Spots On Tongue

  • Ella Brown Bachelor of Science in Biomedical Science, The University of Sheffield

Get health & wellness advice into your inbox

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative

Introduction

Healthy tongues are pink in appearance and have tiny bumps on them called papilla projections, which contain taste buds. These help with tasting food and sensation.1 However the appearance of your tongue can change and other spots can develop that aren't usually present. Whilst abnormal spots on the tongue can be harmless, they can also be an indication of underlying health conditions, in rare cases they are a sign of tongue cancer.

Normal spots on your tongue are usually unnoticeable. There are tiny hairlike bumps (papillae) covering the surface at the back of the tongue. They appear as tiny pink/white bumps. Between these are your taste buds which can't be seen.3

 In certain conditions noticeable, enlarged and painful spots can appear on your tongue.2 Several types of unusual spots can appear on the tongue:  

  • White/ Red patches that don't scrape away2
  • Raised white areas2
  • Small red or white spots2
  • Ulcers / Open sores2
  • Fluid-filled bumps2

Common types of spots on the tongue and their causes 

There are several variations of spots that can appear on tongues, many are harmless but some do indicate underlying health conditions. 

Tongue discolouration

Tongue discolouration means the colour and surface of the tongue change manifesting in unusual spots/patches.4

Conditions that result in this are:

Geographic tongue: 

Appearance: smooth red patches with raised borders on the tongue usually in one area5
  • Geographic tongue is a condition that affects the surface of the tongue 
  • It is an inflammatory condition.5
  • In these conditions, there will be patches  of the tongue with no papillae5
  • These appear as smooth red patches with raised borders5
  • Although these patches can appear alarming and can cause slight pain they are not caused by any health conditions.5
  • It does not require prescribed medical treatment, over pain relief may help with any irritation5
  • The cause of geographic tongue is unknown.5

Black hairy tongue  

Appearance: Tongue has a dark furry look6
  • Black hairy tongue results  from a buildup of dead cells on papillae causing the papillae to become longer than usual
  • They can therefore easily be stained  and trapped with drinks, food, tobacco and bacteria6
  • Although it has an alarming appearance, black hairy tongue tends to be painless and harmless and can be dealt with via tongue cleaning6
  • It can be caused by a range of things including bad oral hygiene, drinking excessive alcohol, black tea or coffee, antibiotics, tobacco, dry mouth, peroxides, and a diet of mainly soft foods6

White spots on the tongue

White spots on your tongue may be noticed when experiencing discomfort in your mouth and when checking your inner cheek. 

 Here are conditions that result in white spots on the tongue:  

Oral thrush: 

Appearance: Raised white patches on tongue/ Inner cheeks and red mouth7
  • Oral thrush is caused by an overgrowth of natural fungus in the mouth7
  • Spots can be scraped off but this will cause bleeding7
  • Irritated patches have a cottage cheese-like appearance7
  • Can cause dry mouth and loss of taste7
  • Not highly contagious but can be spread to people with weakened immune systems7
  • Common in babies 7
  • Treated easily with a prescription of antifungal medication7

Leukoplakia 

Appearance: thick white patches on your tongue, inside of your cheeks, bottom of the mouth and gum8
  • Leukoplakia spots cannot be scraped away 
  • It can be caused by irritation from tobacco8
  • Can be harmless but sometimes represents an early stage of oral cancer so it is important to consult a dentist or doctor if you notice these spots8
  • Lesions can be removed with surgery8

Red or pink spots on the tongue

Transient lingual papillitis (lie bumps)  

Appearance: Inflamed and enlarged papillae that look like small red or white bumps9

  • Transient Lingual Papillitis causes red bumps on the tongue due to papillae inflammation 
  • Inflamed papillae are caused by tongue injury9
  • Other causes include stress, viral infection and malnutrition9
  • It is not a harmful condition, bumps quickly heal themselves9

Erythroplakia 

Appearance: Abnormal red spotted lesion (abnormal tissue) inside your mouth including on your tongue2

  • Red spots don't come off when scrapped2
  • People with Erythroplakia have a higher risk of developing oral cancer2
  • Can be treated with surgery or radiation

Scarlet fever 

Appearance: Red Bumps cover the tongue and it becomes very red known as a strawberry tongue10

  • Scarlet fever is caused by a bacterial infection
  • It has the distinct sign of a strawberry tongue10
  • Scarlet fever will also cause a fever, abdomen rash, sore throat and headache10

