“I was looking at the back of my tongue and there are all these weird looking bumps.  Have I got cancer or some kind of infection going on back there?”

As I looked at Jack’s tongue I saw only the normal, though odd-looking, papillae that form the bumpy service of the back of the tongue – nothing abnormal or pathologic.

Into my third decade of practice, I have several times had occasion to reassure someone who had suddenly focused in on the odd appearance of their normal tongue.  But then there are the actual disorders of the tongue which render it even more bizarre looking.

For example, something called geographic tongue affects about 3% of the population.  It is a condition where there are red smooth patches on the top of the tongue that move around over hours and days.  Usually there are no other symptoms other than occasional sensitivity to spicy foods.  There is also no very effective (or needed) treatment.  Occasionally some of the stronger treatments used to treat psoriasis have been found to clear up geographic tongue.  But the biggest nuisance about geographic tongue is simply that it looks weird and people worry that something bad is going on with their tongue.  The cause of it is still not really understood.

Then there is the wonderful condition called hairy tongue.  As you may guess, the tongue in this condition is not actually hairy.  It involves a disorder of the filiform papillae that results from a variety of irritating factors.  The most common variety of it is black hairy tongue but hairy tongue may also appear brown, white, green, pink, or any of a variety of hues.

Causes of hairy tongue include poor oral hygiene, the use of medications (especially broad-spectrum antibiotics), and therapeutic radiation of the head and the neck. The length of the filiform papillae can be 15 times as long as normal.  And hairy tongue is a rather common occurrence, ranging in prevalence from about 8% in children and young adults to a high of over 50% in persons who are addicted to drugs and incarcerated. Hairy tongue is also more common in those who use tobacco.

Believe it or not, there are some treatments of hairy tongue that include trimming with scissors, but as they say, don’t try this at home!  Usually brushing the tongue gently with a toothbrush a couple times a day, improving oral hygiene, and quitting tobacco use will clear it up.

Another common entity that makes for a weird looking tongue is thrush, an overgrowth of yeast (or Candida).  This may occur after use of antibiotics and is more common in diabetics.  It usually causes a white coating on the tongue and often produces a dry or burning feeling in the tongue.  There are several oral prescription treatments that can usually readily clear this up.

A final condition worth mentioning is glossitis, where the tongue tends to be smooth and sensitive and often burns.  This can have a number of different causes including allergy to oral care products, foods or medicine. I had one patient who was a snorkeler and finally realized he was allergic to the material in his snorkel and that his burning glossitis always showed up after snorkeling.

Injury such as from rough teeth, bad-fitting dentures, or burns can also be the cause of glossitis as can infections and certain diseases such as Sjogren syndrome. Other culprits include irritants such as tobacco, alcohol and spices.

The tongue; even at its most normal it’s a little odd-looking.  But if you notice it’s definitely not looking right, get it checked out.  Hopefully you’ll be able to get it back to its normal weird appearance.