You have difficulty speaking, either pronouncing certain sounds necessary for your language, adding extra sounds and words, elongating words, stuttering, inability to think of or say certain words, or, if IE = 4, you are nonverbal. This gives you a −(IE) penalty on all speech-related ability checks, saving throws, and attack rolls, and you must modify spells with verbal components to work within your verbal range, so you cannot use spell scrolls, and when learning a new spell with a verbal component, it takes twice as long to copy it into your spellbook as usual.

Real-world Examples

Vocal Cord Paralysis, Autism, Attention Deficit Hyperactivity Disorder, Huntington’s Disease, Amyotrophic Lateral Sclerosis

Assistive Options

You can benefit from learning a sign language, which can be exchanged for any language or proficiency.

Magical Assistance

Tools that can project thoughts can telepathically assist with a speech impediment, but they typically allow speaking to only one target at a time or have limited uses. The cause may be more psychological than physical, in which case telepathy may not help.

You experience chronic pain in your mouth due to sensitive tissue or sores or growths. Any action that requires concentration (e.g., maintaining a spell) requires a successful DC 10 + (IE) Constitution saving throw per round to maintain concentration. Because you’re used to managing pain, even though this doesn’t reduce the experience of pain, you have a +(IE) bonus to saving throws against psychic damage. Temperature sensitivity is a common trigger for mouth pain.

Real-world Examples

Oral Thrush, Oral Lichen Planus, Burning Mouth Syndrome, Salivary Gland Stones, Squamous Papilloma, Temperature Sensitivity

Assistive Options

In some cases, ice or a saltwater rinse can help relieve 1 IE of pain for 10 minutes. The GM and player should discuss whether any remedies will help.

The inside of your mouth has decay, including your gums and/or lining. It causes halitosis (GM discretion on social interactions), and every twenty-eight days, the player must roll above the IE on 1d20 or lose a tooth (Roll 1d20 for location: 1−10 top row left-right, 11–20 bottom row left-right).

Real-world Examples

Gingivitis, Periodontitis, Malnutrition

Assistive Options

Normally, this is managed by hygiene and diet, but this awareness requires a technological level not normally available in a fantasy RPG world.

Your mouth dries out quickly, requiring you to drink 1 + (IE) times as much water as typical or experience exhaustion from Dehydration. You also need to take a sip of liquid before casting a spell with a verbal component or making a Charisma (Persuasion) check. If you can’t drink first, you need to succeed at a DC 5 + (IE) Constitution check. If you fail, the spell is not cast, or you have disadvantage on the Charisma (Persuasion) check.

Real-world Examples

Diabetes, Stroke, Thrush, Alzheimer’s disease, Sjögren Syndrome, HIV/AIDS

Assistive Options

Chewing on gum or some other soft substance can help. One piece will reduce the IE by 1 for 10 minutes. Spells with verbal components cannot be cast with gum in the mouth.

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Your mouth does not have the shape of mouths typical of your ancestry. Choose or roll on the following table.

• Chin Shape Difference. Your chin is not a typical shape for the range expected for your ancestry. Choose or roll on the following table. All of these give a −(IE) penalty on disguise attempts.
  

  d20	Chin Shape
  1–4	Bulbous
  5–6	Curled
  7–8	Forked
  9–13	Missing
  14–18	Oversized
  19–20	Pointed

