What Causes a White Tongue? Here’s What Dentists Want You To Know

Ever wonder if you should worry about having a white tongue? For most people, your tongue has a pretty steady appearance: Pink, with a thin whitish coating, and devoid of any cracks or ulcerations. In a healthy tongue, you may also see tiny bumps on top that make it look rough—known as papillae, and contain tastebuds and temperature sensors.

But sometimes, tongues can look a little different than expected—like, if it has a whiter-than-usual appearance—and it could signal a larger issue. For the most part, your tongue can look white for benign reasons (maybe you're dehydrated or skipped a few brushings), but thicker white patches can also be a sign of infection or, in rare cases, mouth or oral cancer.

Here, oral health experts weigh in on what a "white tongue" can mean—and when you should book an appointment with your dentist.

What Is a “White Tongue,” Exactly?

Not all white tongues look exactly the same. Sometimes a white tongue can look like a thick, white coating on your tongue that stays put even after brushing; other times, it can form a thin lace-like pattern. The whiteness can cover your entire tongue, only the back of your tongue, or it can appear in patches, bumps, or specks.

When your tongue has a distinct white appearance, you may also notice other oral symptoms: Your white tongue could be accompanied by a bad taste in your mouth, bad breath, or some redness. Bad breath or bad taste are commonly associated with a white tongue because of the raised papillae. Those raised patches create a larger surface area for food, plaque, and bacteria to build up in your mouth, leading to less-than-pleasant symptoms.

What Typically Causes a White Tongue?

Just like all white tongues don't look exactly the same, white tongues aren't always caused by the same thing. "There are a variety of reasons why you may have white lesions on your tongue, and they can range from something fairly benign and common to more serious and potentially dangerous," Michael Nguyen, DDS, a board-certified periodontist with Mid-Peninsula Dental Specialists in Los Altos, California, told Health.

For the most part, a white tongue occurs when bacteria, food, and dead skin cells get trapped between the papillae on your tongue's surface. That causes those papillae—usually small and string-like—to swell up, causing a white appearance on your tongue. Sometimes, those papillae can grow large enough to give a carpet-like appearance that has a brown or blackish appearance. That buildup on the tongue is largely asymptomatic (aside from the appearance) and can be remedied through improved oral hygiene, not smoking, and dietary interventions (like drinking more water or cutting back on caffeine).

But there could be other causes behind a white tongue as well. Here are six more reasons your tongue could have a whitish appearance—and how best to remedy each one.

Tongue Injury

"It's common to bite or burn your tongue, which can be painful and result in white tissue," Amanda Lewis, DDS, a board-certified dentist based in Dallas, told Health. You might also notice white tissue surrounding a recent tongue piercing. A "geographic tongue," meaning a tongue with glossy, red patches with white or light borders around the edges, is a normal part of healing as your tongue regrows tastebuds. But this condition can also occur without tongue injury or a known cause. Symptoms can be treated with a variety of medications, vitamin A, and zinc. And it's recommended that you avoid alcohol, spicy and sour foods, and acidic fruits and beverages until the symptoms are gone,

Generally, a tongue injury will heal within a week and a half. If you have a pierced tongue, using a mouth rinse after every meal will help prevent bacterial growth in the area.

Leukoplakia

"Leukoplakia is a condition where thick, white patches appear on the tongue," Sharon Huang, DDS, a cosmetic dentist and founder of Les Belles NYC, a dentistry practice in Manhattan, told Health. But the difference between these white patches and others is that they cannot be rubbed off or diagnosed as another condition or disease, according to the Academy of Oral and Maxillofacial Pathology (AAOMP).

It's important to diagnose and treat leukoplakia in a timely manner—per the AAOMP, over time, a percentage of the lesions can transform into oral cancer. To diagnose leukoplakia, an oral surgeon will biopsy the white growth to look for its potential to become cancerous. Changes seen in the biopsy under a microscope can determine if the leukoplakia is "epithelial atypia" or "epithelial dysplasia"—the latter of which is ranked as mild, moderate, or severe.

With epithelial atypia and mild cases of epithelial dysplasia, per the AAOMP, doctors will take a more watchful waiting approach and suggest lifestyle changes (like quitting smoking). With moderate or severe cases, they will likely suggest removing the white patches through scalpel excision, electrocautery, liquid nitrogen application, or laser surgery, the AAOMP said. Sometimes, even after removal, the leukoplakia can recur and need to be removed again.

