Why Do I Have Cracks In My Tongue? Fissured Tongue Explained

man with cracks in tongue red background

When you stick your tongue out and look in the mirror, what do you see? Is your tongue smooth or are their cracks running across it? Is there one big line running down the middle or various cracks on the tongue spread out in every direction? It could be linked to a syndrome or deficiency. Fissured tongue is not to be confused with geographic tongue, but there are some instances where the two could possibly be related.

Cracked Tongue

Is it normal to have cracks on your tongue’s surface? No and yes. A typical tongue doesn’t usually have “big” cracks or deep grooves. But having a fissured tongue isn’t rare enough to say that it’s totally abnormal. Even though there are medical conditions linked to cracks on the tongue, a perfectly healthy person could still have tongue fissures without anything else to worry about.  However, seriously deep or infected cracks on the tongue could be a cause for alarm for your oral health.

What is a Fissured Tongue? 

A fissured tongue is when there is a crack or separation in the top of the tongue, creating a miniaturized version of the Grand Canyon running down the middle or across the top of it. 

Cracks in tongue can be called a variety of different things, but they all tie back to a fissured tongue. The condition is also referred to as “lingua plicata”, “scrotal tongue”, and “plicated tongue.” But all of them are essentially the same thing.

Even though a fissured tongue may look really weird when you stick your tongue out, most people won’t even realize you have it unless you purposely show them.

What a Fissured Tongue Looks Like 

Fissured tongues have visible tongue cracks running through the dorsal surface. The dorsal surface is the top surface that you typically look at when you stick your tongue out; it’s covered in tiny papilla and tastebuds. The fissure may run right through the middle, front to back, or there could be multiple various cracks across the dorsal surface. You’re unlikely to see cracking on the softer mucosa on the bottom of the tongue (ventral surface.) 

Fissured Tongue

Fissures are pretty obvious when you look at them. Although it’s completely normal to have at least some type of a line running down the middle of your tongue, it isn’t normal to have a deep crack. 

Symptoms Of Cracked Tongue

Someone with a cracked tongue won’t usually have physically raw or bleeding skin exposed. But what they will notice is that when they look at their tongue in the mirror, there are visibly deep cracks and fissures where the papilla do not touch one another side by side. Aside from the visible symptoms, very rarely are there physical ones that accompany fissured tongues.

That being said, people who have a cracked tongue but do not do a very good job of cleaning it are more likely to have problems with bad breath (halitosis.) Since those deep crevices can easily harbor bacteria—and most bad breath bacteria are found on the tongue—it can be a lose-lose situation unless they’re keeping their tongue extremely clean.

Occasionally, a fissured tongue will accompany conditions like geographic tongue. And geographic tongue tends to feel sensitive or even like raw skin, which can make talking, chewing food, or swallowing very painful.[1]

What Is Geographic Tongue?

A geographic tongue or benign migratory glossitis, isn’t the same thing as a cracked or fissured tongue. Instead, there are actual “bald” patches on the dorsal surface of your tongue, where the papilla have basically fallen off. What you see is a smooth surface between all of the “normal” looking papilla.

Geographic tongue

Geographic tongue gets its name because of how the condition looks like continents on a map. The smooth areas have clearly defined borders, resembling a map. But…the patches on your tongue don’t just stay in one place. They can morph and move across the tongue from one week to the next. That’s why it’s also known as migratory (moving) glossitis (inflammation of the tongue.)

According to the American Academy of Oral Medicine, geographic tongue can be caused by anything from emotional stress and psychological health issues to diabetes and hormones. Symptoms consist of a cracked tongue appearance and sensitivity to hot and spicy foods. Recently, experts also discovered that it tends to be more prevalent in people who have clinical cases of psoriasis. Talk with your doctor for advice, diagnosis, or treatment.

What Causes of Fissured Tongue 

Your tongue is covered in thousands of tiny fingerlike projections called papillae/papilla. There are several different conditions that can cause the appearance of your papilla to change, whether it’s growing longer (black hairy tongue) or even falling off altogether (like when someone has geographic tongue.) In the instances where the tongue forms physical cracks or crevices between the papilla, a fissured tongue appears.

It’s estimated that somewhere around 5% of people have these cracks on their tongue. Some of them are born with it, while others develop it later on. Experts believe it typically forms as people get older, depending on their underlying medical factors. 

