Your eyes may be the window to your soul, but your mouth is the gateway to your health. After all, there’s a reason one of the first things doctors do at a checkup is make you open up and “say ahh.”
Clues to a number of conditions can manifest on the tongue, lips, teeth and gums. Here are a few to keep an eye on:
Lumps or lesions on the tongue
It’s completely normal to get a canker sore on the tongue or along the gums every now and then. But if you notice a lesion that doesn’t go away after a week or two, make an appointment with your health care provider. The concern: cancer.
Some cancers are in plain sight — you can see them when you stick out your tongue. But they can also lurk under the tongue or at the base, says Nadeem Karimbux, a periodontist and dean of Tufts University School of Dental Medicine in Boston. “So in order to do a good cancer screening, you really want to pull the tongue out and look on either side,” he says.
Smoking and drinking alcohol increase one’s likelihood of developing cancer on the tongue and other parts of the mouth. Age is another risk factor for oral cancer, including tongue cancer, and so is human papillomavirus (HPV), according to the National Institute of Dental and Craniofacial Research.
Look for an ulcer-like sore that is grayish-pink to red; it may also bleed easily, the experts at Cedars-Sinai say. Numbness on the tongue is another possible symptom. And don’t forget to check the rest of your mouth: Oral cancer can also pop up on the tissue lining the mouth and gums, and where the back of the mouth and throat meet.
While rare, psoriasis, a skin disorder, could be another cause of redness and bleeding in the mouth and on the tongue, the National Psoriasis Foundation says. Talk to your dentist or dermatologist if you experience these symptoms.
A white layer on the tongue
If your pink tongue has taken on a new hue, pay attention. A thin, white layer that looks similar to cottage cheese could indicate thrush, which is a fungal infection on the tongue, says Elena Zamora, M.D., assistant professor in the department of family medicine at McGovern Medical School at UTHealth Houston.
Oral thrush is most common in people who are immunocompromised, including those with HIV/AIDS and untreated diabetes. Taking drugs that suppress the immune system can also make developing thrush more likely — and so can using an inhaler for a condition like asthma.
Zamora explains that when people who regularly rely on inhalers don't wash their mouth after each use, “then fungus can actually grow because you're creating a more immunocompromised state by constantly [being exposed] to things like steroids just through an inhaler.”
Wearing dentures and having dry mouth can also increase your risk for oral thrush. Reach out to your health care provider if you think you have it; an antifungal medication may be needed.
A condition known as leukoplakia could also be to blame for white patches on the tongue. According to the U.S. National Library of Medicine, the cause is unknown, but irritation from tobacco or alcohol may be an explanation. A weakened immune system could also be to blame, and age is another risk factor. Leukoplakia usually doesn't lead to permanent damage in the mouth, but it can increase your risk of oral cancer, so it's best to consult a health care provider if you recognize its symptoms.
Finally, some people have reported a coated or patchy-looking tongue as a symptom of COVID-19, according to the ZOE Health Study, which collects data on COVID-19 symptoms through an app. Researchers say, however, that reports of tongue and mouth changes were more common earlier in the pandemic, before vaccines and boosters were widely available.
A dry or swollen tongue
Your doctor may be able to tell if you’re dehydrated just by looking in your mouth. When you stick out your tongue, “there should be some sort of glare,” Zamora says. “Sometimes light bounces off the tongue, but if it's very dry, you may only see some buildup of saliva” or a cracked tongue.
A dry mouth, which can also be a side effect of medication, can have some oral health implications, including tooth decay, Karimbux says. “Because saliva kind of bathes the teeth, and when you lose that … you can be more prone to getting cavities,” he says.
If you notice your tongue looking puffier than normal, especially after a meal, “you may be developing an allergy,” says Zamora, who adds that a scratchy feeling in the back of the throat can also signal an allergic reaction. It’s also possible to be allergic to some toothpastes and mouthwashes, so start cataloging everything you put in your mouth.
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Loss of taste
If you suddenly can’t taste your favorite flavors, a viral infection could be the reason for your muted meals. The flu and common cold can cause the symptom — even aging can take its toll on the taste buds. Loss of taste is also one of the most common symptoms of COVID-19, according to the Centers for Disease Control and Prevention (CDC).
Cracked corners of the mouth
Dry and scaly lips are common in the cold winter months, but if they’re cracked at the corners, don’t be so quick to blame the weather. “It could actually indicate a vitamin deficiency,” Zamora says — specifically vitamin B2 (riboflavin). “So they may need to take riboflavin or a multivitamin,” she adds. Riboflavin can also be found in fortified breakfast cereals, yogurt, milk, beef and clams.
Red and swollen gums right around the tooth may signal gum disease, an infection caused by a buildup of bacteria in the mouth that affects nearly 50 percent of American adults 30 and older and about 70 percent of people 65 and older, according to the CDC.
“Unfortunately, for the majority of people, this chronic inflammatory process can kind of progress very quietly. You don't really feel much pain at all,” Karimbux says. But if left untreated, it could become painful and even lead to tooth loss.
Some people are more at risk for gum disease — also called periodontitis— than others, including smokers, diabetics and people with certain immunocompromising diseases, like HIV/AIDS. Your dentist may advise nonsurgical or surgical treatment options to get an infection under control, as well as the inflammation, which could have more widespread health consequences.
That’s because the chronic inflammation that affects the gums “may increase levels of inflammatory markers in the bloodstream,” the American Dental Association explains, potentially triggering other diseases in distant areas of the body. Some epidemiological studies show a compelling link between oral infections like gum disease and high blood pressure, cardiovascular disease and diabetes.
“Much like when you go to your dermatologist and they say, ‘The more you're in the sun, the more likely you are, potentially, to have skin cancer,’ we would probably say if you have periodontitis, just be aware that you may be at higher risk for cardiovascular disease,” Karimbux says.
Don’t overlook headaches, denture discomfort
Another reason Zamora pays close attention to her patients’ mouths? Sometimes puzzling symptoms like persistent headaches can be from a cavity or some other tooth-related issue that’s causing nerve pain. Signs of teeth grinding can also suggest stress or anxiety.
Finally, if your dentures are causing you pain, it’s important to alert your doctor or dentist. Ill-fitting dentures can make it more difficult to eat. They can also increase a person’s risk for choking.
“Everyone has the right to be able to chew their food and enjoy the process of chewing,” Zamora says. “And I feel like we should just be more mindful of how this can be easily lost with not taking care of our mouth, our tongue, our teeth.”
Should You Clean Your Tongue?
Some people use a tool, called a tongue scraper, to help clean their tongue and perhaps improve their breath. There’s no harm in doing this, the American Dental Association (ADA) says, but there’s also no need. Evidence is scant that brushing or scraping your tongue will improve your breath. “In fact, bad breath bacteria can grow back just as fast as you remove it,” the ADA notes.
Instead, the ADA recommends four steps that can keep your mouth healthy:
- Brush your teeth twice a day with a fluoride toothpaste.
- Clean between your teeth daily.
- Eat a healthy diet that limits sugary beverages and snacks.
- See your dentist regularly for prevention and treatment of dental disease.
Source: American Dental Association
Editor's note: This story, originally published on October 8, 2021, has been updated to include new information.
Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.