Home Symptoms Coated tongue (burning tongue): causes and diagnosis

Coated tongue (burning tongue): causes and diagnosis

by Josephine Andrews
Published: Last Updated on 463 views

coated tongue is usually harmless. The coating develops because food residues, cells or bacteria are deposited on the back of the tongue. This natural coating on the tongue disappears when you chew solid food or brush your teeth. However, if the tongue is permanently occupied, this can indicate a disease. Read here about the possible causes behind a coated tongue and how to prevent and treat tongue coating.

quick overview

  • Forms: white, yellow, red, brown or black tongue coating
  • Causes: diverse, e.g. poor oral hygiene, periodontitis , colds and fever , oral thrush , various digestive disorders and diseases, kidney weakness, anemia due to iron deficiency, scarlet fever , typhus , tongue inflammation, Sjögren’s syndrome , Bowen’s disease (precancerous stage), medication, metals, toxins, Tobacco, coffee, mouthwash
  • Examinations: Initial consultation (anamnesis), examinations of the tongue, oral mucosa, teeth and gums, swabs with laboratory tests, possibly blood tests , gastroscopy , X -rays , magnetic resonance imaging (MRI or magnetic resonance imaging ).
  • Treatment: depending on the cause, eg with medication (antifungal agents, antibiotics, etc.), special tongue hygiene with a tongue cleaner, tablespoon or toothbrush, disinfection

Coated tongue: causes and forms

The surface of the tongue consists of mucous membrane covered by various papillae. Dead cell parts, food residues and bacteria keep getting caught on this rough surface . They form a natural, fine coating on the tongue that disappears when you chew solid food or brush your teeth .

However, if the tongue coating persists, this can either be due to insufficient oral hygiene or an illness. The color of the tongue coating often gives an indication of what is behind it.

White tongue coating: causes

With a white-coated tongue, the coating typically consists of dead cells, microorganisms and food particles that settle on the rough surface of the tongue.

The white coating can also occur more frequently with the following diseases:

  • cold and fever
  • Oral thrush: In the case of an infection with the fungus Candida albicans, white deposits appear all over the mouth , but these can be wiped off without any problems. Underneath, a slightly bleeding, reddened mucous membrane appears.
  • Indigestion: Inflammation of the gastric mucosa (gastritis) and other diseases of the digestive organs (eg the pancreas ) can also be the reason for a whitish coating on the tongue.
  • Leukoplakia: Whitish, firm deposits on the base of the tongue or on the edge of the tongue indicate leukoplakia. The mucous membrane produces more horny cells, which can be a precursor to cancer. Normally, however, the deposits are not only found on the tongue, but also on other mucous membranes.
  • Bowen’s disease : Also a precursor to cancer. Typical of this are reddish discolored mucous membranes, including those of the tongue.
  • Lichen ruber planus: This skin disease affects the oral mucosa, among other things. However, it hardly ever 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: The tongue looks noticeably pale.
  • Typhoid: The typhoid tongue has a grey-white coating in the middle. The affected areas are marked in red from their surroundings.

Yellowish tongue coating: causes

Yellow tongue coating can indicate diseases of the digestive organs. Jaundice (icterus) and bile diseases in particular can cause a yellow tongue.

Red tongue coating: causes

A healthy tongue is slightly pink in color. With some infectious diseases, however, the tongue is very red, for example with:

  • Scarlet fever: This streptococcal infection is associated with fever, chills, sore throat , and a characteristic rash. The tongue is initially coated white, later it turns red with significantly enlarged papillae – one then speaks of a “raspberry tongue”.
  • Vitamin B12 deficiency: This deficiency can result in pernicious anemia . This anemia is noticeable, among other things, by a smooth, red, inflamed tongue and a burning tongue (Hunter 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 coating on the tongue.
  • Sjogren’s Syndrome: This autoimmune disease destroys the salivary glands. A dry mouth and a shiny red “lacquer tongue” are typical symptoms. Mainly women 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, with:

  • taking certain medications
  • Kidney weakness (According to traditional Chinese medicine, a swollen, brown-coated tongue can indicate kidney weakness)
  • the frequent, intensive use of mouthwashes containing chlorhexidine

Black tongue coating: causes

Common causes of a gray-black tongue include:

  • regular consumption of tobacco, mouthwash, coffee and certain coloring foods
  • Increased growth of special tongue papillae : The enlarged papillae appear as if the tongue were covered with fine hairs. The tongue can then turn brown to black due to food influences (black hairy 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 the tongue to have different thicknesses and colors, for example:

tongue abnormalities

Even harmless deviations in the shape and texture of the tongue can promote tongue coating, including:

  • Lingua geographica (map tongue): Here the tongue temporarily loses certain papillae. This creates whitish and reddish areas on the surface of the tongue that resemble a map.
  • Lingua plicata (folded tongue): Some people have hereditary strong folds in their tongues. These offer bacteria an ideal shelter. The result is increased tongue coating.
  • Median rhomboid glossitis: Part of the middle and posterior surface of the tongue is not covered by papillae. There is often white or reddish tongue coating. .

Special case burning tongue

Significantly more women than men struggle with burning mouth syndrome. The tip of the tongue and the lower edge of the tongue are particularly affected, sometimes the entire oral cavity. However, the mucous membrane itself is mostly unchanged. Burning tongue can occur daily or only occasionally. It usually gets worse in the evening. You can learn more about this symptom in the post Burning Tongue .

Coated tongue: diagnosis

A coated tongue is not only associated with a furry feeling, but also often leads to bad breath . It’s uncomfortable, but not a reason to see a doctor. You should only see a doctor (GP or dentist) if additional symptoms such as burning tongue, fever or a general feeling of illness occur or if the coating on the tongue changes significantly.

The doctor will first ask about your medical history in the first consultation (anamnesis). For example, he can have your symptoms described in detail, ask how long they have existed and whether you are aware of any underlying diseases.

The interview is followed by physical examinations to identify possible underlying diseases. The doctor will thoroughly examine the coated tongue, oral mucosa and teeth. Your dentist should rule out gum disease and dental problems.

A swab is usually taken from the coating of the tongue and examined in the laboratory for possible infections with bacteria, viruses or the fungus Candida albicans.

Sometimes further investigations are necessary to find the cause of the coated tongues. These include, for example, taking a blood sample, a gastroscopy or imaging procedures such as X-rays or magnetic resonance imaging (MRI).

Coated tongue: treatment

Treatment for coated tongue depends on the cause. For example, infections with fungi, bacteria or viruses can often be treated well with special medication – antifungal agents ( antimycotics ), antibiotics or antiviral agents.

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 coating of the tongue without a serious cause. Special tongue hygiene is particularly important. Because 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. Examples of suitable tools are:

  • Tongue cleaner with brush and scraper side. Rub the brush over the tongue several times to loosen the coating. Then remove it with the scraper. Rinse your mouth thoroughly with water or mouthwash.
  • Tablespoon or Toothbrush: If you don’t have a tongue cleaner handy , you can use a tablespoon. Stroke the edge of the hollow side across the back of the tongue several times. This is how you can remove the pads. If necessary, you can also use the toothbrush for this. Afterwards you should wash them very thoroughly.
  • Disinfection: Using disinfectant mouthwash after brushing your teeth reduces the number of germs in your mouth. You can buy ready-made mouthwash or you can make your own from sage , myrrh and thyme . However, the active ingredients in the plants can discolour the tongue brownish.

In addition to tongue care, chewing helps against tongue coating: Eat as much solid food as possible ( e.g. raw vegetables), because chewing hard crusts and crunchy vegetables removes the coating itself – the most natural way to avoid a coated tongue .

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