Even though we know cracks on the tongue are linked with certain medical conditions, oral medicine experts still do not know the primary cause of fissured tongue. But they do feel that it’s somewhat linked with geographic tongue, which we have a much better understanding of. Cracked tongues aren’t something that’s alarming to the point your dentist or doctor would order a biopsy, so it’s nothing to start stressing out over.[2]

There have even been accounts where a fissured tongue was just one of many different oral symptoms of people who had COVID-19. Others included mouth ulcers and sores, redness, and halitosis. [3]

6 Conditions Associated With Fissured Tongue

A lot of the conditions that we see linked with situations like fissured tongue or tongue cracks are related to gastrointestinal (gut) health, nutrition-related issues, or other oral health issues. Yes, it’s possible for someone to have a dry, sticky mouth or cracked lips if they’ve gotten dehydrated, been out in the sun for hours on end, or even have some type of a fungal infection. But if you’ve had a chronic cracked or fissured tongue (especially one that lasts more than a few days) it might be due to one of the following diagnoses:

1. Orofacial Granulomatosis

This condition causes swelling inside of the mouth, like along the gums and cheeks. It’s often linked with conditions such as Crohn’s disease and Melkersson-Rosenthal syndrome.[4] It can also cause swollen lips and inflammation across the face. It’s a condition that may tend to come and go, but will typically become persistent without treatment.[5]

2. Down Syndrome

People who have Down syndrome typically exhibit a larger-than-normal tongue and less muscular control for activities like swallowing. Because of their tongue size, many of them are instinctively “mouth breathers” because their mouth doesn’t rest in a fully closed position. When that happens, the constant air and lack of moisture (saliva) will result in their tongue being more prone to cracking or fissures.

3. Pustular Psoriasis

In one study of people who had psoriasis, about 14% of the subjects showed evidence of a fissured tongue. However, it wasn’t found to have anything to do with “geographic tongue”, which lead researchers to claim that geographic tongue wasn’t a symptom of psoriasis.[6]

4. Melkersson-Rosenthal Syndrome 

Both fissured tongue and orofacial granulomatosis are symptoms of Melkersson-Rosenthal syndrome. This neurological condition is fairly rare and can cause facial paralysis. Mild forms of the syndrome usually improve on their own over time. It’s thought to be either genetic or a result of conditions like Crohn’s disease.

5. Vitamin Deficiencies

It’s known that certain vitamin deficiencies can contribute to symptoms like burning tongue, and possibly fissured tongue as a result.[7] Deficiencies in iron (which can cause anemia), as well as B2, B12, and zinc, are all closely related to tongue health. We know that people who are anemic can develop an “anemic tongue” where their tongue smooths out because of papilla loss, and even sometimes get cracks in their tongue.[8]

6. Malnutrition

Considering that vitamin deficiencies contribute so strongly to tongue fissures, it’s important to consider how malnutrition or malabsorption can contribute to oral irregularities. The overlap between gastrointestinal health (like Crohn’s disease) and the oral cavity could also tie back to a deficiency in caloric or nutritional intake. But in areas of the world with food shortages or where patients have come from situations where they battled malnutrition, any signs of a fissured tongue could be related to their diet history.

Treatment for Tongue Cracks & Fissured Tongue

There isn’t an actual treatment to repair cracks on the tongue, so it’s important to identify risk factors or medical conditions that may require the attention of your physician.

Since cracks in tongues can accumulate food particles and plaque biofilm, it’s important to brush your tongue well daily. This will help manage potential bad breath or infections inside of the cracks on your tongue.

Talk with your dentist about other ways to clean the cracks or fissures in your tongue without causing additional discomfort or damage, such as a water flosser or tongue scraper.

What Is Pustular Psoriasis?

Pustular psoriasis is a skin condition where small pus-filled areas flare up across the skin. It occurs across the body and makes the skin extremely tender to the touch.

Oddly, it’s fairly common to see cracks on the tongue in people who have pustular psoriasis. But since fissured tongue tends to be a fairly chronic (that is, long-term) condition, it may not be helpful in predicting flareups. Especially since fissures in the tongue have been shown to possibly be linked back to psoriasis in some individuals.[9]

Dermatologists note that conditions like pustular psoriasis can be triggered by things like certain medications or even infection. People with fissured tongues will want to be especially careful to keep their mouths free of bacterial buildup.

When to Talk With Your Doctor 

If you’re suddenly developing a fissured or cracked tongue, talk with your dentist or your medical doctor. Technically there isn’t a treatment for it, but they can help you identify possible medical conditions that are linked to it. And your dentist can always check your fissured tongue during routine checkups to make sure you’re not developing any type of oral infection.

Make sure to see your doctor if you’re experiencing any other type of physical ailments, such as fever, fatigue, GI issues, or skin rashes. If you are, it could possibly be that you’re starting to show the signs of another medical condition that just hasn’t been diagnosed yet.

Overcoming Cracks In Your Tongue

Having cracks on the tongue or geographic tongue isn’t a medical emergency. But a fissured tongue isn’t exactly normal, either. Always make a point to keep it clean, so that it doesn’t get infected or contribute to bad breath and poor oral hygiene. Be sure to communicate your medical history with your dental team, so that they can help you make the connection between oral signs and symptoms and underlying systematic issues. With a bit of detective work, you may be able to adjust your appetite or add supplements to help with the symptoms or severity of your cracked tongue.