What You Need to Know About Those White Patches on Your Tongue

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While white patches on the tongue are generally benign, in rare cases they can be a sign of a more serious condition. It is important to contact a healthcare professional to get any questions answered and to receive proper treatment if it is needed.

doctor checking white patched on tongue

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Causes of White Patches on Your Tongue

In general, a white tongue or white patches on the tongue is caused by poor oral hygiene. When there is white on the tongue, it is typically covered by a coating that can extend over the entire surface or appear as patches in certain areas. Some people might notice redness, bad breath, or a bad taste in the mouth.

This condition can show up in an instant if there is an infection or irritation, or it can build up over some time. There are different causes for a white tongue, such as:

  • Dehydration
  • Mouth breathing
  • Dry mouth
  • Fever
  • Poor oral hygiene

Conditions That Can Cause White Patches

There are conditions that can cause white patches on the tongue. These include:

Oral Thrush

Oral thrush is a fungal infection in the mouth that is usually located in the lining of the mouth and tongue.

The cause of thrush is an overgrowth of Candida.

This growth has raised white lesions on the inner cheeks and tongue and can cause:

  • Redness and pain in the mouth
  • A cottony feeling
  • Loss of taste

Thrush is usually diagnosed by taking a throat culture or an X-ray of the esophagus. It's important to check with a healthcare provider to get the proper diagnosis and treatment.

Leukoplakia

Leukoplakia happens when one or more lesions or white patches form inside the mouth. This condition is known to develop into oral cancer.

The two types of leukoplakia are:

  • Homogenous: A thin patch that is evenly colored. It is primarily a consistent white, smooth, rigid, or wrinkled surface.
  • Non-homogenous: An irregularly shaped patch that is elevated, flat, or has protrusions.

Diagnosis is usually from a biopsy.

It is important to speak with a healthcare professional to get a proper diagnosis, treatment, and plan that will give the best outcome.

Syphilis

Syphilis is a sexually transmitted infection that can occur and spread through sexual contact with someone who has the condition. If the infection is left untreated, syphilis can lead to serious health issues, including:

  • Damage to the brain, eyes, heart
  • Mental health disorders
  • Blindness
  • Death

This condition also includes white on the tongue. The symptoms are dependent on the stages. It typically starts as a small sore that is painless, then a bumpy rash may appear on the body—typically the hands or soles of the feet or palms. Other symptoms include flu-like ones such as muscle aches, fever, sore throat, or fatigue.

It is important to speak with a healthcare professional to get the proper treatment and education regarding the infection.

Oral Lichen Planus

Oral lichen planus is a condition that appears in the mouth. It stems from lichen planus, a chronic disease that affects the mucous membranes and skin. This happens when mucus is secreted from the thin layers of tissue that line the body cavity. This is not contagious, and it usually affects people who are more than 50 years old.

Symptoms include white patches on the inside of the cheeks that are slightly raised or the look of web-like threads. If it is excessive, the gums are bright red. If it is severe, ulcers tend to develop on the gums of the mucosal tissue.

There is no definite known cause of this condition, although research suggests that genetics and the immune system play a part. Some medications and diseases can also cause oral lichen. These include nonsteroidal anti-inflammatory drugs and beta-blockers. The diseases include primary biliary cirrhosis and hepatitis B.

Certain medications such as antibiotics and muscle relaxers are known to cause white patches. Antibiotics create yeast, which can lead to the occurrence of white patches in the mouth.

How White Patches on the Tongue Are Treated

In general, white patches don’t require treatment, but the condition that caused them may need to be treated.

Oral Thrush

The typical treatment for oral thrush is a prescription of antifungal medication. This can come in the form of lozenges, tablets, or liquid. This treatment is usually prescribed for 10 to 14 days.

Treatment also depends on:

  • Age
  • Severity
  • Immune system

Your healthcare provider can give you the proper treatment and also rule out if there are other medical conditions that are a result of what is presented.

Leukoplakia

When treating leukoplakia, the goal is to prevent cancer. Although the lesions can be removed, they can also return. If a patient smokes and drinks alcohol regularly, it is important that they stop.

Treatments include:

  • Quitting smoking or drinking
  • Vitamin A
  • Isotretinoin supplements
  • Beta-carotene supplements
  • Eating a diet rich in fruits and vegetables

Another option is surgery to remove the lesions. Although a patient may opt for surgery, there is a 10% to 20% chance that the lesions could return.

Syphilis

Syphilis is typically treated with antibiotics. Your healthcare provider will test your blood after the entire course of treatment is complete. It is important to get tested regularly and to practice safe sex.

Oral Lichen Planus

If oral lichen planus is mild, it may go away on its own over time. A healthcare professional will monitor the condition, and treatment may not be needed. In the event that the symptoms worsen, the doctor may recommend treatments. Some of the medications used to treat oral lichen planus are:

  • Aczone (dapsone)
  • Neorral, Gengraf (cyclosporine)
  • Corticosteroids
  • Lidoderm, Xylocaine (lidocaine)
  • Prograf, Protopic (tacrolimus)

When to See a Doctor

It is important to see a doctor if you notice anything unusual in your mouth, including:

  • Excessive or unusual white patches
  • Pain
  • Redness
  • Pus
  • Fever
  • Rash
  • Bleeding

It is better to catch something early, take preventive measures, and get the best plan and treatment possible.

Preventing White Patches

Prevention of any condition is the goal. Proper mouth hygiene, avoiding tobacco and alcohol,
and getting regular checkups from the dentist and doctor can help prevent white patches.

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Article Sources
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  1. Cleveland Clinic. White tongue. Updated June 22, 2020.

  2. Cleveland Clinic. Thrush. Updated October 22, 2019.

  3. Cleveland Clinic. Leukoplakia. Updated August 5, 2020.

  4. Cleveland Clinic. Syphilis. Updated August 13, 2020.

  5. Cleveland Clinic. Oral lichen planus. Updated November 16, 2018.