Who is healthier, a person with thick tongue coating or a person with thin tongue coating? The answer is…

Have you ever observed your tongue coating? In the article "A detail that is easy to miss when brushing your teeth may cause bad breath! (Review previous articles)", many people are very curious about the color of their tongue coating.

Everyone's tongue coating is different in color, and even the color of a person's tongue coating at different times can be different. Some are thin and white like icing, some are thick and white like putty, and some are thick and yellow like the edge of a fried egg... Are these different tongue coatings related to health? Let's talk about it today.

What is tongue coating?

The tongue coating is a layer of moss-like substance covering the back of the tongue. It is formed by a mixture of desquamated keratinized epithelial cells, food residues, bacteria, saliva and metabolic products.

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Specifically, the mucosal cells of the oral cavity and tongue are constantly metabolizing, and the shed epithelial cells are mixed in the saliva. The saliva contains a variety of substances, such as mucin, which will adhere to the surface of the tongue together with the shed cells to form the tongue coating. At the same time, when people eat, food residues will also remain on the tongue surface. After a period of time, these residues will mix with other components in the oral cavity to form part of the tongue coating.

The oral cavity is a "big world" of microorganisms, with a large number of bacteria, fungi and other microorganisms. These microorganisms will decompose food residues, and their metabolites will also adhere to the surface of the tongue and participate in the formation of tongue coating.

Under normal circumstances, the tongue coating is thin and evenly distributed, and is pale white, referred to as "pale red tongue, thin white coating". It is one of the signs of oral and digestive system health.

Thick tongue coating

Don't worry in most cases

The thickness of the tongue coating is related to the shedding and renewal rate of oral cells. If the metabolism is vigorous, the shedding cells increase and accumulate on the tongue surface, and the tongue coating will become thicker, otherwise the tongue coating will become thinner. Therefore, the metabolism of different individuals and the same individual at different times will vary, and the tongue coating will also change.

In addition, there are some physiological factors that can also make the tongue coating thicker:

Differences in saliva production

Saliva can effectively wash the tongue surface, reducing the accumulation of food residues, bacteria and exfoliated cells. When the amount of saliva secretion decreases, the tongue coating tends to thicken. In addition, the viscosity of saliva will also affect the washing effect . People with thick saliva tend to have thicker tongue coating than those with clear saliva.

The impact of eating habits

For people who consume liquid or soft food for a long time , the tongue surface lacks friction, the natural cleaning mechanism is weakened, and the tongue coating is prone to thickening; greasy food rich in fat (such as hot pot, barbecue, frying, etc.) and high-protein diet may promote thickening of the tongue coating.

The impact of oral hygiene:

Oral hygiene is the most important factor affecting the formation of tongue coating. If you do not pay attention to oral hygiene, food residues and bacteria will accumulate on the tongue surface, causing the tongue coating to become thick.

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These diseases

May cause abnormal tongue coating

1

Digestive system disorders

Insufficient gastrointestinal motility and gastrointestinal dysfunction (such as gastritis and constipation) will affect food digestion and absorption, lead to accumulation of metabolic waste, and cause thick, greasy, and yellow tongue coating.

2

Infection or inflammation

When you have a cold or fever, your body's immunity decreases, saliva secretion decreases, tongue movement decreases, and bacteria proliferate in your mouth, which may cause the tongue coating to thicken.

When the tongue mucosa is infected by fungi (such as Candida albicans) , the tongue coating is like a thick layer of cheese tightly attached to the back of the tongue.

3

Certain chronic systemic diseases

If diabetic patients do not control their blood sugar well, it will lead to the proliferation of bacteria and increased metabolic products in the mouth, the tongue coating will turn yellow and thick , and the saliva secretion will decrease, leading to dry tongue coating. Liver disease or metabolic syndrome, etc., can also cause the problem of long-term thick tongue coating.

4

Other diseases

Anemia, vitamin B2 and folic acid deficiency can cause atrophy of the tongue papillae, making the back of the tongue smooth and free of tongue coating, forming a "mirror tongue".

