What your tongue’s appearance means
Published 8:46 am Friday, June 19, 2020
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Hi Dr. Kim,
For years I have had white, scaly patches on my tongue that come and go. Sometimes the patches are painful. I have been diagnosed with geographic tongue and I want to know what it means and if something can be done about it. Help! —Anonymous, Johnson City
Dear Anonymous,
Thank you for writing in with your question about the geographic tongue. I have seen many cases of this in the clinic, and can assure you that it is common. To answer your question I will first address geographic tongue, the importance of differentiating it from oral lichen, and follow up with an explanation of how the appearance of the tongue reflects the health.
First, you may be surprised to hear that the Mayo Clinic lists some interesting facts about geographic tongue. It is listed as “very common,” but also falls under the categories of “chronic, requiring diagnosis, and self-treatable.” This is quite a combination of categories. Chronic means it is long-lasting and may have a tendency to come and go, just as you described. Requiring diagnosis means you should have it checked by a physician. Self-treatable indicates there are things you can do at home to help this condition.
A geographic tongue has a patchy appearance with varying red and white patches. It is named so because of the map-like pattern which appears like an imprint on the tongue, consisting of patches. They can change location, size, and even their shape. Usually the patches are red, surrounded by white borders, and as you said, they can be painful. The usual treatment for a geographic tongue consists of pain relievers and oral rinses. These can alleviate symptoms but they do not influence the root cause of the painful tongue. The specific medical cause of geographic tongue is unknown. This condition is considered benign, meaning it will not cause another health problem. However, I do believe that pre-existing health problems can show up as a geographic tongue. For example, people who are young (and thus have young, undeveloped immune systems), have psoriasis, or certain types of arthritis are more prone to developing geographic tongue. Hormone imbalances, nutritional deficiencies, allergies, diabetes, stress, and genetics also have links with the development of geographic tongue, which leads me to believe there is usually an underlying health condition. Get a full physical and complete lab work just in case.
If your tongue looks like this, it is important to have a physician examine it and order the relevant tests, to differentiate geographic tongue from oral lichen planus. Oral lichen, or oral lichen plans is inflammation of the membranes of the mount which can also affect the tongue. Oral lichen takes the appearance of white or red lacy or alternating patches. The patches can become painful sores. Geographic tongue and oral lichen are not contagious. Both conditions have no specific cure and involve sensitivity to sweet or acidic foods. T lymphocytes (immune cells) are active during outbreaks of oral lichen. This shows that there is an underlying condition that the immune system is fishting. Oral lichen is more serious than geographic tongue, because the sores can eventually cause scarring. Breaks in the mouth tissue open the door to other infections. For both geographic tongue and oral lichen, topical medications are prescribed to let the patchy areas or sores heal. Mouth rinses may be used, and keeping a food and symptom journal will help you avoid foods that aggravate the condition.
The appearance of the tongue indicates the overall state of health or disease in the body. On your own tongue you can observe colors, cracks, patches, shape, and coating for clues on your state of health. Oriental Medicine has a long tradition of observing the tongue for signs of health and disease. Hippocrates, the ancient Greek Father of Medicine, often observed the tongue for its appearance in diagnosis. Here is a general overview of tongue signs according to Oriental medicine and its close equivalent to modern medicine. These examples are specific to geographic tongue and oral lichen.
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Red all over: Heat, Dryness (Systemic inflammation, inflamed conditions or heat shock)
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Red tipped: Heart Fire (Heart organ condition or emotional upset)
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White: Spleen Qi or Blood deficiency (Slow metabolism, anemia or borderline anemia).
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Purple: Blood or Qi Stagnation (poor circulation or a disease affecting only one body area)
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Thick white coat: Phlegm (immune system is active because the body is fighting a pathogen, also it could be a side effect of drugs)
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White patchy coat: Yin deficiency and Phlegm (the body is in a weak state while fighting a pathogen)
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Yellow coat: Interior heat (body has inflammation affecting membranes or a toxin has been ingested)
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Grey coat: Qi deficiency (a sign of chronic disease, exhaustion or severely weakened energy)
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Black coat: Interior Fire (severe body inflammation, such as cancer, or a spontaneous reaction to drugs)
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Missing coat: Fire consuming Yin (body inflammation is depleting vital hydration and nutrients).
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Red and white patches: Yin / Yang imbalance. The body has excesses (such as a pathogen or bacteria) and deficiencies (of nutrition and hydration) at the same time.
In Oriental Medicine’s theory of tongue diagnosis, a long-lasting geographic tongue might be considered a severe Yin deficiency (lack of nutrition/hydration) giving rise to excess heat (inflammatory conditions). Oral lichen, being related to mucous and infections, may be considered a pathogenic invader, or an unhealthy excess. Though they are similar conditions objectively, the symptoms of them can be markedly different in two different people. That is why a differential diagnosis is needed. Seek a second and third opinion, especially if you are left without answers after having your tongue examined! Licensed Acupuncturists often provide traditional tongue diagnosis as part of the consultation, working within Oriental Medicine theory.
To help your oral health at home, try to identify foods and beverages that worsen the condition, and avoid them. Try meditation, guided meditation, or earthing (using a mat or outdoors) because as crazy as it sounds, mouth-relation conditions are made worse by states of emotional upset. If you are under pressure or chronic stress, your body will have grown accustomed to a state of emotional tension, leaving you more upset than you realize. You could try using an Ayurvedic mouthwash, such as Auromere, to gently clean and balance oral bacteria (you need the healthy bacteria). Ask your care provider about the side effects of your medications to see if one of them could be contributing to the tongue condition as a side effect. Try to go to bed and wake up at the same time each day (at least 8 hours of sleep for an adult). Sleeping well will revitalize your immune system and help control inflammation. It is while we are sleeping that our body cells rebuild.
Dear reader, thanks again for your question. I do urge you to seek another opinion, take note of your lifestyle, eating, and sleeping habits, and to take care of yourself.
Dr. Kimberly McMurtrey DNP, APRN, FNP-C is the Primary Provider at Tri Cities Health, located on West Elk Ave., Elizabethton. If you would like to submit a question for her to answer you can call 423-543-7000 or email your questions to tricitieshealth@outlook.com.
**Medical Disclaimer: The information contained in this column is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment.