Why Is Your Tongue White? Here's What Dentists Want You to Know
Unless you've just eaten a blue raspberry Jolly Rancher, 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 of it that make it look rough—those are 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 at hand. For the most part, your tongue can look white for totally benign reasons (maybe you're dehydrated or you 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: According to the Cleveland Clinic, 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, per the Cleveland Clinic—those raised patches create a larger surface area for food, plaque, and bacteria to build up in your mouth, leading to the 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, either. "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, tells 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—normally small and string-like—to swell up, causing a white appearance on your tongue. Sometimes, those papillae can grow large enough to give off a brown or blackish appearance, according to Brigham and Woman's Hospital's Division of Oral Medicine and Dentistry. That buildup on the tongue, per Brigham and Women's, is largely asymptomatic (aside from the white appearance) and can be remedied through oral health 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.
"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, tells 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.
Generally, a tongue injury will heal within a week and a half. Just avoid irritating substances like hot, spicy, or acidic foods and drinks to support the process. If you've recently gotten your tongue pierced, an antifungal mouthwash like Nystatin (like Nystop®) could also help combat bacterial growth in the area, per the Cleveland Clinic.
"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, tells Health. But the difference between these white patches and others are that they cannot be rubbed off or diagnosed as another condition or disease, according to the Academy of Oral and Maxillofacial Pathology (AOMP).
It's important to diagnose and treat leukoplakia in a timely manner—per the AOMP, 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 AOMP, 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 AOMP says. Sometimes, even after removal, the leukoplakia can recur and will 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 AOMP. According to Dr. Huang, this is a chronic inflammatory condition, meaning it's not thought to be caused by an infection or lifestyle habit.
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, the AOMP says. Neither kind is contagious.
"There is no cure for lichen planus, so treatment is mainly to alleviate any painful symptoms," says Dr. Nyugen. This may include medication such as corticosteroid pills and pain-relieving mouth rinses, plus lifestyle changes like gently brushing your teeth with a plain toothpaste and avoiding tobacco, alcohol, and irritating foods, per the Mayo Clinic.
Oral candidiasis—sometimes more commonly known as oral thrush—is a fungal infection that occurs in the mouth, says 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, per the AOMP).
Though everyone has the fungus living in or on their bodies, an infection by it is most common in immunocompromised people, like those living with HIV/AIDS, diabetes, or cancer; or those who smoke, have a dry mouth, or wear dentures, per the Centers for Disease Control & Prevention (CDC).
Doctors will usually prescribe antifungal medication for cases of oral candidiasis, the AOMP says, and the infection can clear up pretty quickly once medication is being used, says Dr. Huang. The AOMP warns, however, that home remedies like eating yogurt or avoiding yeast will treat or prevent the condition.
"Syphilis is a sexually transmitted bacterial infection that can leave oral lesions in several areas including the tongue, lips, and roof of the mouth," says Dr. Nyugen. According to the CDC, 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, per the CDC.
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, says Dr. Nyugen. Among other factors, a family history of cancer, a habit of drinking alcohol, or a human papillomavirus (HPV) infection could also increase your risk, according to the American Cancer Society (ACS).
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 you may also consider additional radiation or a combination of radiation and chemotherapy, according to the ACS.
When should you see a doctor for a white tongue?
Often, you can treat a white tongue at home with good oral hygiene practices (more on this later!). However, if it doesn't go away within a week, causes so much pain it's hard to drink, eat, or speak, or comes with other concerning symptoms like a fever, call a dentist or your primary care doctor 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 says. "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 are a list of the top tips to maintain a healthy mouth (and thusly, prevent any strange color changes of your tongue) throughout your lifetime, per the CDC:
- 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 once a year—even if you wear dentures
- Don't use tobacco products and limit use of alcohol
- If you have diabetes, work to maintain the disease
- Avoid medications that cause dry mouth; if that's not possible, manage it with plenty of water and sugarless gum
- Contact your dentist ASAP if you notice any sudden changes in your mouth
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