What causes a white tongue?

In many cases, a white coating on the tongue is caused by a layer of dead skin cells and debris that can be cleaned or scraped off the tongue. Some common conditions that lead to a visible white layer include dehydration, poor oral hygiene, excessive alcohol use, and smoking tobacco. A white tongue can also be a symptom of a variety of other disorders and diseases, such as a bacterial infection or a precancerous lesion.

White spots or patches on the tongue (and other oral structures) can be due to leukoplakia (precancerous lesion), oral thrush (yeast infection), or oral lichen planus (an inflammatory disorder of the mouth).

Oral lichen planus can also appear as a lace-like pattern on the tongue and the inside of the cheeks. The underlying cause of lichen planus is not known, although it may be related to oral hygiene and irritants, such as tobacco smoke.

Oral thrush (candidiasis) can occur in all age groups and populations, but is common in HIV-positive individuals who are immunocompromised and more susceptible to the overgrowth of yeast, such as Candida albicans. Antibiotic use, diabetes, and immunosuppressant therapy can also lead to an overgrowth of Candida albicans.

A white tongue combined with a sore throat may be due to a streptococcal infection or other bacterial infection. Injured and inflamed areas of the tongue are more susceptible to infectious microorganisms, such as the herpes virus, streptococcal bacteria, Staphylococcus aureus, and pathogenic fungi.

Common conditions that can cause a white tongue

A white tongue, particularly a white coating, can be due to the following conditions:

  • Alcohol use

  • Breathing through your mouth, which leads to a dry mouth

  • Dehydration

  • Smoking

  • Xerostomia (dry mouth due to inadequate saliva)

Infections that can cause a white tongue

A white tongue can be due to infectious diseases including:

  • Bacterial infection, such as an infection with streptococcal or staphylococcal bacteria

  • Hairy leukoplakia (caused by Epstein-Barr virus; occurs most often in people with HIV/AIDS infection)

  • Oral herpes virus infection (also known as herpetic stomatitis)

  • Oral thrush (also known as candidiasis, which is caused by the yeast Candida albicans)

  • Syphilis

Trauma or injuries that can cause a white tongue

A white tongue can be caused by tongue trauma and inflamed tissues, which make the tongue more susceptible to infection. Potential traumatic causes of white tongue include:

  • Acid or corrosive chemical burn

  • Biting the tongue

  • Blisters or ulcers

  • Burning the tongue

  • Canker sores

  • Dental appliances, dentures, or jagged or misaligned teeth

  • Laceration (cut)

Other disorders that can cause a white tongue

A white tongue can be due to a variety of other diseases, disorders and conditions including:

  • Geographic tongue (an inflammatory disorder)

  • Leukoplakia (precancerous sores in the oral cavity that can lead to cancer)

  • Oral lichen planus (an inflammatory disorder)

  • Tongue or oral cancer (sometimes caused by human papillomavirus)

Questions for diagnosing the cause of a white tongue

To diagnose the underlying cause of a white tongue, your doctor or licensed health care practitioner will ask you several questions related to your symptoms. Providing complete answers to these questions will help your provider in diagnosing the cause of a white tongue:

  • Are you having tongue or mouth pain?
  • Describe all diseases and conditions in your medical and dental history
  • List all the medications, supplements, and herbal drugs you are taking.
  • Do you smoke?
  • Describe any other changes in the texture and appearance of the tongue. Have you noticed any tongue swelling, mouth sores, or lesions?
  • Describe any other symptoms you are having. Have you noticed a change in taste?
  • Have you been in recent contact with any unusual substances or environments, such as hot or spicy foods?
  • When did the white tongue first appear?

What are the potential complications of a white tongue?

Complications associated with a white tongue can be progressive and may vary depending on the underlying cause. Because a white tongue can be caused by a serious disease, failure to seek treatment can result in complications and permanent damage. It is important to contact your health care provider when you experience any kind of persistent discoloration, pain or other unusual symptoms of the tongue or mouth. Once the underlying cause is diagnosed, following the treatment plan outlined by your doctor can help reduce any potential complications including:

  • Adverse effects of treatment
  • Cosmetic disfigurement
  • Spread of infection
  • Tongue or oral cancer
  • Tongue removal due a serious infection or malignant condition
  • Transmission of STDs to sexual partners
  • Weight loss

References:

  1. Tongue problems. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/003047.htm.
  2. Leukoplakia. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/001046.htm.
  3. Oral (throat) photographs. ENT USA. http://www.entusa.com/oral_photos.htm.
  4. Cawson, RA and Odell, EW. Cawson’s Essentials of Oral Pathology and Oral Medicine. 8th ed. Elsevier. 2008:246-248.
  5. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
INTRODUCTION

What is a white tongue?

A white tongue is white discoloration of all or a part of the tongue, an organ that is composed mainly of muscle. Your tongue may look like it has a white coating or white patches or spots, and may or may not be painful.

A white tongue may be caused by a coating of dead cells and debris, which can accumulate due to poor oral hygiene, excessive alcohol use, smoking, or dehydration... Read more about white tongueintroduction

SYMPTOMS

What other symptoms might occur with a white tongue?

A white tongue may occur with other symptoms, which vary depending on the underlying disease, disorder or condition. Common symptoms include:  

Medical Reviewer: William C. Lloyd III, MD, FACS Last Annual Review Date: Sep 30, 2013 Copyright: © Copyright 2014 Health Grades, Inc. All rights reserved. May not be reproduced or reprinted without permission from Health Grades, Inc. Use of this information is governed by the HealthGrades User Agreement.

This Article is Filed Under: Mouth, Teeth and Oral Health