  • Bulbous. Your chin is spherical, (IE) × 2 inches in diameter.
  • Curled. Your chin sticks out and curls 2 inches per IE. (Player and GM decide on direction and shape.) It’s nearly impossible to shave, so if you have facial hair, it won’t likely be shaved off your chin. This gives you +(IE) to Dexterity (Sleight of Hand) checks but −(IE) to Charisma (Persuasion) checks with people who don’t know you due to many people’s discomfort around those with unexpected appearances.
  • Forked. Your chin forks into (IE) + 1 branches. This gives you advantage on Dexterity (Sleight of Hand) checks but disadvantage on Charisma (Persuasion) checks with those who don’t know you due to many people’s discomfort around those with unexpected appearances.
  • Missing. You have no chin — just under your lower teeth, your jaw curves sharply into your neck, This difference has no IE. This gives you advantage on Dexterity (Sleight of Hand) checks but disadvantage on Charisma (Persuasion) checks with those who don’t know you due to many people’s discomfort around those with unexpected appearances.
  • Oversized. Your lower jaw around your chin area is oversized, sticking out (IE) inches farther than normal. This gives you +(IE) to Dexterity (Sleight of Hand) checks but −(IE) to Charisma (Persuasion) checks with people who don’t know you due to many people’s discomfort around those with unexpected appearances.
  • Pointed. You have a straight horn on the end of your chin. This allows you to make an unarmed attack and cause (IE) piercing damage. With those who don’t know you, you have disadvantage on Charisma (Persuasion) checks but advantage on Charisma (Intimidation) checks due to suspicion of fiendish origin.
• Jaw Dislocation: You can dislocate your jaw when eating and have a flexible esophagus and neck, allowing you to swallow large objects whole. When eating around others, you need to succeed on a DC 8 Strength saving throw to keep the dislocation from happening unintentionally, which is disconcerting for those who see it. This difference has no IE. If you fail this check, you have disadvantage on Charisma (Persuasion) checks with those who don’t know you and who saw it due to many people’s discomfort around those with unexpected appearances or performing unexpected behaviors.
• Lip Absence: You have no skin covering your teeth and gums. This difference has no IE. This gives you advantage on Dexterity (Sleight of Hand) checks but disadvantage on Charisma (Persuasion) checks with those who don’t know you due to many people’s discomfort around those with unexpected appearances. You must also find a way to manage drooling, and you may choose Moisture Imbalance as an additional trait. Because you lack lips, you must modify spells with verbal components to work within your verbal range, so you cannot use spell scrolls, and when learning a new spell with a verbal component, it takes twice as long to copy it into your spellbook as usual. You also have disadvantage in disguise attempts.
• Minimal Opening. Your mouth opening is small, less than an inch diameter, requiring you to cut your food small, requiring twice as long to eat a meal, and making it difficult to speak loudly. Drinking a potion takes 2 rounds. This difference has no IE. You have disadvantage on Charisma (Persuasion) checks with those who don’t know you due to many people’s discomfort around those with unexpected appearances. It also gives disadvantage on disguise attempts.
• Mouth Location Difference. Your mouth is not in the usual place on your face as would be expected for your ancestry, either location (80 percent) or angle (20 percent). For location, roll 1d12 and use it as a clock face to determine the direction of the mouth from its typical location, (IE) inches distant. If the difference is angle, the resulting angle is (IE) × 20 degrees clockwise or counterclockwise (player and GM decide). This gives you +(IE) to Dexterity (Sleight of Hand) checks but −(IE) to Charisma (Persuasion) checks with people who don’t know you due to many people’s discomfort around those with unexpected appearances. It also gives a −(IE) penalty on disguise attempts.
• Misaligned Jaw. You have a “faulty jaw,” overbite, or underbite such that your upper and lower jaw don’t match up. This causes difficulty eating, drinking, speaking, and breathing. This gives you a −(IE) penalty on Charisma (Persuasion) checks with those who don’t know you, and every time you cast a spell with a verbal component, you have to succeed on a DC 5 + (IE) check using your spellcasting ability. On a failed check, the spell fails, but the spell slot is not used. You also have to succeed on a DC 5 + (IE) check every time you eat or drink to avoid some of it falling out of your mouth, which can give you a −(IE) penalty on Charisma (Persuasion) checks.
• Oversized Mouth. Your mouth extends (IE) inches farther in each direction than usually expected for your ancestry. This causes difficulty eating and drinking. This gives you a −(IE) penalty on Charisma (Persuasion) checks with those who don’t know you. You also have to succeed on a DC 5 + (IE) check every time you eat or drink to avoid some of it falling out of your mouth, which can give you a −(IE) penalty on Charisma (Persuasion) checks.

Real-world Examples

Malocclusion, Freeman-Sheldon Syndrome, Facial Asymmetry, Temporomandibular Joint Disorders

Assistive Options

A bandana, scarf, or other loose mask can typically cover the mouth but will look suspicious depending on climate and culture. Strategic facial hair can, in some cases, make differences slightly less obvious.

Your lips (50 percent), tongue (40 percent), or entire mouth interior (10 percent) is a color not normally associated with your ancestry. (The player and GM should discuss color or choose randomly from https://www.random.org/colors/hex.) While not extremely noticeable or easy to explain away, this gives disadvantage on disguise attempts and Charisma (Persuasion) checks in subcultures that emphasize appearance such as nobility or military. This trait has no IE.

Real-world Examples

Cyanosis, Oral Thrush, Anemia, Addison Disease, Kaposi Sarcoma, Lichen Planus, Leukoplakia

Assistive Options

Eating fruit that matches a normative mouth color can help but wears off in 2d10 minutes. Lipstick can cover lip color differences but wears off while eating or exposure to liquids.

