Brief overview
- Forms: white, yellow, red, brown or black tongue coating
- Causes: various, e.g. lack of oral hygiene, periodontitis, cold and fever, oral thrush, various digestive disorders and diseases, kidney weakness, anemia due to iron deficiency, scarlet fever, typhoid fever, inflammation of the tongue, Sjögren’s syndrome, Bowen’s disease (precancerous condition), medications, metals, toxins, tobacco, coffee, mouthwash
- Examinations: Initial consultation (anamnesis), examination of tongue, oral mucosa, teeth and gums, smear test with laboratory examination, possibly blood test, gastroscopy, X-ray, magnetic resonance imaging (MRI or magnetic resonance imaging).
- Treatment: depending on the cause, e.g. with medication (antifungals, antibiotics, etc.), special tongue hygiene with tongue cleaner, tablespoon or toothbrush, disinfection
Slippery tongue: Causes and forms
However, if the tongue coating persists, this may be due to either insufficient oral hygiene or a disease. The color of the tongue coating often gives an indication of what is behind it.
White tongue coating: Causes
In the case of a white-coated tongue, the coating typically consists of dead cells, microorganisms and food residues that settle on the rough tongue surface.
White coating may also be more prevalent in the following conditions:
- Cold and fever
- Oral thrush: In the case of an infection with the fungus Candida albicans, white coatings appear all over the mouth, but can be wiped off without difficulty. A slightly bleeding, reddened mucous membrane is then revealed underneath.
- Digestive disorders: Inflammation of the gastric mucosa (gastritis) and other diseases of the digestive organs (e.g., the pancreas) can also be the reason for whitish tongue coating.
- Bowen’s disease: Also a precancerous condition. It is characterized by reddish mucous membranes, including those of the tongue.
- Lichen ruber planus: This skin disease affects the oral mucosa, among other areas. However, it almost never shows up on the surface of the tongue. Only the underside of the tongue and the inside of the cheeks are covered with white coatings.
- Iron deficiency anemia: In this case, the tongue looks strikingly pale.
- Typhoid fever: The tongue of typhoid fever has a grayish-white coating in the middle. The affected areas are demarcated from their surroundings by red.
Yellowish tongue coating: Causes
Yellow tongue coating can indicate diseases of the digestive organs. Especially jaundice (icterus) and bilious diseases can cause a yellowish coated tongue.
Red tongue coating: Causes
A healthy tongue is slightly pink in color. However, in some infectious diseases, the tongue presents with a strong redness, for example in:
- Vitamin B12 deficiency: Pernicious anemia can develop from this deficiency. This anemia is noticeable, among other things, by a smooth, red, inflamed tongue and burning of the tongue (Hunter’s glossitis).
- Inflammation of the tongue (glossitis): The tongue can become inflamed as a result of bacterial or viral infections, an unbalanced diet, systemic diseases and regular alcohol or nicotine consumption. A sign of this is a reddish tongue coating.
- Sjögren’s syndrome: This autoimmune disease destroys the salivary glands. A dry mouth and a shiny red “varnish tongue” are typical symptoms. Women in particular are affected.
- Kawaski syndrome: Similar to scarlet fever, this disease manifests itself with fever and a red raspberry tongue.
Brown tongue coating: Causes
A brown tongue coating can occur, for example, in:
- taking certain medications
- the frequent, intensive use of mouthwash with chlorhexidine
Black tongue coating: Causes
Common causes of a gray-black discolored tongue are:
- regular use of tobacco, mouthwash, coffee and certain foods that stain the tongue
- increased growth of special tongue papillae: The enlarged papillae appear visually as if the tongue is covered with fine hairs. Food influences can then cause the tongue to turn brown to black (black hair tongue = lingua villosa nigra). The phenomenon is harmless. Men are affected more often than women.
Other causes of tongue coating
There are many other factors that can cause a tongue that is coated in varying degrees and colors, for example:
- Periodontitis
- Syphilis
- Diphtheria
- Immunodeficiency
- Poisons/Metals
Tongue abnormalities
Even harmless abnormalities in the shape and texture of the tongue can promote tongue coating, including:
- Lingua plicata (wrinkled tongue): Some people have – hereditary – severe wrinkles in the tongue. These provide an ideal harbor for bacteria. The result is increased tongue coating.
- Glossitis mediana rhombica: Part of the middle and rear tongue surface is not covered by papillae. White or reddish tongue coating is often found there. .
Special case of burning tongue
Significantly more women than men have to struggle with burning mouth syndrome. The tip of the tongue and the lower edge of the tongue are particularly affected, sometimes also the entire oral cavity. However, the mucous membrane itself usually appears unchanged. The burning of the tongue can occur daily or only occasionally. It usually becomes more severe in the evening. You can learn more about this symptom in the article Tongue burning.
Slippery tongue: Diagnosis
The physician will first ask you about your medical history during the initial consultation (anamnesis). For example, he will ask you to describe your symptoms in detail, how long they have existed and whether you have any known underlying diseases.
The interview is followed by physical examinations to identify possible underlying diseases. For example, the doctor will thoroughly examine the coated tongue, the oral mucosa and the teeth. Your dentist should rule out gum disease and dental problems.
Usually, a swab of the tongue coating is taken and examined in the laboratory for possible infections with bacteria, viruses or the fungus Candida albicans.
Sometimes further examinations are necessary to trace the cause of the coated tongues. These include, for example, a blood sample, a gastroscopy or imaging procedures such as X-rays or a magnetic resonance imaging (MRI).
Sluggish tongue: treatment
If tooth or gum problems are responsible for the tongue coating, the dentist should take over the treatment.
What you can do yourself!
You can do a lot yourself against harmless tongue coating without a serious cause. Special tongue hygiene is particularly important. The rough surface of the tongue is an ideal breeding ground for bacteria, fungi and viruses. When brushing your teeth, you should therefore not only take care of your teeth, but also your tongue. Suitable aids are, for example:
- Tongue cleaner with brush and scraper side. Sweep the tongue several times with the brush to loosen the coating. Then remove it with the scraper. Rinse the mouth thoroughly with water or a mouth rinse.
- Disinfection: The use of disinfecting mouthwash after brushing the teeth reduces the number of germs in the mouth. You can buy such mouthwash ready-made or make it yourself from sage, myrrh and thyme, for example. However, the active plant substances can discolor the tongue brownish.
In addition to tongue care, chewing helps against tongue coating: eat as much solid food as possible (for example, raw vegetables), because chewing hard crusts and crunchy vegetables removes the coating by itself – the most natural way to avoid a coated tongue.
