White Tongue Causes

Have you ever looked in the mirror and been surprised to find that your tongue has transformed into an unexpected shade of white? It's a peculiar sight, one that often raises questions and concerns about what might be lurking beneath the surface. The human tongue, that humble organ responsible for tasting, speaking, and even singing, can sometimes reveal more about your health than you might imagine.

White tongue can be caused by a variety of factors. It might be because of your poor oral hygiene, or it might be a symptom of an underlying medical condition. The white tongue might look alarming, but it is usually temporary. However, it is essential to identify the specific cause for appropriate treatment and management. 

What is a white tongue?

White tongue, as the name suggests, is when the top surface of your tongue is coated with a thick white film. It might cover the entire surface of the tongue, or it might appear in patches. It can be transient, resolving by brushing your tongue, or it can be persistent and associated with other symptoms. 

When a white tongue is a result of poor oral hygiene, the coating consists of numerous bacteria, dead cells, and food particles lodged between the tiny papillae that cover our tongue.¹ 

Let's uncover the various factors that might be turning your tongue white. 

Common causes of white tongue

• Oral Thrush

Oral thrush, or oral candidiasis (pseudomembranous form), is a fungal infection that affects the mucous membranes of the oral cavity, including the palate, tongue, and inner lining of lips and cheeks. It appears as white patches that can be easily removed by gauze, revealing a red sore tongue underneath. It is also sometimes associated with symptoms like a burning sensation and alteration of taste.³ 

 There are some predisposing factors that make one more susceptible to this fungal infection. These include prolonged consumption of some drugs, dry mouth, wearing of dentures, smoking, diabetes, extremes of age, malignancies, and medical conditions that weaken the immune system. 

• Leukoplakia

The World Health Organization (WHO) has defined leukoplakia as ‘A white patch or plaque that cannot be characterized clinically or pathologically as any other disease.’ ^4,5

It appears as a white patch that may occur anywhere inside the mouth, including the tongue. 

It is important to note that leukoplakia has the potential to develop into a serious condition such as oral cancer,⁴ so it's recommended that you get an oral checkup done by a dental surgeon and keep a follow-up routine to rule out any doubts.

• Oral Lichen Planus

Lichen Planus is a chronic inflammatory condition that affects the skin, nails, and the mucous membranes of the mouth. Lichen planus of mouth, or Oral Lichen planus (OLP), has many forms; it may be circular, thread-like, or in patches. Pain, burning sensation, and discomfort are other symptoms associated with this condition. 

• Geographic Tongue

Geographic tongue is a benign condition where map-like patches appear on the surface of the tongue due to inflammation. These red patches with white borders frequently change their shape and migrate from one place to another on your tongue. It is usually pain-free and resolves over time without any specific treatment. 

• Poor Oral Hygiene

Oral hygiene has been proven to be one of the most common factors for a coating to appear on your tongue.2  Inadequate brushing can lead to a build-up of bacteria, dead cells and food debris on the surface of your tongue. These result in a yellowish-white coating that can also contribute to bad breath, as the bacteria produce foul-smelling compounds.

• Medication

In our mouth, ‘good bacteria’ are naturally present and play a vital role in maintaining the health of our oral cavity. However, prolonged use of drugs like broad-spectrum antibiotics inhibits these bacteria to function properly. This puts our oral cavity at risk of opportunistic infections like oral candidiasis (thrush). 

Other treatment modalities include prolonged use of steroids, immunosuppression medications after transplant, and chemotherapy that weakens the body’s immune system, increasing the risk of getting oral thrush, hence, white patches on your tongue or other parts of the mouth.⁶

• Syphilis 

Syphilis is a bacterial infection and one of the sexually transmitted diseases (STDs). In its early stages, it appears as painful sores on your lips, tongue, gums, and back of the mouth that are contagious. They start as red patches and eventually turn into large open sores that are red, yellow, or grey in colour.

In this case, you must definitely check with your physician. Treatment of syphilis is very important because if left untreated, it may affect your other organs. 

• Tongue Injury

A sharp edge of a tooth, filling or denture may injure your tongue, resulting in a traumatic ulcer. It is usually found on the lateral border of the tongue. It usually goes away within 2 weeks after the causative agent is removed.⁷

• Oral cancer

A sore or white patch or lump on your tongue that persists for more than a few weeks might be a sign that it's oral cancer. Other symptoms include pain, numbness or tingling, difficulty in swallowing, and difficulty in moving the tongue. 

It's crucial to consult a healthcare professional or an oral and maxillofacial specialist for a thorough evaluation. Early diagnosis and prompt treatment are critical for improving the prognosis of tongue cancer. 

Treatment

The treatment approach may vary based on the specific diagnosis, so it's crucial to work with a healthcare professional to determine the most appropriate course of action for your white tongue. 

• Tongue scraping 

Gently scraping your tongue reduces the bacteria and debris that accumulate on it and helps get rid of the white coating caused by poor oral hygiene. It can be done with a tongue scraper. However, a toothbrush does the job, too. 

• Oral thrush 

It is treated with the help of antifungal drugs that are either topical (applied to specific areas of concern) or systemic (that affects the whole body). These are available in drops, lozenges, gel, oral suspensions, or tablets.³

• Syphilis 

Your physician will prescribe you antibiotics like penicillin to target the bacteria.

• Oral lichen planus

It does not have a specific treatment; however, in some cases, topical steroids (steroidal mouthwash or suspensions) are prescribed. 

• Oral cancer

If the white patch on the tongue is confirmed as oral cancer, the treatment is decided based on the staging of the cancer. According to Cancer Research UK, there are various treatment options, including surgery, radiation therapy, chemotherapy, chemoradiotherapy, and immunotherapy.  

• Foods to avoid

Avoid foods that are hot, spicy, and acidic and anything that may irritate your tongue.

Prevention

White tongue is not always preventable. However, you can reduce its chances by:¹⁰

• Maintaining good oral hygiene; brushing and flossing regularly
• Brushing or scraping your tongue
• Regular dental checkups 
• Reducing the consumption of alcohol 
• Quitting smoking or the use of tobacco
• Adopting healthy dietary changes 
• Engaging in safe sex
• Drinking sufficient water 

When to see a doctor?

Seek medical attention immediately if you witness any of the following symptoms:

• Persistence: A white sore or patch persists for more than 2-3 weeks even after the cause has been addressed 
• Tingling or burning sensation
• Difficulty in swallowing or moving tongue 
• Sore throat

FAQs

Is it unhealthy to have a white tongue?

A thin white coating on your tongue is normal; however, a thick coating or patches may indicate there is an underlying problem for which you must get your evaluation done by a dental professional. 

Is the white tongue a cause of vitamin deficiency?

Vitamin deficiencies like Vitamin B₁₂, folic acid, niacin, and iron can present as sore, glossy, and beefy-red tongue.⁸

Can stomach problems cause a white tongue?

Yes, in many instances, a white coating on the tongue has been related to gastrointestinal disorders like chronic gastritis. ⁹

Summary

The culprits behind a white tongue can be as simple as poor oral hygiene or more complex conditions like infections or even cancer. Therefore, it's important to get an evaluation done so it can be treated promptly. Your tongue is a very essential organ; it helps you perform numerous functions like chewing, tasting, speaking, and swallowing; therefore, it requires as much attention and care as any other organ in your body. Practicing good oral hygiene, avoiding alcohol and tobacco, consuming a nutrient-rich diet, and hydrating yourself are some ways you can maintain your oral health as well as your overall health.