When Your Tongue Turns White: Could It Be Thrush or Something Else Entirely?

The appearance of your tongue can be an indicator of your overall health. A normal, healthy tongue is pink and covered with papillae (small bumps). If your tongue looks different than this, it may mean something is out of balance in your mouth or even systemically (throughout your body).

The appearance of a white tongue is a common symptom of several oral conditions, and commonly indicates the presence of oral thrush.

This article discusses conditions sometimes mistaken for oral thrush, along with causes and prevention.

While a white tongue often indicates thrush, it can be a sign of another condition. Several oral conditions have similar symptoms to thrush, causing them to sometimes be mistaken for thrush.

Below are conditions that may be mistaken for thrush.

Geographic Tongue

Geographic tongue is a harmless condition in which the tongue has smooth, reddish patches surrounded by white borders.

It does not cause any long-term health problems, and it is not contagious. Most people have no symptoms or mild symptoms, and it is considered a cosmetic problem.

Symptoms can include:

Red Patches on the Tongue

• Appear in an irregular map-like pattern
• Often surrounded by white or gray borders
• Can appear anywhere on the top, sides, and tip of the tongue
• Patches may come and go
• Patches can change size, shape, and location over time

Smooth Patches

• Insides of the red patches do not have any papillae (tiny bumps)

Burning Sensation

• Stinging, tingling, or burning sensation on the tongue
• Worse when eating
• Usually mild and can come and go along with the red patches

Red Patches in Other Areas of the Mouth

• Geographic stomatitis (not the same as the rash that occurs with Lyme disease)
• Similar red patches on the gums, the top of the mouth, or inside the cheeks

Geographic tongue happens when parts of the upper layer of skin on the tongue shed too quickly, leaving red areas, while other parts of the tongue stay in place too long and turn a white color.

It's not known exactly what causes geographic tongue, but it has been linked to:

• Heredity: It tends to run in families.
• Psoriasis: It is common for people with geographic tongue to also have psoriasis (an inflammatory skin condition).
• Hormonal surges: Such as with oral contraceptives (birth control pills)
• Vitamin deficiencies: Such as zinc, iron, folic acid, vitamin B6, and vitamin B12
• Fissured tongue: A condition that causes deep grooves or wrinkles on the tongue
• Diabetes: Especially type 1 diabetes
• Allergies: Eczema, hay fever, and other allergies may be tied to an increased risk of geographic tongue.
• Emotional stress: There appears to be a link between increased stress and geographic tongue.

Treatment for a geographic tongue isn't necessary, but if discomfort occurs, the following may be tried:

• Avoiding anything that irritates the tongue, such as spicy foods
• Mouthwash with an antihistamine (medication to relieve allergic reaction)
• Topical analgesics (pain relievers) applied directly to the tongue
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Oral Lichen Planus

Oral lichen planus is a chronic (long-term) inflammatory condition of the mouth. It can also affect other areas of the skin and mucous membranes. Almost half of people with oral lichen planus also have skin lichen planus.

While anyone can get oral lichen planus, it occurs twice as often in women as in men.

Oral lichen planus mostly occurs in adults ages 50 and older.

It is not contagious.

Symptoms include:

Reticular Type

• White patches or weblike threads on the inside of the cheeks
• Patches and threads are raised slightly
• Usually not painful

Erosive Type

• Bright red gum tissue
• Ulcers on the gums of mucosal tissues inside the mouth, or on the tongue (severe cases)
• May be painful to eat or drink spicy, hot, or acidic foods or beverages

The exact cause of oral lichen planus is unknown, but research suggests it may be related to genetic makeup and the immune system.

It has also been linked to:

• Taking certain medications: Such as beta-blockers and nonsteroidal anti-inflammatory drugs (NSAIDs)
• Certain medical conditions: Such as the liver conditions hepatitis B and primary biliary cirrhosis

If the case is mild, it may clear up on its own over time, particularly if it was triggered by medication and the medication is discontinued.

More severe cases of oral lichen planus may be treated with one or several medications, including:

• Lidocaine (Lidoderm, Xylocaine)
• Tacrolimus (Prograf, Protopic)
• Corticosteroids
• Dapsone (Aczone)
• Cyclosporine (Neoral, Gengraf)

Occasional flare-ups are common with oral lichen planus as it is a chronic condition.