Atrophic glossitis (mirror tongue or smooth tongue)

5

Drug effects

Long-term use of some drugs can also lead to abnormal tongue coating. For example, long-term or large-scale use of antibiotics will destroy the balance of oral flora, causing individual bacteria or fungi to multiply in large numbers, causing thick tongue coating.

Some drugs (such as amoxicillin and chloramphenicol) produce melanin during metabolism, causing the tongue coating to turn black. Long-term use of chlorhexidine mouthwash and taking bismuth agents can also cause the tongue coating to turn black, which can be restored after stopping the medication.

Some antidepressant and antipsychotic drugs can reduce oral saliva secretion, which is not conducive to the self-cleaning function of the tongue and causes the tongue coating to become thicker.

It should be noted that the tongue coating is only an external manifestation of the imbalance of the body's internal environment. It is not the direct cause of these diseases, nor is it used as a diagnostic criterion for the disease.

Parents may sometimes find that their children have red and white patches on their tongues, surrounded by a circle of raised edges, with a winding shape, like a map. This condition is vividly called "geographic tongue".

Geographic tongue is also called exfoliative glossitis or migratory glossitis . Its main symptom is the temporary exfoliation and disappearance of the filiform papillae on the back of the tongue. The lesions are shallow and gradually spread to the surrounding areas, forming an irregular map shape. This is a benign, non-infectious, chronic, recurrent oral inflammatory condition that can occur in people of any age, but is more common in children.

The cause of geographic tongue is still unclear . It may be related to genetics, mental and psychological (mood swings, mental stress, fatigue, insomnia, etc.), nutritional (indigestion, vitamin B deficiency, zinc deficiency, anemia and other nutritional problems are related to the occurrence of geographic tongue), immunity (geographic tongue is more common in people with allergic constitution), and other local factors. Children's caries, stimulation of the eruption of deciduous teeth, etc. may also induce geographic tongue.

Geographic tongue is a self-limiting disease and generally does not require special treatment . There is no need to be too anxious. If it does affect your life, you can try to find the cause under the guidance of a specialist (pediatrician, dentist) and adjust the treatment direction in a targeted manner to achieve the best treatment effect.

In daily life, you can also pay attention to the following aspects:

Diet adjustment: Maintain a balanced diet and avoid spicy and irritating foods.

Oral hygiene: Keep your mouth clean, brush your teeth and rinse your mouth regularly.

Emotional management: Maintain a good attitude and avoid excessive tension and anxiety.

Regular check-ups: Perform regular oral examinations to detect and treat oral diseases in a timely manner.

References

[1]. Seerangaiyan, K. et al. Tongue coating: its characteristics and role in intra-oral halitosis and general health-a review[J]. Journal of breath research, 2018,12(3), 034001.

[2]. Van der Sleen et al. The effect of tongue cleaning on breath odour and tongue coating: a systematic review[J]. Int J Dent Hygiene, 2010(8),258–268.

[3]. Vartul Dwivedi et al. Effectiveness of Various Tongue Cleaning Aids in the Reduction of Tongue Coating and Bacterial Load: A Comparative Clinical Study[J]. The Journal of Contemporary Dental Practice, 2019(20:4),444-448.

[4]. Matsui et al. Effects of tongue cleaning on bacterial flora in tongue coating and dental plaque: a crossover study[J]. BMC Oral Health, 2014,14:4.

[5]. Timmesfeld N et al. Mechanical tongue cleaning is a worthwhile procedure to improve the taste sensation[J]. J Oral Rehabil 2021;48:45–54.

[6]. Vinicius Pedrazzi et al. Tongue-cleaning methods: A comparative clinical trial employing a toothbrush and a tonque scraper[J]. J Periodontol, 2004,75(7):1009-1012.

[7]. Yang Huamei, Zhou Yu, Zeng Xin, et al. Research progress on risk factors of geographic tongue[J]. West China Journal of Stomatology, 2015, 33(1): 93-97.

Planning and production

Author: Zhao Hechuan Zhuozheng Medical

Reviewer: Wu Bin, Director of the Department of Stomatology, Beijing Chest Hospital, Capital Medical University

Planning丨Yang Yaping

Editor: Yang Yaping

Proofread by Xu Lai and Lin Lin