Other colours and their potential causes

Fluid-filled blisters on the tongue  

The appearance of fluid-filled blisters on the tongue can also be known as a cold sore: 

Appearance: Clusters of fluid-filled blisters often appear around your lips but can also develop on your tongue. 2

  • Cold sores are caused by the Herpes simplex virus 1 (HSV-1)
  • HSV-1 spreads via salvia or close contact11
  • HSV-1 is very contiguous, most people catch it before they are 5 years old11
  • About 20-40% of people with the virus will develop cold sores11
  • Factors that can trigger their development in infected individuals vary from person to person and include Pregnancy, Fatigue, stress and extreme temperatures11
  • Cold sores can be healed with over-the-counter medication; these will not get rid of the HSV-1, and once infected you are for life11

White/Yellow ulcers 

Tongue ulcers are small sores that can form on your tongue. Canker sores are a type of ulcer 2

Appearance: White/yellowish ulcers with red borders that can develop on your tongue as well as the inside of your lips, gums and roof of your mouth

  • Canker sores are very small12
  • They can be painful and can cause a burning feeling in the mouth12
  • Simple Canker sores can appear up to 4 times per year12
  • Complex Canker sores appear more often. Usually, this happens to people who have a history of getting Canker sores and people with weakened immune systems12
  • There is no certain cause but experts believe that mouth injury, stress, acidic foods, braces, dentures and nonsteroidal anti-inflammatories can trigger canker sore development12

Tongue spots as a symptom of cancer 

Tongue cancer is a type of head and neck cancer. Cancer is when abnormal cells grow uncontrollably. Squamous cell carcinoma is the most common type of tongue cancer.13 Tongue cancer itself is relatively rare. 13 Abnormal white or red patches on the tongue can be associated with this. Ulcers and open sores that do not heal or go away can also be associated with tongue cancer.13 Tongue cancer is typically diagnosed via Nandsendcopy and a biopsy.14

  • Nasendoscopy: A thin tube with a light and camera at the end that allows doctors to look at the back of your tongue, throat and inside your nose. 
  • Biopsy: Removal of small pieces of tissue or cells from the area of the tongue that appears abnormal. This can be done under general anaesthetic or during a nasendoscopy.14

Treatment for tongue cancer includes a range of options including:14

  • Surgery
  • Radiotherapy 
  • Immunotherapy
  • Chemotherapy 
  • Chemoradiotherapy 

It should be noted that the majority of the time the development of spots on your tongue will be harmless or easily treated like many of the conditions discussed above.2

When should I contact my doctor?

If you experience red/white patches and or open sores and ulcers that will not go away and or tongue pain that won't go away and gets worse over time contact your healthcare provider for an appointment to assess if they are associated with a health condition.2

Prevention

Here are some general ways one can avoid developing spots on their tongue and maintain good tongue health:15

  • Staying hydrated
  • Good oral hygiene can be maintained by brushing your teeth twice a day, flossing once a day and visiting your dentist twice a year 
  • Avoid spicy or acidic foods that may irritate the tongue 
  • Avoid tobacco products 
  • Use Alcohol-Free mouthwash

Summary 

A healthy tongue is pink in appearance, with tiny white/pink bumps which are papillae which help you grip food when you chew and contain your taste buds.1 Changes to your tongue's appearance can occur in the form of spots that are not usually there.2 The appearance of these spots varies between each condition but tends to fall into these categories 

  • White spots2
  • Red Spots2
  • Tongue discolouration2
  • Ulcers / Open sores2

Often the appearance of spots on your tongue will not be cause for concern, although the appearance of spots can look alarming and cause slight pain. Sometimes there is no association with health conditions or spots just indicate a minor tongue injury for example geographic tongue and transient Lingual papillitis 2. Lifestyle choices can also be responsible for spots on the tongue. For example, black tongue discolouration (Black hairy tongue) can be caused by consuming excess acidic foods, tobacco and black coffee.6 Again this is a harmless condition dealt with via tongue cleaning.6  

Other types of spots on the tongue can be associated with pathogens for example cold sores are associated with HSV-1 and oral thrush is a result of an overgrowth of natural mouth fungus.2,7 These spots can be easily healed with medication.2 In some instances however the development of spots on the tongue can be a symptom of cancer.14 Painful, abnormal red /white spots and open sores ulcers that last a long time should be noted and discussed with your doctor.2