Erosive oral lichen planus is more serious and may mean a more likely chance of developing oral cancer. Approximately 1% to 3% of people with oral lichen planus eventually develop oral cancer, but the research is inconclusive as some cases may not have been true lichen planus.

People with erosive lichen planus should be monitored by their healthcare providers with checkups every three months.

Leukoplakia

Leukoplakia involves white patches on the tongue and inside the mouth caused by an overgrowth of cells in the lining of the mouth combining with keratin (the protein found in hair).

While leukoplakia isn't dangerous in and of itself, it can eventually develop into oral cancer. About 3% to 17.5% of people with leukoplakia will develop squamous cell carcinoma (a common type of skin cancer) within 15 years.

There are two main types of leukoplakia:

Homogenous

• Mostly white, evenly colored thin patch
• May have a smooth, wrinkled, or ridged surface that is consistent throughout

Non-Homogenous

• Mainly white or white-and-red, irregularly shaped patch
• May be flat, nodular (having protrusions), or verrucous (elevated)
• Seven times more likely to become cancerous than the homogenous type

A rare but especially aggressive form of oral leukoplakia also exists:

Proliferative Verrucous Leukoplakia

• Also called florid papillomatosis
• Strongly associated with the presence of Epstein-Barr virus (a type of herpes virus)
• Nearly all cases will eventually become cancerous at a number of different sites
• Usually diagnosed late in the development of leukoplakia, as it takes time to spread to multiple sites
• Has a high rate of recurrence

Leukoplakia occurs most often in men who are between the ages of 50 and 70. It is rare in younger adults, with fewer than 1% of cases occurring in people less than 30 years of age.

Leukoplakia is commonly seen in people who use tobacco products, which can irritate the tongue and mouth.

Leukoplakia is often associated with:

• Smoking tobacco
• Use of chewing tobacco or snuff
• Chewing areca nut (also known as betel nut), which grows in the tropics of Asia, the Pacific, and parts of east Africa
• Heavy use of alcohol (this link is contradictory between studies)

Symptoms of leukoplakia include:

• One or more white patches on the surface of the tongue, underneath the tongue, or on the insides of the cheeks
• The patches cannot be rubbed off
• Cannot be traced to any other cause
• No pain or other symptoms are present

Strong indicators that the leukoplakia is transforming to cancer include the appearance of:

• Nodules
• White or red masses with a pebbled appearance
• Ulceration (formation of a break on the skin or on the surface of an organ)
• Increased firmness
• Bleeding

Treatment for leukoplakia is usually centered on preventing it from becoming cancerous. The efficacy of treatment is mixed. The lesions may be removed, but they often return.

Treatment may involve medical management, surgery, or both.

Medical management

• Stop using tobacco products.
• Stop drinking alcohol.
• Include lots of fruits and vegetables in your diet.
• Retinoids (vitamin A-based treatments) taken orally may help reduce lesions, but relapses and side effects are common.
• Oral vitamin A and beta-carotene supplements can help clear the white patches, while the supplements are being taken, but the patches will appear again once the supplements are stopped.
• Isotretinoin (a medication used to treat severe cystic acne) supplements may be more effective than beta-carotene in preventing cancerous changes.

Surgical management

• Removing lesions with surgery (there is a 10% to 20% chance that the lesions will return after surgical removal, and a 3% to 12% chance of developing cancer in the treated areas)
• Removal of lesions with a laser
• Photodynamic therapy (use of light-activated cancer drugs)
• Cryotherapy (use of freezing to remove lesions)
• Electrocauterization (use of an electrically heated needle or another instrument to remove lesions)

Even if it isn't causing discomfort, people with leukoplakia should check in with their healthcare provider every three to six months for monitoring and biopsies as needed.

If patches are surgically removed, an examination every six to 12 months is still recommended until treatment sites remain free of abnormalities for at least three years. A healthcare provider may recommend follow-up visits for a longer period of time.

Aphthous Mouth Ulcers (Canker Sores)

Canker sores are small, often painful, ulcers that develop in the lining of the mouth.

Canker sores typically occur in people between the ages of 10 and 20, but anyone can get them.

