What a healthy tongue looks like
A healthy tongue is pink, moist and covered with small bumps called papillae, which contain taste buds. A thin, white coating, especially at the back, is normal, and the colour can vary slightly between people and during the day. Food, drinks and sweets can temporarily stain it.
Cleaning the tongue regularly keeps the coating thin; see how to clean your tongue.
White tongue
- White coating: trapped debris and bacteria, common with dry mouth, dehydration, mouth breathing, smoking and illness.
- Oral thrush: creamy white patches that can be wiped off, leaving red areas; more common in babies, denture wearers, after antibiotics and with inhaled steroids.
- Leukoplakia: white patches that cannot be wiped off, linked to smoking; needs assessment because a small proportion can become cancerous.
- Oral lichen planus: lacy white lines, sometimes sore.
Red tongue
- Vitamin deficiencies: B12, folate and iron deficiency can cause a smooth, red, sore tongue (glossitis).
- Strawberry tongue: red with prominent bumps, seen in scarlet fever and Kawasaki disease; see strawberry tongue.
- Geographic tongue: smooth red patches with white borders that change location over days; harmless.
- Burns and irritation: from hot or spicy food.
Black tongue and black dots
Black hairy tongue happens when the papillae grow longer than usual and trap pigments from coffee, tea, tobacco, food and bacteria, giving a dark, furry appearance. It is harmless and improves with tongue cleaning, stopping smoking and improving oral hygiene. Bismuth-containing stomach medicines can also temporarily turn the tongue black.
Small black dots can be stained papillae, harmless pigment spots, or small blood vessels. A new dark spot that grows or changes should be checked.
Yellow, brown and orange tongue
- Usually a coating stained by food, drinks, smoking or medicines.
- Can occur with dry mouth and mouth breathing.
- May be an early stage of black hairy tongue.
- Rarely, yellow colouring of the tongue together with yellow skin and eyes (jaundice) suggests a liver problem.
Pale or purple tongue
A pale tongue can reflect anaemia, often with tiredness, breathlessness and pale skin. A bluish or purple tongue may indicate low oxygen levels, which needs urgent assessment if it comes with breathlessness.
Changes in texture
- Cracks: fissured tongue is common and usually harmless; see cracked tongue.
- Bumps at the back: normal papillae and lymphoid tissue; see bumps on back of tongue.
- Smooth surface: loss of papillae from deficiencies or dry mouth.
- Swelling: allergic reactions; urgent if breathing is affected.
Tongue colour in babies and children
Babies often have a white tongue from milk, which wipes off easily; white patches that do not wipe off may be thrush. Children with a red strawberry tongue and fever, sore throat or rash should see a doctor to check for scarlet fever or, rarely, Kawasaki disease, which causes prolonged fever, red eyes and swollen hands and feet.
Keeping your tongue healthy
- Brush your teeth twice a day and clean your tongue gently.
- Drink enough water.
- Stop smoking and limit alcohol.
- Eat a varied diet rich in B vitamins and iron.
- Have regular dental check-ups.
Medicines, food and habits that change tongue colour
- Coffee, tea, red wine, berries and coloured sweets stain the tongue temporarily.
- Smoking and vaping cause yellow-brown staining and black hairy tongue.
- Bismuth stomach medicines can turn the tongue and stools black.
- Antibiotics and inhaled steroids increase the risk of thrush.
- Some mouthwashes, such as chlorhexidine, can cause brown staining.
Colour changes from these causes fade once the habit or medicine stops and the tongue is cleaned.
When to see a dentist or doctor
- A white or red patch that does not wipe off or lasts more than 3 weeks.
- An ulcer, lump or thickened area on the tongue.
- A new dark spot that grows or changes.
- A sore, smooth tongue with tiredness or tingling (possible deficiency).
- A red tongue with fever and rash in a child.
- Swelling of the tongue or difficulty breathing or swallowing.
Key points to remember
- A healthy tongue is pink with a thin white coating.
- White coating, black hairy tongue and staining are common and harmless.
- Red smooth tongue can reflect vitamin deficiency; strawberry tongue can reflect infection.
- Persistent patches, ulcers or lumps need checking.
Questions about tongue colour
These answers are general information and do not replace an examination or individual medical advice.
What colour should a healthy tongue be?
Pink with a thin whitish coating.
Why is my tongue white?
Usually a coating of debris and bacteria; thrush and other conditions are less common causes.
What causes black dots on the tongue?
Stained papillae, pigment spots or small blood vessels are common causes.
Can dehydration change tongue colour?
Yes. A dry mouth can make the tongue look whiter or more coated.
What vitamin deficiency causes a red tongue?
Vitamin B12, folate and iron deficiencies can cause a red, smooth, sore tongue.
Is a yellow tongue serious?
Usually not; it is often a stained coating. With yellow skin or eyes, see a doctor.
How do I get rid of black hairy tongue?
Clean your tongue daily, stop smoking, reduce coffee and tea, and keep your mouth hydrated.
Can medicines change tongue colour?
Yes. Bismuth medicines, antibiotics and some mouthwashes can change tongue colour.
Sources
- NHS · Sore or white tongue
- NHS · Oral thrush (mouth thrush)
- NHS · Vitamin B12 or folate deficiency anaemia
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.