White tongue: Causes, pictures, when to see a doctor, and remedies

The most common cause of a white tongue is poor oral hygiene. Small bumps on the tongue called papillae can swell up and become inflamed in a mouth that is not cared for well.

Plenty of germs, debris, food particles, and dead cells can get stuck between these papillae. This causes the tongue to appear white as the particles build.

Oral and hygiene issues that can lead to a white tongue include:

• dry mouth caused by mouth breathing or sleeping with the mouth open
• not brushing or flossing the teeth correctly
• not cleaning the tongue
• dehydration
• irritation from sharp edges inside the mouth, such as teeth, braces, or dentures
• regular alcohol consumption
• smoking, chewing, or dipping tobacco

Basic oral hygiene is essential for everyone, but some conditions cause a white tongue even in people who take great care of their mouths. These include:

Oral lichen planus

Oral lichen planus is a chronic inflammatory condition that can affect the mouth and tongue. It can also affect the lips, inside of the cheeks, and gums. Researchers are unsure what causes it, but it may be due to an immune response or genetic factors.

Symptoms that affect the mouth include:

• white, lace-like patches of skin
• ulcers
• pain, including discomfort, soreness, or a burning sensation
• swelling and redness

Treatment

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Oral lichen planus is a chronic condition, and in many cases, a doctor or dentist will simply monitor it to make sure lesions heal properly.

In severe cases, a doctor may prescribe topical or oral corticosteroids.

Leukoplakia

Irritants such as tobacco and alcohol can lead to leukoplakia. It may also result from inflammatory conditions and irritation from dentures. It can affect all areas of the mouth, including the tongue, cheeks, and gums.

Leukoplakia may appear as thick, white patches that cannot be scraped off. Sometimes, the patches may appear red and white.

The patches that leukoplakia cause are harmless by themselves. In rare cases, leukoplakia can progress to cancer, so it is best to have a doctor diagnose this right away.

Treatment

A healthcare professional should monitor leukoplakia to make sure it is not getting worse. They may recommend cutting down the amount of alcohol a person drinks or stopping smoking.

Sometimes, a doctor needs to remove the patches with surgery.

Oral thrush

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Oral thrush is another condition that may cause the tongue to appear white. Oral thrush is a fungal infection caused by the Candida yeast.

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Symptoms include:

• white or off-white patches in the mouth and on the tongue
• unpleasant taste or loss of taste
• pain, especially when eating or drinking
• redness or soreness

People who have a weakened immune system may be more likely to develop oral thrush. This includes people who have recently taken antibiotics or undergone chemotherapy. Poor oral hygiene or wearing poorly fitting dentures are other risk factors.

The use of inhaled corticosteroids for asthma can also cause oral thrush. Certain conditions, including diabetes and HIV, may increase the risk of infection.

Treatment

Treatment for oral thrush typically includes antifungal medications. A person applies these medications to the inside of the mouth for 1 to 2 weeks until the condition has run its course. For severe cases, a healthcare professional may prescribe oral or intravenous antifungal medications.

Syphilis

Syphilis is a sexually transmitted infection (STI) that can lead to symptoms in several areas of the body, including the mouth.

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Symptoms include:

• white patches on the tongue
• red and white sores, known as chancres, on the tongue or lips
• firm, raised lesions in the mouth

These symptoms typically arise 10-90 days after a person comes into contact with the bacteria. Chancres may resolve on their own with time, but the disease can remain in the body and progress without treatment.

Treatment

Syphilis requires medical treatment with the antibiotic penicillin. This antibiotic kills the bacteria that cause the disease. People who are allergic to penicillin may take a different type of antibiotic.

Reducing irritants in the mouth, such as alcohol and tobacco, may also help clear up the white patches.

Other conditions

Rarer but sometimes serious conditions can lead to white patches on the tongue.

Mouth or tongue cancer may cause a white tongue. Common causes of these types of cancer include chronic tobacco or alcohol use and human papillomavirus (HPV) infections.

Underlying chronic inflammatory disorders may influence a white tongue as well.