Symptoms of canker sores include:

• A sore or sores on the tongue, soft palate (the back portion of the roof of the mouth), or inside the cheeks
• Sores are round, white, or gray and have a red edge or border
• Sores are often painful, especially when eating or talking
• Sores are usually small (less than 1 millimeter) but may be as large as half an inch to an inch in diameter
• May experience tingling or a burning sensation before the sore appears

While the exact cause is not known, simple canker sores are believed to be caused by a minor injury to the inside of the mouth. Friction from teeth, dental wear such as braces, or poorly fitting dentures can also prompt the development of a canker sore.

Some foods, especially citrus or acidic fruits and vegetables, may cause or irritate a canker sore. Nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin) may also cause them.

Complex canker sores are sometimes observed in people with diseases of the immune system such as lupus, Behcet's disease, inflammatory bowel diseases, and AIDS.

Nutritional deficiencies, such as in vitamin B-12, zinc, folic acid, or iron, may also contribute to canker sores.

Canker sores usually clear up on their own within a couple of weeks. To ease the pain, over-the-counter products can be used, such as:

• Kank-A
• Zilactin
• Orajel

In more serious cases, treatment might include:

• Prescription antibacterial mouth rinse
• Corticosteroid ointment
• Prescription or nonprescription solution to reduce the pain and irritation

Coated/Hairy Tongue

Coated/hairy tongue is a harmless condition involving the lengthening of the papillae (little bumps) on the tongue.

Papillae are composed of keratin. When the keratin accumulates more than normal, a coating on the tongue or thickening of the tongue dorsum (upper surface of the tongue) develops.

The coating usually appears white, but may look black or brown (because of stains from tobacco or food).

Harmless bacteria on the tongue can also make the tongue look black, brown, yellow, or greenish.

Most people with coated/hairy tongue have no symptoms other than a cosmetic concern. Some people experience an unpleasant, stale, or abnormal taste in their mouth, or a dry-feeling mouth.

Very rarely, the long papillae can cause an irritating or gagging sensation.

Coated/hairy tongue is caused by:

Dehydration/oral dryness

• Saliva becomes stickier and less watery
• The keratin on the tongue papillae sticks together longer than they should rather than shedding
• Common in people who have been ill and/or have been on certain medications (such as antibiotics or chemotherapy)
• Dry mouth can be caused by smoking or using alcohol-containing or dehydrating mouth rinses

Lack of activities that normally help the papillae to shed

• Eating a diet of soft foods
• Lack of eating

Coated/hairy tongue is not contagious.

Coated/hairy tongue will usually resolve on its own once whatever triggered it (such as illness or medication) is finished.

Other ways to help include:

• Drinking water/staying hydrated
• Limiting caffeine
• Avoiding dehydrating mouth rinses
• Eating a balanced diet
• Gentle brushing of the tongue

Milk Tongue

A white tongue is common in young babies and doesn't always mean it's thrush.

It might just be milk tongue if:

• It is only on the tongue, not on other parts of the mouth such as inside the lips or cheeks.
• It shows up right after feedings.
• It can be easily wiped away.

Milk tongue is normal and will go away once solid foods become a regular part of the baby's diet.

The best way to manage a milk tongue is to practice good oral hygiene habits for babies, including gently wiping the tongue.

Causes and Prevention

Each condition that causes a white tongue, including thrush, has unique causes, treatments, and prevention, but they also have some in common.

Ways to encourage oral health include:

• Stop smoking and using tobacco products (or never start).
• Avoid or limit alcohol consumption.
• Stay hydrated/drink more water (up to eight glasses a day).
• Practice good oral hygiene.
• Visit your dentist for a checkup and a teeth/tongue cleaning every six months.
• Brush your teeth at least twice a day with a soft toothbrush and a mild fluoride toothpaste that doesn’t contain sodium lauryl sulfate.
• Floss once a day.
• Use fluoride, alcohol-free mouthwash.
• Brush your tongue, or use a tongue scraper (or a turned-over teaspoon).
• Eat a healthy diet that includes lots of fruit and vegetables.
• Avoid food and drinks that are spicy, salty, acidic, very hot in temperature, or that otherwise irritate your mouth.
• See your healthcare provider for regular examinations.

A Word From Verywell

Whether caused by thrush or another condition, a white tongue is a common symptom of a potential problem happening in your mouth.

While a white tongue is often harmless, it can signal a more serious health condition and can be difficult to self-diagnose.

Always seek dental or medical help if you are concerned about tongue symptoms or have any other oral health concerns.

Adopting a healthy overall lifestyle, including healthy oral hygiene habits, helps to keep your tongue in good shape.