Observing the Tongue to Understand Bodily Health
Smooth Tongue: Fungiform papillae atrophy, tongue surface smooth and hairless like a mirror, pale tongue without luster. Commonly seen in malignant anemia, gastric acid deficiency, gastric cancer, malnutrition, or pellagra. Vitamin A deficiency causes smooth tongue with patchy areas. Vitamin B2 deficiency leads to smooth tongue or blue spots.
Abnormal Tongue Coating: Yellow and dry coating with constipation often indicates hypertension or hemorrhoids. Thin coating with deep red tongue suggests late stage of cold/fever.
Fissured Tongue: Commonly seen in wasting diseases and vitamin B2 deficiency; occasionally congenital, also seen in healthy individuals.
Strawberry Tongue: Seen in early stages of scarlet fever or long-term fever. May have white coating, enlarged and red tip papillae; in late stages, coating disappears entirely, papillae enlarge resembling a strawberry.
Geographic Tongue: Yellow epithelial cell deposits form raised areas on the tongue surface with irregular borders; areas of coating loss reveal newly formed papillae, resembling a map. No pain. This migratory glossitis may result from vitamin B2 deficiency.
Pigmentation and Leukoplakia: Pigmentation appears in patients with chronic adrenal insufficiency, with dark brown, slightly elevated or depressed melanotic spots on both sides of the tongue. Leukoplakia often results from chronic irritation due to smoking or dental pain.
Tongue Tremor: Trembling when tongue is extended, commonly seen in hyperthyroidism or neurotic individuals.
Tongue Numbness: Commonly seen in central motor nerve diseases, especially in obese individuals. If numbness occurs at the base of the tongue, with numbness in index and middle fingers, it may be a precursor to stroke, often caused by temporary cerebral ischemia.