Anemia Tongue: Symptoms, Causes, And Treatments

Anemia tongue or glossitis is a condition that causes pain and changes in the tongue's appearance.  This condition has many underlying causes, including infections, adverse medication reactions, dental trauma, and nutritional deficiencies.

This guide focuses on what symptoms to expect if you develop an anemia tongue, the causes, and what treatments are available to relieve or eliminate it.

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Anemia tongue explained

Usually, anemia tongue is a benign condition. Adding nutrient supplements to your diet or treating underlying causes can help relieve its symptoms. The tongue's appearance may cause some anxiety, but this condition is not generally life-threatening. 

Even if glossitis is the symptom of a more severe condition (for example, diabetes), as long as the diabetes is diagnosed and treated, anemic tongue symptoms will be relieved. 

Who does glossitis affect?

Glossitis affects people with a poor diet that does not include enough iron or other nutrients. In addition, those with an underlying condition, for example, sickle cell anemia, infections, or neuropathy caused by diabetes, can develop glossitis.

Is glossitis contagious?

The condition of glossitis is not contagious. However, be aware of infections that cause glossitis, such as oral herpes, since they can be contagious.

Common symptoms of anemia tongue

Because not enough nutrients are getting to the tongue, this can cause symptoms such as:

  • Changes in color and texture of the top of the tongue, the papillae, and taste buds 

  • General reduction of papillae, which are the bumps on the tongue that grip food

  • Enlargement of the fungiform papillae, located around the tip of the tongue

  • Changes in color and texture to the undersurface of the tongue, connected to and closest to the floor of the mouth

  • Lesions or ulcers

  • Redness

  • Swelling

  • Reduced sense of taste

Can anemia cause a sore tongue?

Because the tongue is inflamed, soreness can be a consequence of this condition.

What is causing an anemic tongue?

A healthy circulatory system requires healthy red blood cells carrying the right amount of oxygen and nutrients to organs and tissues. Conversely, anemia occurs when healthy red blood cells are lacking, negatively affecting oxygen and nutrients transport to the whole body.

Anemia can generate several symptoms, including anemia tongue, or glossitis. When anemia tongue occurs, insufficient oxygen and nutrients reach the tongue, causing inflammation and other symptoms.

Does anemia cause glossitis?

When there is insufficient iron to form hemoglobin, a crucial part of the red blood cell, this iron deficiency can cause glossitis.

Pernicious anemia can also cause glossitis. The production of red blood cells depends on the availability of vitamin B12. When there is a deficiency of vitamin B12 (cyanocobalamin), there won't be enough red blood cells to carry needed oxygen and nutrients throughout the body, possibly causing glossitis. 

Nutritional deficiencies, such as pernicious anemia, are a common cause of this condition. Glossitis presents in up to 25% of people with pernicious anemia.¹

What other nutritional deficiencies can cause glossitis?

Besides iron and vitamin B12, other nutritional deficiencies can cause glossitis, such as:

  • Vitamin B1, thiamine

  • Vitamin B2, riboflavin

  • Vitamin B3, niacin

  • Vitamin B6, pyridoxine

  • Vitamin B9, folic acid

What else can cause glossitis?

Herpes viruses or bacterial, fungal, or parasitic infections can cause glossitis. Glossitis can occur by taking medications such as:

  • ACE Inhibitors, a medication that helps lower blood pressure

  • Albuterol, which treats breathing problems through oral inhalers

  • Organosulfur antimicrobial or antibacterial drugs

  • Oral contraceptive pills from elevated levels of hormones

  • Lithium carbonate can cause insufficient saliva secretion and cause dry mouth conditions

Other examples of factors that can cause glossitis are various conditions, including:

  • Anxiety

  • Neurological system disorder

  • Psoriasis and other autoimmune conditions

  • Diabetic neuropathy

  • Acid reflux

  • Conditions that cause fissures or patterns of patches to form on the tongue

  • Down syndrome

  • Allergies or adverse reactions to food


  • Chronic dental trauma

  • Mechanical irritations

  • Burns

Lifestyle situation:

  • Exposure to irritants: alcohol, spicy food, and tobacco

  • Poor hydration

  • Protein-calorie, iron, or vitamin malnutrition

What does glossitis look like

Glossitis can change from the pinkish color of a regular tongue to more of a reddish color. It may also have white patches or surrounding white borders caused by the reduction of papillae.

The tongue can have a smooth, shiny, dry appearance because of the decrease of lingual papillae, which contain the taste buds and secrete some of the fluid in saliva.

Glossitis causes red, plaque-like lesions that will usually be present in the center of the top of the tongue to appear. Cracks or fissures can also be present all over the tongue, and swelling can occur too.

What does the tongue look like with pernicious anemia?

When pernicious anemia causes glossitis, this can make the tongue look smooth and reddish. In some cases, the tongue will be swollen or appear thick. Cracks can also appear on the tongue.

Forms of glossitis

The observation of appearance can differentiate the different forms of glossitis. In addition, the location on the tongue that reflects anomalies also determines the type of glossitis.

What are the types of glossitis?

  • Atrophic glossitis: A partial or complete absence of filiform papillae located on the central axis of the tongue.

  • Median rhomboid glossitis: Glossitis occurs on the middle or back of the tongue.

  • Benign migratory glossitis: The tongue may have white patches or a surrounding white border around areas with papillae loss.

  • Geometric glossitis: This glossitis displays painful cracks and fissures throughout the tongue.

  • Strawberry tongue: This type of glossitis produces a smooth and reddish tongue with enlarged fungiform papillae on the tip of the tongue.

How to treat anemia tongue

Different treatments depend on what can be causing the anemia tongue. These include the following:

  • Receiving intramuscular injections of vitamin B12 or supplementing your diet with vitamin B12  to help reduce pernicious anemia

  • Supplementing your diet with iron or treating the cause of iron deficiency

  • Treating infections with antifungals or antivirals if they are causing anemia tongue

  • Using a mouth rinse to reduce symptoms

  • Controlling diabetes if this is the cause

How long does glossitis take to heal?

Glossitis can take several days to heal. Causes can be reversible with the treatment of underlying conditions. However, be aware that it can be a chronic or lifelong condition that will occasionally flare up.

When to seek medical help

If symptoms are still present after ten days, consult a doctor. Also, if tongue swelling prevents you from breathing, swallowing, chewing, or speaking normally, you should seek medical attention immediately.

The lowdown

Severe conditions can cause anemia tongue, but it is not a serious condition by itself. As long as your doctor can diagnose it and treat the underlying condition, like pernicious anemia or diabetes, you won't have to suffer from the symptoms of an anemia tongue.

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