papillae. Gentle brushing should alleviate the problem.

As previously mentioned, hairy tongue is the hypergrowth of the tongue's papillae and is usually associated with white, tan, or black discoloration. Hairy tongue is the third most common tongue condition and is considered harmless. Gentle brushing or scraping of the tongue may be helpful. No other treatment is necessary.

Median rhomboid glossitis is a lesion at the midline of the dorsum of the tongue. It usually looks like a smooth, red, shiny, and sharply defined area. The underlying cause is usually a fungal infection. Treatment options include topical oral antifungal agents such as nystatin (Mycostatin) or fluconazole (Diflucan).

Tongue pain

Pain with the tongue can be associated with anemia, canker sores (aphthous ulcers), oral herpes, neuralgia, cancer, poorly fitting dentures, or irritation from dental work.

Canker sores are commonly found on the tongue and can be very painful. They appear as a yellow-white center with a red halo. These ulcerations are thought to be caused by local injury, stress, or genetic predisposition; however, no definitive cause has been found. No treatment is usually necessary as these ulcerations generally resolve in less than two weeks.

Oral herpes is caused by the herpes virus and appears as fluid-filled lesions. These lesions usually resolve in two weeks' time, but oral herpes can also be treated with antiviral medications such as acyclovir (Zovirax) to shorten the duration of symptoms.

"Burning mouth syndrome" is a phenomenon that often includes the tongue (often called "burning tongue"). Other symptoms include increased thirst with the feeling of a dry mouth, as well as an altered or metallic taste. It has been associated with other conditions that include menopause, anxiety, depression, acid reflux, nutritional deficiencies, and mouth conditions such as dry mouth or oral thrush. Treatment is usually for the underlying condition (for example antifungals for oral thrush, supplement for nutrition deficiencies, or medications to treat anxiety or depression).

Altered sensation of the tongue

Paresthesia is an abnormal or altered sensation. Paresthesia of the tongue can occur with damage to the lingual nerve, the nerve of sensation for the tongue. The most common cause of lingual nerve damage occurs during wisdom teeth extractions where the nerve is very close to the tooth being extracted. The nerve damage is usually noticed well after the procedure and symptoms include altered, decreased, or complete loss of sensation. Senses of pain, taste, touch, perception of temperature and perception of relative position and movement (proprioception) may be affected. The sensation of "pins and needles" similar to being numb during a dental procedure may persist. Usually, treatment involves waiting for the nerve to self-repair itself in a period of six months to a year. If there is no improvement, surgery may be an option to repair the injured nerve.

Taste problems

Dysgeusia is the term used to describe the distortion of the sense of taste. Common causes of dysgeusia include medications, cancer therapy, dry mouth, gum disease, and the common cold or flu. Cancer therapy that involves chemotherapy and radiation to the head and neck area can greatly affect taste. Radiation therapy can damage taste buds and salivary glands. Decreased flow of saliva causes a dry mouth and further compounds the problem. Cigarette smoking also can affect taste. Dysgeusia can be a temporary condition and should resolve once the cause is eliminated. Damage to taste buds through radiation therapy may require time for healing to occur. Taste may slowly return and greatly depends on the amount of damage from radiation therapy. Artificial saliva and zinc supplementation may help in restoring taste for some individuals. A lack of taste sensation (ageusia) is rare.

Problems with tongue movement

Tongue movement problems are often caused by nerve damage (for example, post-stroke or post-surgery nerve damage). Limited tongue mobility can greatly affect our eating, swallowing, and speech. Depending on the extent of nerve damage, sometimes physical therapy may help in regaining control of the tongue.

Ankyloglossia, also known as "tongue-tie," is a less common condition where a band of tissue that connects the tongue to the floor of the mouth is too short or tight and impedes tongue movement. Because the tongue is vital for sucking, infants with ankyloglossia may be unable to breastfeed properly. For toddlers and older children, sometimes the tongue is able to compensate for most oral functions, but speech may be affected. The treatment for ankyloglossia is a surgical procedure (frenulectomy) that relaxes the tight band of tissue that is restricting the tongue's movements.