It’s drilled into us from a young age: brush your teeth twice a day. But when it comes to oral health, experts say we’re leaving out something important.
“Everyone needs to be educated about cleaning the tongue,” says Dr Maria Figueroa, a dentist and program director at NYC Health + Hospitals/Lincoln. “This is as important as your teeth.”
Adding another step to your routine may be a big ask. “I’ll be transparent: it’s very difficult just to get people to floss,” says Dr Thomas Salinas, a prosthodontist and chair of dental specialties at the Mayo Clinic in Rochester, Minnesota. But that doesn’t mean it shouldn’t be done.
Tongue cleaning is “a reasonable and helpful thing to do”, Salinas says. “We should be brushing and flossing our teeth and cleaning our tongues.”
What are the benefits of cleaning the tongue?
Brushing targets the teeth, and flossing targets the hard-to-reach areas between them. Doing both diligently reduces the risk of tooth decay and gum disease by removing the biofilm that collects on and around our teeth.
Biofilm is a collection of bacteria, viruses and other debris, like food particles, explains Robert Shields, an oral microbiologist and assistant professor at the University of Florida College of Dentistry.
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Biofilm also settles on the tongue. Dental biofilm is made up of different bacterial species than those that comprise tongue biofilm, because these species adapt to live on either the hard enamel of teeth or the warm environment of the tongue, Shields says.
The tongue is coated in lots of little bumps called papillae. These help us do things such as speak and chew, and affect food preferences. Biofilm accumulates between and around papillae. This biofilm can act as a reservoir for bacteria, which can spread back to the other parts of the mouth and potentially lead to health concerns such as gum disease, explains Dr Luana Dias, a dentist-scientist and postdoctoral associate in Shields’s lab.
While more research is needed, some evidence suggests this reservoir may be associated with other systemic health issues, such as diabetes and cardiovascular disease.
An overgrowth of bacteria can also lead to bad breath, says Dias. When sulfur-producing bacteria on the tongue break down, the process can produce compounds that cause bad breath. Indications that this might be happening include a white coating on the tongue and a constant metallic taste. Gentle tongue cleaning can help.
It’s better to use a tongue scraper than a toothbrush, says Salinas. Cross-contamination can occur if you use the same tool for both parts.
“It’s not wrong to use a brush, but it’s better to use a tongue scraper if you can,” he says.
Toothbrush bristles can also be too harsh on the tongue, says Figueroa. She’s seen “super brushers” – people who clean repeatedly throughout the day – create scar tissue on the top of their tongue from overdoing it.
Dias recommends using a metal scraper, such as stainless steel or copper, rather than a plastic one. Plastic can degrade over time, and plastic tools can leave micro-scratches on the tongue. Copper has also been associated with removing toxins, but this claim is not backed by research, says Salinas.
Figueroa also prefers scrapers over other tools, but endorses toothbrushes that have a rubber scraper on the other side of the brush head because of their ease and convenience.
A good rule of thumb is to replace rubber, plastic and bristle oral healthcare tools every three months, says Figueroa. While metal scrapers can be sanitized, speak with a dental hygienist about what cleaning routine works best for you.
How do you clean the tongue?
Cleaning your tongue should be part of your daily routine, just like washing your face, says Figueroa. She recommends cleaning it twice daily as part of your dental routine, just like brushing and flossing: in the morning and before bed.
Shields cautions against overcleaning the tongue as the effects of cleaning on the oral microbiome are still being debated. Some experts think tongue cleaning can remove good bacteria, such as microbes that process nutrients, along with the debris. Overall, it’s an argument for moderation, he says.
If you’re especially conscious of bad breath, you can add mouthwash to the end of your routine, Shields says. Mouthwash doesn’t kill bacteria, but it will freshen your breath. Avoid mouthwash that contains alcohol, he says, because this type can disrupt the oral microbiome and possibly damage oral cells.
When cleaning, stick out your tongue and focus on the front part. This should be achievable even for people with a gag reflex because the rear is typically what activates that reflex, says Figueroa. Use a simple raking motion to sweep over the tongue.
If you use a scraper, it will pick up a thin, white layer of biofilm. It’s best to use the scraper gently, Salinas explains. People may be tempted to push harder in the hopes of being “cleaner”, but this can damage the tongue. He recommends rinsing the tongue scraper between each pass.
After you clean your tongue, rinse off your tool and let it air out. Otherwise, it can harbor bacteria, says Figueroa.
While you’re sticking out your tongue, you can add another preventive health step, says Salinas: check out its sides and underside. This is where signs of oral cancer, like lumps or sores, can show up.
“If you see any irregularities, you should definitely see a professional for evaluation,” says Salinas. “That’s probably the most important tip.”