References

  1. Cleveland Clinic [Internet]. [cited 2024 Jan 5]. Tongue: definition, location, anatomy & function. Available from: https://my.clevelandclinic.org/health/body/22845-tongue
  2. Cleveland Clinic [Internet]. [cited 2024 Jan 5]. What do those spots on your tongue mean? Available from: https://my.clevelandclinic.org/health/articles/24632-spots-on-tongue
  3. Lumps on the tongue - causes and treatment | colgate® [Internet]. [cited 2024 Jan 5]. Available from:https://www.colgate.com/en-gb/oral-health/adult-oral-care/bumps-on-the-back-of-the-tongue-normal-or-abnormal
  4. MSD Manual Consumer Version [Internet]. [cited 2024 Jan 5]. Tongue discolouration and other changes - mouth and dental disorders. Available from https://www.msdmanuals.com/en-gb/home/mouth-and-dental-disorders/lip-and-tongue-disorders/tongue-discoloration-and-other-changes
  5. Mayo Clinic [Internet]. [cited 2024 Jan 5]. Geographic tongue - Symptoms and causes. Available from: https://www.mayoclinic.org/diseases-conditions/geographic-tongue/symptoms-causes/syc-20354396
  6. Mayo Clinic [Internet]. [cited 2024 Jan 5]. Black hairy tongue - Symptoms and causes. Available from: https://www.mayoclinic.org/diseases-conditions/black-hairy-tongue/symptoms-causes/syc-20356077
  7. White spot on the tongue: is it serious? [Internet]. [cited 2024 Jan 5]. Available from: https://www.colgate.com/en-gb/oral-health/mouth-sores-and-infections/white-spot-on-the-tongue-1215
  8. Cleveland Clinic [Internet]. [cited 2024 Jan 8]. Leukoplakia. Available from: https://my.clevelandclinic.org/health/diseases/17655-leukoplakia
  9. Cleveland Clinic [Internet]. [cited 2024 Jan 8]. Liar’s tongue, lie bumps and angry papillae. Available from:https://my.clevelandclinic.org/health/diseases/transient-lingual-papillitis-lie-bumps
  10. Dental C. Red dots on tongue | the causes and how to treat them [Internet]. Champions Dental. 2021 [cited 2024 Jan 8]. Available from: https://championsdental.com/red-dots-on-tongue-the-causes-and-how-to-treat-them/
  11. Cleveland Clinic [Internet]. [cited 2024 Jan 8]. Mouth ulcers: harmful or just annoying? Available from: https://my.clevelandclinic.org/health/diseases/21766-mouth-ulcer
  12. Cleveland Clinic [Internet]. [cited 2024 Jan 8]. Canker sore (Aphthous ulcer): what it is, causes & treatment. Available from: https://my.clevelandclinic.org/health/diseases/10945-canker-sores
  13. What is tongue cancer? [Internet]. [cited 2024 Jan 8]. Available from: https://www.cancerresearchuk.org/about-cancer/mouth-cancer/stages-types-grades/tongue-cancer/about
  14. Tongue cancer [Internet]. [cited 2024 Jan 8]. Available from: https://www.macmillan.org.uk/cancer-information-and-support/head-and-neck-cancer/tongue-cancer
  15. Crest [Internet]. [cited 2024 Jan 8]. Tongue bumps: enlarged papillae and other problems. Available from: https://crest.com/en-us/oral-care-tips/tongue-health/tongue-bumps-enlarged-papillae-and-other-problems

Get health & wellness advice into your inbox

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative
[optin-monster-inline slug="yw0fgpzdy6fjeb0bbekx"]
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

Get our health newsletter

Get daily health and wellness advice from our medical team.
Your privacy is important to us. Any information you provide to this website may be placed by us on our servers. If you do not agree do not provide the information.

Ella Brown

Bachelor of Science in Biomedical Science, The University of Sheffield

Biomedical Science Graduate with extensive knowledge of human health and disease. Experienced in explaining complex scientific concepts to the lay audience in clear and engaging ways.

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
Email:
Klarity / Managed Self Ltd
Alum House
5 Alum Chine Road
Westbourne Bournemouth BH4 8DT
VAT Number: 362 5758 74
Company Number: 10696687

Phone Number:

 +44 20 3239 9818