Q. My tongue seems to have lost papillae at some places. Why?

Answered by
Dr. Krishna Swaroop Achanta
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 20, 2021 and last reviewed on: Aug 14, 2021

Hi doctor,

Part of my tongue seems to have lost some papillae. I have attached some pictures. Is this something to worry about? I take Nexium 40 mg daily. Kindly give your opinion.



Welcome to

I have seen the images attached (attachments removed to protect the patient's identity). The tongue will definitely be affected by tobacco usage or by drinking wine (alcohol consumption in any form will have an impact).

Also, Nexium (Esomeprazole) 40 mg is used for treating GERD (gastroesophageal reflux disease) or colorectal disorder. So it is quite potent in preventing that, so it will also have added side effects on your tongue.

If you are noticing any altered or foul changes in your taste, you will definitely need to ask your physician to give you an alternative to Nexium. If there are no taste changes, then you can use it for your gastro treatment as normally as before.

Coming to the point of the blackness or the hairy feature of your tongue (what you notice as a visible change in the papillae), you can be sure it is nothing to be alarmed about, but there are several things you will need to follow.

If there is pain or numbness or altered sense of taste, then please visit a maxillofacial surgeon in person for investigation. A biopsy might have to be done. If none of the above symptoms, then just follow precautions to maintain good oral hygiene.

1) Rinse twice daily with warm salt water and preferably with a non-irritating antiseptic mouthwash like Chlorhexidine 0.12%.

2) Take a vitamin-rich fortified diet or add antioxidant-rich foods available locally into your daily diet that will prevent tongue-related fungal infections or papillary infections.

3) Avoid caffeine and alcohol consumption in any form.

4) Smoking is strictly prohibited. So please avoid tobacco or nicotine consumption or cigars because they will aggravate tongue infections.

5) Brush your tongue with the backside of the soft toothbrush twice daily.

6) If you notice frequent tongue inflammation, then apply Choline Salicylate and Lignocaine Hydrochloride gel combination (brands will vary locally, but it is this same composition) onto the affected or inflamed patch or area of the tongue.

I hope this was helpful.

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