Magical Assistance

The Color Flesh cantrip can temporarily modify mouth color, but the target will not notice when it wears off.

Your mouth produces a discharge that you have trouble containing. You may choose Dysgeusia (Disruption) as an additional trait. Choose or roll on the following table.

Blood. Blood drains out of your mouth at a rate of (IE)² ounces per day. Because of this blood loss, you need to eat more to compensate, consuming an additional (IE) days’ worth of food per week to avoid exhaustion. This also gives you a −(IE) penalty on Charisma (Persuasion) checks but a +(IE) to Charisma (Intimidation) checks due to vampiric implications.

Cold. Your breath gets frosty, freezing anything that comes within (IE) feet of it. If you bring your mouth that close to a target, they take (IE) cold damage on a failed DC 8 + (IE) Constitution saving throw, half damage on a successful saving throw.

Fire. Your breath combusts, burning anything that comes within (IE) feet of it. If you bring your mouth that close to a target, they take (IE) fire damage on a failed DC 8 + (IE) Constitution saving throw, half damage on a successful saving throw.

Gas. Your breath smells fetid, so anyone within (IE) feet of your mouth is affected as if by a Stinking Cloud spell, requiring a successful DC 8 + (IE) Constitution saving throw to avoid the effects.

Mucus. Mucus fills and flows from your mouth at a rate of (IE)² ounces per day. Because of constantly wiping your mouth, your nose and mouth are raw, and you have a −(IE) penalty on taste-related ability checks and saving throws and Charisma (Persuasion) checks. If you attempt to swallow more than a nominal amount, you will become nauseous and will vomit if you fail a DC 8 + (IE) Constitution saving throw.

Saliva. Due to mild numbness, palsy, or malformation in your lips, saliva drools out of your mouth at a rate of (IE)² ounces per day. Because of this fluid loss, you need to drink additional water to assist with the loss to avoid Dehydration and exhaustion. If you consciously focus on sucking it into your mouth to swallow it, you can do so, but the sound is audible and requires a successful DC 8 + (IE) Dexterity (Stealth) check to do so without being noticeable. Attempting this consistently can lead to Pneumonia.

Smoke. Sulfurous-smelling black smoke streams out of your mouth. The smell gives you a −(IE) penalty on Dexterity (Stealth) and Charisma (Persuasion) checks but advantage on Charisma (Intimidation) checks due to suspicion of draconic or fiendish origin. If left 1 ÷ (IE) hours in a room without ventilation, everyone in the room except you must succeed on a Constitution saving throw or be affected as if by a Stinking Cloud spell.

Real-world Examples

Halitosis, Cerebral Palsy, Parkinson’s Disease, Amyotrophic Lateral Sclerosis

Assistive Options

A specialized mask can reduce 1 IE of some of these discharges, but the mask becomes clogged and useless after 1 hour and must be cleaned and dried before using again.

Magical Assistance

The Prestidigitation spell can clean the affected area but does not stop the discharge.

You have an altered sense of taste. Choose or roll on the following table.

Amplification. Your sense of taste is more sensitive than most. This gives you a +(IE) on Wisdom (Perception) checks involving taste but a −(IE) penalty on Constitution saving throws against taste and smell-related effects.

Disruption. Your sense of taste is less sensitive than most. This gives you a −(IE) penalty on Wisdom (Perception) checks involving taste but a +(IE) benefit on Constitution saving throws against taste and smell-related effects.

Discrimination Modification. You taste things differently than other people. Sour foods may taste sweet — mild, spicy. This gives you a −(IE) penalty on Wisdom (Perception) checks involving taste but a +(IE) benefit on Constitution saving throws against taste and smell-related effects. The player and GM should discuss the exact effect on you and any resulting changes to rolls.

Sensitivity. You are extremely sensitive to (IE) types of tastes. Roll on the following table for each type:

If you eat a food that even mildly fits into the corresponding taste category, you must succeed on a DC 5 + (IE) Constitution saving throw or become obsessed with finding another food or drink to cleanse and can do nothing else until then or until (IE) d20 minutes has passed, at which point your mouth has naturally washed out the flavor.

Real-world Examples

GI Disease, Parkinson’s Disease, Diabetes, Dementia

Assistive Options

Some people find it helpful to lick a food first to determine the taste. This will normally not trigger a strong reaction but give a sense of how it might affect you. Note that many cultures would find this behavior rude or strange.

Magical Assistance

The Prestidigitation spell can alter the flavor of food.