What Causes White Tongue?

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When your tongue turns white, you may be immediately concerned. While a white tongue, otherwise known as a coated tongue, isn’t always something to worry about, there are some rare instances in which a white tongue could alert you to a more serious medical condition.

This article discusses the possible causes, symptoms, and treatment options for a white tongue.

Healthcare provider examining tongue and oral cavity of child

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Symptoms of White Tongue

The main characteristic of white tongue is discoloration. That said, other symptoms may accompany white tongue, depending on the cause. People with white tongue may also experience:

Other symptoms may also develop if an underlying health disorder is present, and those signs will be specific to the cause.

Causes of White Tongue

Common causes of a white tongue include:

  • Poor oral hygiene
  • Dry mouth, which can increase the number of bacteria within the mouth
  • Dehydration, which helps bacteria grow out of control
  • Irritation from teeth, dentures, or braces that cause injury to the tongue

There are tiny bumps on the tongue known as papillae. When these bumps become inflamed or swollen, things such as dead cells, bacteria, or other pathogens and food get trapped on the tongue, resulting in hairy tongue.

That is what changes the coloring of your tongue from its typical shade to white. Injury to the tongue, such as burning it on hot food or liquid, is one way in which the tiny bumps can become inflamed.

The collection of debris that causes the white tongue could also accumulate because of poor oral hygiene, such as not brushing, flossing, or gently scraping the tongue correctly or as often as you should.

Alcohol, Smoking, and White Tongue

While drinking alcohol or smoking doesn’t directly cause white tongue, it can increase the risk of developing specific health ailments or conditions that can cause it, such as dehydration or cancer.

What Medications Can Cause White Tongue?

Certain medications can cause you to develop a white tongue, including:

  • The smoking cessation aid Chantix (varenicline)
  • Topical chemotherapeutic drugs such as metronidazole
  • Antiviral medications such as Prezista (darunavir)
  • Antinausea and antiemetics (treatments that relieve nausea and vomiting) such as Aloxi (palonosetron)

How Common is Drug-Induced White Tongue?

The occurrence of white tongue caused by medication is a rare adverse reaction and should not stop you from taking medication that has been prescribed to you.

Complications and Risk Factors of White Tongue

In rarer cases of white tongue, you may have an underlying health issue. Some health conditions that can cause a white tongue to develop include:

  • Leukoplakia: Leukoplakia appears as white patches on the tongue and inside the mouth. It could develop due to repeated injury to the tongue or mouth cancer.
  • Geographic tongue: Geographic tongue appears as blotchy patches of red surrounded by a white border on the tongue. It develops when the number of papillae on your tongue decreases.
  • Oral thrush: Oral thrush is a yeast infection in the mouth. When the fungus that causes the condition builds up on the tongue, it can cause a white coating to develop in patches.
  • Oral lichen planus: Oral lichen planus is a type of inflammatory condition that is chronic (long-lasting). It leads to white patches on the tongue that can be painful or burn.
  • Syphilis: If a person acquires syphilis, the infection can develop as leukoplakia within the mouth.
  • Tongue or oral cancer: Cancer that develops on the tongue or mouth can lead to white patches.

Leukoplakia Causes

The cause of leukoplakia isn’t well known, but it may be due to the following:

  • Chronic irritation or injury from rough teeth or dentures
  • Tobacco use
  • A weakened immune system due to certain inflammatory health disorders
  • Excessive and long-term alcohol use

Are There Tests to Diagnose White Tongue?

There are no specific tests designed to diagnose white tongue. Healthcare providers or dentists will examine the tongue and ask about any other possible symptoms you're experiencing. They may try a "wait-and-see" approach, which involves giving white tongue the time to clear up on its own.

If it doesn't clear up or there are other symptoms, they will decide if further testing is needed. Other tests are used to determine if an underlying health disorder is driving the discoloration of the tongue. Since there are several causes associated with white tongue, the tests will vary significantly. They could include:

  • Blood tests
  • Biopsies (taking tissue samples of the white film on the tongue)
  • Physical exams to check on whole body health

How to Treat White Tongue

In many cases, you will not have to treat white tongue because it is harmless and will go away on its own with time and good oral hygiene, such as brushing your teeth at least twice daily and cleaning between your teeth daily.

Drinking lots of water to avoid dehydration and dry mouth may speed up the process, as could using a soft tongue scraper to gently scrape the white coating off of your tongue.

