Have you ever wondered why doctors often ask you to stick out your tongue during a routine check-up? While it may seem like a small, almost trivial request, this simple act serves as a crucial diagnostic tool.
The tongue is a muscular organ made up of four main parts: the tip, body, root, and underside. The tip helps with speech and tasting sweet flavors. The body aids in chewing and tasting, while the root connects to the throat and assists with swallowing. The top surface (dorsum) has tiny bumps called papillae, which contain taste buds, while the smooth underside reveals blood vessels and helps absorb certain medicines. The tongue’s movement and shape come from its strong muscles, making it essential for talking, eating, and tasting.
There are several conditions that can affect the tongue — such as tongue cancer, glossitis, thrush and other oral health issues which may impact its appearance or function. And beyond its essential roles in taste, chewing, and swallowing, the tongue can provide invaluable insights into health conditions, many of which may not yet show visible symptoms. Its appearance, texture, and coating can reveal key clues about your nutritional status, oral hygiene and even systemic health issues. Doctors across specialties emphasis that paying close attention to the condition of the tongue can serve as an early warning system for a wide range of underlying health issues.
The link between the tongue and overall health
Lokesh Mahajan, Head of Pediatrics at Marengo Asia Hospitals, Faridabad, explains, “The tongue is not just a local indicator of oral health; it reflects broader systemic conditions. Conditions like vitamin deficiencies, thyroid disorders and even infections can manifest through noticeable changes in the tongue’s appearance.”
For example, a red, smooth tongue could indicate a deficiency in vitamin B12 or folic acid, while a white coating may point to a fungal infection such as candidiasis. Dr. Mahajan emphasises, “A pale tongue may signal anemia, while an unusually red tongue could point to inflammation or systemic infection. These are subtle but important signals the body is giving us.”
In paediatric care, changes in the tongue are also critical. P. Priyatharshini, consultant in Paediatric Critical Care at SRM Global Hospitals, Chennai, says, “For children, conditions like Kawasaki Disease — a syndrome, mainly affecting children under five, that causes a high fever and inflammation of the blood vessels, including the coronary arteries — often present with a ‘strawberry’ tongue — red, swollen, and with a bumpy texture. This is a critical sign that requires immediate attention.” She also points out that even systemic conditions like hypothyroidism can alter the tongue’s appearance, with signs ranging from swelling to a glossy appearance.
Dr. Priyatharshini adds, “Certain rare diseases like sarcoidosis or rheumatoid arthritis can cause ulcers in the mouth, including the tongue, which can be mistaken for minor irritations if not examined closely.”
Indicator of deficiencies and infections
The tongue also serves as an indicator of nutritional deficiencies. Sneha Bokdia, consultant dentist, House of Tooth, Chennai, explains, “A pale tongue often suggests iron deficiency anaemia. A red, smooth tongue, on the other hand, could be a sign of vitamin B12 or folate deficiency. Both of these conditions can be detected early by a simple examination of the tongue.”
The tongue’s coating is also important in identifying health issues. A thick white coating often signifies poor oral hygiene, which can lead to bacterial growth and bad breath. Dr. Bokadia highlights, “If left untreated, poor oral hygiene can result in serious oral infections like oral candidiasis, especially in children..”
Dr. Bokadia emphasises that children are particularly vulnerable to oral health problems. “Conditions like stomatitis, which involve inflammation and redness of the tongue, are commonly seen in children due to poor nutrition or irritations caused by braces. These symptoms should never be ignored, as they can lead to more severe complications.”
The connection between the tongue and systemic health is profound says Dr. Mahajan, “A pale tongue can be a sign of anaemia, while a yellowish tongue may suggest liver issues or jaundice. A blue-tinged tongue often indicates a lack of oxygen in the blood, seen in conditions like cyanotic heart disease. Such changes in tongue colour are early warning signs and must not be ignored.” Dr. Priyatharshini highlights, “Infective endocarditis, an infection of the heart valves, can sometimes be traced back to bacteria originating from the mouth. This is especially a concern for individuals with pre-existing heart conditions.”
The role of oral hygiene and regular monitoring
Gowri Shankar, senior consultant ENT specialist at SIMS Hospital, Chennai, points out, “A healthy tongue can help maintain the balance of bacteria in the mouth, which is important for preventing systemic infections.” Dr. Shankar further explains, “A dry, red tongue may indicate dehydration, while a tongue coated in food debris, bacteria, and dead cells can be a sign of poor oral hygiene. In some cases, conditions like macroglossia, an enlarged tongue, are seen in patients with thyroid disorders. This can lead to sleep apnea or snoring, which obstructs the airway.”
She adds, “Maintaining good oral hygiene can help avoid the buildup of harmful bacteria, which could otherwise enter the bloodstream and affect the heart or other organs. For instance, bacteria in the mouth can lead to endocarditis, a serious heart infection.”
Regular checkups are essential in maintaining tongue health. Dr. Mahajan stresses, “Routine dental and medical checkups are essential for early detection of potential issues. A thorough tongue examination should be part of these checkups, as it can provide critical clues about your overall health.”
Maintaining good oral hygiene is vital, as Dr. Bokadia advises, “Brushing twice daily with fluoride toothpaste, using a tongue cleaner, and avoiding excessive use of antibiotics are simple yet effective ways to keep the tongue clean and healthy. For children, starting oral care early –around six months of age– can prevent long-term issues.”
Dr. Shankar also recommends staying hydrated, eating a balanced diet, and using mouthwash after meals to help prevent bacterial growth on the tongue.“These steps not only help maintain oral hygiene but also reduce the risk of developing serious systemic issues.”
The tongue is more than just a tool for taste; it is a valuable indicator of your health. As doctors across various specialties highlight, the appearance, texture, and coating of the tongue can provide early warning signs of nutritional deficiencies, systemic diseases and oral health problems. Regular checkups and attention to the tongue’s condition can help detect potential issues before they become serious. As Dr. Priyatharshini sums it up, “The tongue is often the first to show signs of trouble within the body. By observing it closely, we can take proactive steps towards maintaining our health, preventing complications, and improving quality of life.”
Published – June 12, 2025 05:00 pm IST