Possible Nutrient Deficiencies: Gums, Lips, Teeth, Tongue, Salivary glands

Excesses Attributed to Certain Disorders



  • low Vitamin C

Bright Red (marginal)

  • high Vitamin A (chronic)

Gingival Hypertrophy

  • low Vitamin C (scurvy)


  • low Niacin
  • low Riboflavin
  • low Vitamin A

low Vitamin C (scurvy)
Hemorrhages may precede a hyperplastic hemorrhagic gingivitis with redding blue edematous, friable gums and localized necrotic lesions.


Cheilitis (angular stomatitis; inflammation, with fissures radiating from the corners of the mouth)

  • low Folic Acid
  • low Iron
  • low Niacin
  • low Pantothenic Acid
  • low Protein
  • low Riboflavin
  • high Vitamin A
  • low Vitamin B6

Dry & Fissured

  • low Niacin (pellagra)
  • low Riboflavin
    also smooth

high Vitamin A

Salivary Glands

Excessive Salivation

  • high Iodine


high Iodine



  • low Calcium
  • low Fluorine
  • low Phosphorus
  • low Protein-Calorie


  • low Vitamin C (scurvy)

Mottling of Enamel

  • high Fluorine (fluoride)

Periodontal Disease

low Calcium


Ignore tongue color in evaluating patients whose hemoglobins are below 8 g/dl because severe anemia will make tongue color normal (Friedman PJ, Hodges RE.  Tongue colour and B-vitamin deficiencies.  Letter. Lancet i:1159-60, 1977).

Acute Glossitis (bright scarlet red, painful, inflamed tongue with prominent papillae)

  • low Folic Acid (mild)

  • low iron (mild)

  • low Niacin (pellagra) (mild)

  • low Riboflavin (mild)

  • high Vitamin B6 (mild)

  • low Vitamin B12 (mild)

Atrophic Glossitis (smooth, small, glistening, non-painful tongue with atrophy of the filiform papillae)

Patients tend to have multiple nutritional deficiencies (Drinka PJ, Langer EH, Voeks SK, et al.  Nutritional correlates of atrophic glossitis: possible role of vitamin E in papillary atrophy.  J Am Coll Nutr 12 (1);14-20, 1993).

“The thin epithelium of the ‘bald’ tongue seems to be a poor veil over the capillary bed, thereby yielding an abnormally blue or cyanotic tongue.  Patients with severe anaemia and papillary atrophy may retain a normal tongue colour because the capillary bed is pale rather than cyanotic” (Friedman PJ, Hodges RE.  Tongue colour and B-vitamin deficiencies.  Letter. Lancet i:1159-60, 1977).

There is an 80% chance of a niacin or riboflavin deficiency in a patient without hypoxemia or severe anemia whose tongue shows papillary atrophy along with an abnormal color (Leevy CM, Baker H, TenHove W, et al.  Am J Clin Nutr 16:339, 1964

  • low Biotin (rare)
  • low Folic Acid (chronic or in remission)
  • low Iron (chronic)
  • low Niacin (chronic)
  • low Protein
  • low Riboflavin
  • low Vitamin B6
  • low Vitamin B12 (chronic or in remission)
  • low Vitamin C
  • low Vitamin E

-with Magenta color (deep, purplish-red tongue)

“The cyanotic tongue colour in hypoxaemia cannot be distinguished clinically from that produced by nutritional deficiencies.  Hypoxaemia, however, does not lead to papillary atrophy, so a bald tongue is a clue to underlying B-vitamin deficiencies” (Friedman PJ, Hodges RE.  Tongue colour and B-vitamin deficiencies.  Letter. Lancet i:1159-60, 1977).

  • low Biotin (rare) – also swollen and painful
  • low Niacin (pellagra) (more common) – also swollen, raw and fissured
  • low Pantothenic Acid – usually painless
  • low Riboflavin (more common) – also dry; painless or sore; may be swollen

with Black color

  • low Niacin (pellagra) (less common)

low Riboflavin (less common)