For conditions that cause white tongue, different treatment options are used, such as:

  • Leukoplakia: There is no universal treatment available for leukoplakia. Treatment will vary based on its cause. In some cases, surgery may be performed to remove the white patches from the tongue; in others, treatment isn’t necessary.
  • Geographic tongue: Treatment isn’t necessary for geographic tongue, but practicing good oral hygiene and avoiding foods that may irritate the tongue may help with symptoms. If there is pain, anti-inflammatory medications or numbing agents may be used.
  • Oral thrush: Antifungal medications will be used to treat oral thrush since it is caused by a fungus.
  • Oral lichen planus: There is no cure for oral lichen planus, and you must manage the condition as best you can. Healthcare providers may recommend avoiding certain foods or using certain oral hygiene products. In severe cases, medications that lower inflammation or suppress the immune system may be needed.
  • Syphilis: Syphilis is a sexually transmitted infection (STI) caused by bacteria and is, therefore, treated with antibiotics. The antibiotic of choice usually is penicillin.
  • Tongue or oral cancer: Surgery is the first-line therapy for oral or tongue cancer. However, radiation and chemotherapy may also be explored.

Treating the Cause of White Tongue

Since white tongue has many causes, finding the proper treatment will come after a diagnosis from your healthcare provider.

When to See a Healthcare Provider

Having a white tongue without any other symptoms typically isn’t something to worry about. However, if you experience any other signs that something may be wrong, you should contact your medical provider.

Other signs along with a white tongue that warrant a trip to your medical provider include:

  • Sores inside the mouth or on the tongue
  • Pain or a burning sensation on the tongue
  • Difficulty talking, chewing, or swallowing
  • Other symptoms accompany the white tongue, such as rapid weight loss, fever, or a rash
  • An itchy tongue
  • A worsening instead of improving white tongue

How Long to Wait to See a Healthcare Provider for White Tongue

The time you wait between noticing the white tongue and seeing a healthcare provider is entirely up to you and what other symptoms are present. If your white tongue does not clear up within two weeks of practicing good oral hygiene, you should make an appointment with a healthcare provider.


White tongue is often harmless and can be caused by poor oral hygiene or something as simple as dehydration. It can also develop because of several medical conditions, such as syphilis, oral thrush, and oral lichen planus.

Because there are several medical causes of white tongue, seeing a medical provider if it doesn’t clear up on its own will give you a proper diagnosis and treatment.

Frequently Asked Questions

  • What causes a white tongue?

    Many things can cause a white tongue. For example, dehydration and poor oral hygiene can lead to a build-up of bacteria and other tongue debris, leading to a white-colored coating. In rarer cases, medical conditions such as syphilis, oral thrush, or leukoplakia can be the cause.

  • Is a white tongue a sign of a serious health issue?

    Not usually. Iin most cases, having a white tongue does not signal that you have something more serious. That said, some conditions that cause white tongue require treatment. The most serious health condition is cancer, but that is rare.

  • How is white tongue treated?

    The treatment of white tongue depends on the cause. In many cases, it will clear up on its own. If a health condition is causing the white tongue, the condition itself will be treated, which will remedy the symptom.

14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Oral Medicine. Hairy tongue.

  2. Seerangaiyan K, Jüch F, Winkel EG. Tongue coating: its characteristics and role in intra-oral halitosis and general health-a review. J Breath Res. 2018;12(3):034001. doi:10.1088/1752-7163/aaa3a1

  3. Crest. Why is my tongue white?

  4. Liang W, Li X, Li Y, et al. Tongue coating microbiome regulates the changes in tongue texture and coating in patients with post-menopausal osteoporosis of Gan-shen deficiency syndrome type. Int J Mol Med. 2013;32(5):1069-1076. doi:10.3892/ijmm.2013.1485

  5. National Health Service. Sore or white tongue.

  6. Aziz Y, Rademacher WMH, Hielema A, et al. Oral adverse effects: drug-induced tongue disorders. Oral Dis. 2021;27(6):1528-1541. doi:10.1111/odi.13680

  7. Swanson J, Welch J. The great imitator strikes again: syphilis presenting as "tongue changing colors". Case Rep Emerg Med. 2016;2016:1607583. doi:10.1155/2016/1607583

  8. American Cancer Society. Signs and Symptoms of Oral Cavity and Oropharyngeal Cancer.

  9. Brigham and Women's Hospital Division of Oral Medicine and Dentistry. Coated/Hairy tongue.

  10. Holmstrup P, Dabelsteen E. Oral leukoplakia-to treat or not to treat. Oral Dis. 2016;22(6):494-497. doi:10.1111/odi.12443

  11. National Organization for Rare Disorders. Geographic tongue.

  12. Quindós G, Gil-Alonso S, Marcos-Arias C, et al. Therapeutic tools for oral candidiasis: current and new antifungal drugs. Med Oral Patol Oral Cir Bucal. 2019;24(2):e172-e180. doi:10.4317/medoral.22978

  13. Shavit E, Hagen K, Shear N. Oral lichen planus: a novel staging and algorithmic approach and all that is essential to know. F1000Res. 2020;9:F1000 Faculty Rev-206. doi:10.12688/f1000research.18713.1

  14. American Cancer Society. Treatment options for oral cavity cancer by stage.

By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.