What Causes a Smooth Tongue?

The appearance of your tongue says a lot about your general state of health. Nutritional disorder, autoimmune diseases, infections, blood diseases and endocrine problems can all changes in the color and consistency of the tongue – and tongue changes can be the first sign of a medical problem. One tongue abnormality that merits further investigation is a glossy, smooth tongue. What causes a smooth, glossy tongue, and should you be concerned if you have one?

A Smooth Tongue May Be Atrophic Glossitis

The normal color of the tongue ranges from warm pink to light red, and it usually has a thin, white coating. Normal tongues have a textured surface due to the tiny papillae that cover their surface, with the most common being the fungiform papillae. The taste buds usually rest on top of these papillae.

When the papillae that line the tongue and give it texture atrophy, the tongue becomes glossy and smooth in appearance – a condition called atrophic glossitis. Atrophic glossitis isn’t really a disease but a sign of a problem elsewhere in the body, usually nutritional in nature.

What Causes a Smooth Tongue Due to Atrophic Glossitis?

Atrophic glossitis has a variety of causes with the most common being nutritional deficiencies. Deficiencies in B vitamins, particularly vitamin B12, and iron are the most common causes of atrophic glossitis. Atrophic glossitis is frequently seen in people with pernicious anemia, a type of anemia caused by a deficiency or inability to absorb vitamin B12. Pernicious anemia and B12 deficiency is a serious condition that can lead to neurological damage or even death if it isn’t treated promptly.

A deficiency in other B vitamins including folate, vitamin B2, vitamin B3 and vitamin B6 can also cause atrophic glossitis. Alcoholics and people who are malnourished due to eating disorders are more likely to have deficiencies of these vitamins.

Other Causes of Atrophic Glossitis

People who have conditions such as tropical sprue or celiac disease that cause intestinal malabsorption are more prone to atrophic glossitis as are people on cancer chemotherapy.

Other Signs and Symptoms of Atrophic Glossitis

A glossy, smooth tongue with loss of the normal tongue papillae is the most common sign of atrophic glossitis. The tongue may turn a deep red “beefy” color and become sore and painful, making it difficult to eat. It may have patchy bald spots due to patchy loss of tongue papillae or be completely smooth from global atrophy of the papillae.

Smooth Tongue: The Bottom Line?

If you have a glossy, smooth tongue, see your doctor right away. Nutritional deficiencies are the most common cause, and these should be treated as quickly as possible to prevent further problems. A smooth tongue always needs evaluation.

References:

American Family Practice. Volume 82, Number 11. December 1, 2010.

Merck Manual. Eighteen edition. 2006.