White tongue

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 14, 2015
StartSymptomsWhite tongue

There may be times in a person's life when they notice that their tongue is not quite the normal color. This could be because of something they have had to eat or drink, but this often wears off quickly. If someone notices that their tongue is white or has white spots, this can be something that is a bit different.

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Definition & Facts

White tongue is a coating on your tongue that gives your tongue the appearance of being white. The coating is made up of dead cells, debris, and bacteria. A tongue that is white can be a bit scary, but it often is not serious and typically does not last that long.

But there are some cases where a white tongue can be an indicator of something more serious that ranges from a condition that is precancerous to an infection. The coating may give a person's tongue the appearance of being all white or could be spots of white.

Causes

The white appearance of a white tongue comes from dead cells, debris, and bacteria creating a coating on the tongue. The reason this coating is on a person's tongue is due to the papillae, which are tiny projections that look like tiny fingers, on the tongue that become swollen or overgrown. This swelling or overgrown papillae will then trap the dead cells, debris, and bacteria creating the white coating. There are a number of causes for the swollen papillae:

When to see a doctor

Most of the time white tongue is harmless and is not a sign of anything serious. It can be removed by brushing the tongue gently with a toothbrush or by using a tongue scraper along with drinking plenty of water. But there are times when white tongue can be the sign of something more serious that may need medical attention.

A person should contact their doctor if the tongue hurts when it is white, if there are concerns about changes in the tongue, or if the white tongue does not go away after a few weeks. In these cases, it is important to contact a doctor because a white tongue could be a sign of something more serious. Some of the conditions of a white tongue that would need medical attention are:

  • Oral thrush (an infection in the mouth caused by yeast)
  • Leukoplakia (a potential precancerous sign, often noticed in smokers)
  • Geographic tongue (patches or lesions on the tongue that can often be quite painful)
  • Oral lichen planus (an inflammatory condition that can cause pain, a burning feeling, or other discomfort)
  • HIV/AIDS (often looks like leukoplakia, but appears to be hairy - often called hairy leukoplakia)

Treatment & Therapy

The treatment for white tongue will depend on what is causing it. When white tongue is not the sign of a medical condition or issue, using a toothbrush or tongue scraper will be the treatment. A toothbrush can be used to gently brush the tongue. A tongue scraper can also be used to gently scrape the bacteria and dead cells from the tongue.

Drinking plenty of water will also help to eliminate the white tongue. If a person's white tongue is a sign of something more serious, the treatment will depend of the medical condition. If the condition is thrush, an antifungal medication will be used as the treatment. It the white tongue is a sign of leukoplakia, the doctor may want to have a biopsy done in order to determine whether or not there are cancerous cells.

The doctor may also decide to monitor the white tongue to determine whether or not it is getting any worse. A dentist or ear, nose, and throat doctor may also be the ones to monitor the white tongue. Oral lichen planus will be monitored on a regular basis. If there are any changes to the white tongue in this case, it could be a sign of cancer. A biopsy will need to be done in order to determine whether or not there are cancerous cells. In the case of hairy leukoplakia, the doctor will want to have HIV testing done on the patient. Antiviral medications will be used in this case.

Prevention & Prophylaxis

In many cases white tongue can be prevented. This can be done with good oral hygiene. Taking the time to ensure that teeth are thoroughly brushed, along with the gums and tongue, at least twice a day. A healthy diet can also help with preventing white tongue. Included within a healthy diet should be drinking plenty of fluids, with water being a big portion of the fluids.

These things are not going to prevent white tongue in the cases where an underlying medical condition is the cause. It is still important to have good oral hygiene and to have a healthy diet, but there are other things that should also be done in order to try and prevent white tongue in these cases. When trying to prevent oral cancer, it is best to try and either quit drinking alcohol and smoking or to moderate how much alcohol is being drank and trying to smoke as little as possible.

Doing this can help to reduce the risk of getting oral cancer. Regular dental visits can also help to prevent white tongue. Not only is a regular dental visit good for the health of a person's teeth and gums, but are a great way to have your tongue and mouth screened for any early signs of oral cancer. Screenings for oral cancer can also be done by an ear, nose, and throat doctor.

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