Oral Lichen Planus

Lichen planus is a benign condition that can affect the tongue or inside of the mouth, and sometimes both, per the AAOMP. Dr. Huang explained this is a chronic inflammatory condition, meaning it's not thought to be caused by an infection or lifestyle habit. Lichen planus affects an estimated 0.5% to 2% of the population.

When lichen planus shows up in the mouth, it can take one of two forms: reticular lichen planus, which usually shows up as a lace-like white pattern, or erosive lichen planus, which is characterized by erosions in the mouth that can be tender or painful, according to the AAOMP. Neither kind is contagious.

"There is no cure for lichen planus, so treatment is mainly to alleviate any painful symptoms," Dr. Nyugen said. This may include medication such as corticosteroid pills and pain-relieving mouth rinses, and if necessary other treatments may include surgery, ultraviolet light therapy, or laser treatment.

Oral Candidiasis

Oral candidiasis—sometimes more commonly known as oral thrush—is a fungal infection that occurs in the mouth, said Dr. Nyugen. It can show up as creamy white lesions on the tongue or inner cheeks, and it's caused by an overgrowth of a yeast-like fungal organism, Candida albicans, which is naturally present on your skin and inside your mouth. (This fungus can also cause vaginal yeast infections in women.)

Though everyone has this fungus living in or on their bodies, an infection by it is most common in immunocompromised people, like those living with HIV/AIDS or cancer. It is also common in people who smoke, have a dry mouth, or wear dentures.

Doctors will usually prescribe antifungal medication for cases of oral candidiasis, the AAOMP said, and the infection can clear up quickly once the medication is used, Dr. Huang said. The AAOMP warns, however, that home remedies like eating yogurt or avoiding yeast will not treat or prevent the condition.

Syphilis

"Syphilis is a sexually transmitted bacterial infection that can leave oral lesions in several areas, including the tongue, lips, and roof of the mouth," Dr. Nyugen said. Painless lesions typically emerge about 21 days after exposure and have a firm, round appearance.

If you suspect your white tongue is linked to syphilis, it's important to seek treatment immediately. Depending on the stage of your infection, one or multiple injections of an antibiotic will kill the bacterium and prevent further damage.

Oral Cancer

If you have white spots on your tongue, oral cancer is another possibility—especially if you have a history of risky behaviors like smoking or chewing tobacco, Dr. Nyugen said. Among other factors, a family history of cancer, a habit of drinking alcohol, or a human papillomavirus (HPV) infection could also increase your risk.

With an exam and biopsy, a dentist can determine whether you have mouth cancer. After that, surgery is the most common treatment option, but depending on the stage of cancer, additional radiation or a combination of radiation and chemotherapy may be recommended.

When Should You See a Healthcare Provider for a White Tongue?

Often, you can treat a white tongue at home with good oral hygiene practices. However, if it doesn't go away within a week, causes so much pain it's hard to drink, eat, speak, or comes with other concerning symptoms like fever, call a dentist or your healthcare provider immediately.

"If you see a suspicious white lesion on your tongue, even if it isn't symptomatic, it is a good idea to ask your dentist about it," Dr. Nyugen said. "It's always better safe than sorry, and a simple dental visit is the best way to find out what the white lesion may be."

At your appointment, your dentist may take a high-quality photograph to diagnose the root cause of your problem and monitor any changes over time.

How Can You Prevent a White Tongue?

Sometimes, there's nothing you can do to prevent a white tongue. But you can do your best to avoid the most likely reason for a white tongue: poor oral hygiene. Here is a list of the top tips to maintain a healthy mouth (and like this, prevent any strange color changes of your tongue) throughout your lifetime.

• Use fluoride toothpaste and drink fluoridated water, if you can
• Brush your teeth twice a day and floss between your teeth daily
• Visit your dentist regularly
• Don't use tobacco products, and limit alcohol
• Limit sugary snacks and drinks
• If you have diabetes, work to manage the condition
• Contact your dentist ASAP if you notice any sudden changes in your mouth

A Quick Review

Most of the time, having a white tongue is harmless, and practicing good oral hygiene will keep your mouth healthy. But if you have symptoms or think you have one of the conditions described here, talk with a dentist or healthcare provider who can help you get the treatment you need.