What Causes White Tongue?

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.

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:

• Irritation on the tongue
• Bad breath
• Hairy tongue (lingua villosa)

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.

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)

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.

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.

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

Summary

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.