The following symptoms and complaints may occur together with tongue coating:
Leading symptom
Associated symptoms
- Burning of the tongue (glossodynia)* .
- Itching, tingling or stabbing pain on the tongue* .
- Xerostomia (dry mouth)* .
- Disturbances of the sense of taste*
- Halitosis (bad breath)
* Symptoms indicative of burning mouth syndrome. Tongue coating and color changes of the tongue.
| Tongue coating/color change |
Possible causes |
| White (to dirty-white) tongue coating |
- Predominantly liquid diet (eg, fasting).
- Poor oral hygiene
- Candida albicans (fungal infection)clinical picture: white, strippable plaques throughout the mouth; underneath slightly bleeding, reddened surface.
- Gastritis (gastritis) [see below gastritis].
- Leukoplakia of the oral mucosa (single or multiple present); they are not wipe away [see below Leukoplakia of the oral mucosa].
- Iron deficiency anemia: the tongue appears rather pale; burning of the tongue [see below iron deficiency anemia].
- Typhoid fever: centrally gray-white/yellow coated tongue with free reddish edges (so-called typhoid tongue) [see below Typhoid fever].
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| Yellowish tongue coating |
- Poor oral hygiene
- Smoking (tongue coating often yellow to brownish).
- Liver disease? [Significance is controversially assessed]
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| Red tongue coating |
- Glossitis (inflammation of the tongue) [see below Glossitis].
- Kawasaki syndrome (acute, febrile, systemic illness characterized by necrotizing vasculitis of the small and medium-sized arteries); red raspberry tongue and brittle patent lips [see below vasculitis/Kawasaki syndrome]
- Liver cirrhosis (irreversible (non-reversible) damage to the liver and a marked remodeling of liver tissue); lacquer tongue (especially red and uncoated tongue) and lacquer lips (smooth, lacquer-red lips) [see below Liver Cirrhosis]
- Scarlet fever: initially white coated tongue, later red colored tongue with enlarged tongue poplars (so-called “raspberry tongue”) [see below scarlet fever].
- Sjögren’s syndrome (autoimmune disease (excessive reaction of the immune system against the body’s own tissue) from the group of collagenoses, which leads to a chronic inflammatory disease or destruction of the exocrine glands, whereby the salivary and lacrimal glands with the consequence of a dry mouth, are most often affected); often shows a typical red, shiny lacquer tongue (especially red and unoccupied tongue) [see below Sjögren’s syndrome]
- Vitamin B12 deficiency: pernicious anemia (synonym: Biermer’s disease) is the most common subtype of vitamin B12 deficiency anemia; smooth, red inflamed tongue and tongue burning (“Hunter’s glossitis”) [see below megaloblastic anemia]
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| Brown tongue coating |
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| Black tongue coating |
- Tobacco and coffee consumption
- Black hair tongue (Lingua pilosa nigra; Nigrities linguae; Lingua villosa nigra (simplified also Lingua nigra)): hair tongue is not supposed to have a disease value in the actual sense. Occurrence: 3-5% of the normal population, mainly in men; caused by the elongation of certain papillae (hyperplasia of the papillae filiformes) of the tongue, which form a hairy and usually dark coating on the rear part of the back of the tongue.
- Prolonged antibiotic administration (“black hairy tongue”).
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| Occupied tongue of different color and thickness |
- Periodontitis: belongs to the periodontopathies (diseases of the periodontium).
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| Tongue abnormalities |
- Lingua geographica (map tongue): harmless alteration of the tongue surface; constitutional anomaly; the tongue acquires its typical appearance by shedding of the epithelium of the filiform papillae of the tongue surface (papillae filiformes); whitish and reddish districts resembling a map are seen; spectrum of symptoms ranges from asymptomatic to a burning sensation or burning pain.
- Lingua plicata (wrinkle tongue; synonyms: Folded tongue, notched tongue, furrowed tongue, lingua fissurata, lingua scrotalis, lingua dissecta, lingua cerebelliformis): autosomal dominant inherited variant of the texture of the tongue surface; increased longitudinal and/or transverse wrinkling; has no disease value; partial symptom in Melkersson-Rosenthal syndrome; also frequently found in patients with trisomy 21 (Down syndrome).
- Glossitis mediana rhombica: oval painless change in the middle third of the dorsum of the tongue not covered by papillae; unknown cause.
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