Most of the time, our tongues look pink. You might occasionally see little red bumps on your tongue or different color variations, especially if you eat something with strong dyes in it. But if you see white patches you’re probably wondering, “Why is my tongue white?” that’s entirely another issue!
Being familiar with changes in your tongue can also help you potentially self-diagnose conditions like oral cancer. Unfortunately, this deadly disease often goes undetected until it’s extremely pronounced. Communicating with your dentist and having routine oral cancer screenings could, quite literally, save your life.
The good news is that most situations involving a white tongue are simple and non-threatening. But they often require some modifications in your home care routine.
Most white tongues will have residue that you can wipe or scrape off, but it might not remove all of it. Sometimes the white areas are fixed in place, which may be more cause for alarm.
Some types of white tongues are nothing to be alarmed about, while others require immediate attention. Your hygiene routine and medical history play a big role. Here are some of the most common conditions your dentist will want to rule out if you call to ask, “Why is my tongue white?”
Oral thrush is a common type of oral yeast infection caused by fungal growth. It’s most often seen in immunocompromised individuals like infants and elderly patients. Newborns may develop thrush and spread it to their mothers during breastfeeding. It can be extremely painful. Your entire tongue is covered in creamy white lesions. It almost looks like cottage cheese and tends to experience burning, soreness, and other oral symptoms.
You can treat an oral fungal infection with good hygiene and antifungal medication, depending on the age of the patient. Luckily oral thrush can resolves on its own with proper oral care.
Good oral hygiene is so important. If you aren’t cleaning your tongue whenever you brush your teeth, you’ll have trapped food, plaque bacteria, and dead cells between all of the papillae (bumps on the tongue).
Practicing good oral hygiene is easily done at home. Add tongue cleaning by using a tongue scraper at least once a day and/or brush your tongue every time you brush your teeth. Don't forget to brush twice (with a soft toothbrush) and floss once a day.
Leukoplakia is when there is a white residue or area of tissues somewhere in your mouth. It’s most common inside of your cheeks or along the gums. They look like white patches in the mouth. You can’t wipe them off or remove them with a toothbrush. People who have a weakened immune system are more prone to leukoplakia.
A biopsy may be needed to determine the best course of treatment. If you have a known condition like HIV/AIDS or the Epstein-Barr Virus, your medical doctor will manage those as appropriate. If chronic irritation is contributing to the issue, your dentist can adjust existing restorations to minimize tissue trauma.
Your tongue is covered in thousands of tiny fingerlike projections called papillae. Sometimes, those papillae can become elongated. When they do, it makes the surface of your tongue look like it has hair on it. If you search for “black hairy tongue” or “white hairy tongue” you’ll see exactly what I’m talking about. It’s not really hair on your tongue. But it does look like it. If you aren’t eating a normal diet, the papillae on your tongue might not “shed” like they’re supposed to, which can cause them to become elongated over time. Some medications or not cleaning your tongue regularly can also be to blame. If you have the Epstein-Barr virus or HIV/AIDS, you’re more at risk for this anomaly.
Clean your tongue every day with a tongue scraper or toothbrush. Then reassess what you’re eating and drinking to make sure you’re getting plenty of fresh fruits and vegetables and whole grains. Processed foods can make it worse, as can rinsing with hydrogen peroxide. Finally, talk to your doctor about the medications you’re taking.
Oral lichen planus creates lacy patches or white layers of tissues inside of your cheeks, across the roof of the mouth, or on your tongue. In many situations, there are also red or sore areas interwoven with the white ones. Sore gums and burning sensations are also common in those parts of the mouth. There’s also an increased risk of developing oral cancer in those locations.
Chronic dry mouth is a common side effect of prescription and over-the-counter medication. It’s also common in older individuals, mouth breathers, or people who have been treated for cancer. Because of the lack of saliva flow, dry mouth, white tongue, and increased tooth decay are common.
Avoid alcohol, caffeine, or mouth-drying agents. Supplement with a moisturizing mouth rinse and sugar-free mints will help stimulate saliva production and keep your mouth feeling moist. Take frequent sips of water throughout the day. Be sure to use fluoride toothpaste every day, too, because you’ll be at a higher risk of getting cavities.
Normally, you should be able to breathe out of your nose. But some people—especially those with allergies or sinus infections or who snore a lot—breathe out of their mouths. When they do, it dries out their mouth and throws the balance off of all of the normal bacteria, which can contribute to a “cotton mouth” or a white tongue. It looks like there a white coating on your tongue.
Treating your sinus obstruction or seeing a sleep dentistry team to talk about your mouth breathing is a great first step to take. Be sure to drink plenty of water throughout the day and brush your teeth and tongue once you wake up in the morning. Using a tongue scraper to remove bacteria buildup works well.
Whenever you lose too many fluids—either because of a serious stomach bug or intense physical activity—it can cause your body and mouth to dry out causing tongue discoloration. Some physicians will even check your tongue for signs of dehydration to tell how serious the situation is.
Geographic tongue is a type of anomaly where the papilla (tiny fingerlike bumps on the tongue) fall off and leave a “bald” area behind. It looks like continents on a map with clearly-defined borders, which can change morph and shape over time. Usually, geographic tongue leaves red areas, but the edges of the smooth surfaces may have a white border.
Treatment for geographic tongue usually comes with nutritional supplements and identifying your triggers, which might be certain types of foods (spicy) or even stress.
Early diagnosis is key, as it allows you to treat cancer before it spreads elsewhere. Oral cancer is flat-out dangerous. Smoking or chewing tobacco greatly increases your risk for oral cancer. Your dentist will probably send you to an oral surgeon for further evaluation and a biopsy. From there, they can partner with an oncologist to determine the best method of treatment (i.e., surgery, radiation, etc.)
Your doctor will need to prescribe antibiotics. Do not let it go untreated, as syphilis can cause major issues with your internal organs as far as 10-15 years later.
A tongue piercing can cause a white tongue. Especially if the tissues immediately around the piercing aren’t getting cleaned well (because your toothbrush or tongue scraper skips over them). Or when the keratinized tissues immediately around the piercing tend to roughen up.
Having a tongue piercing places you at an even higher risk of broken teeth than it does a white tongue. Particularly because people don’t think about their piercing after a while, and they simply bite down wrong and hit their stud. When that happens, it can crack a tooth in half, break out fillings, and cause seriously painful or expensive dental emergencies.
The #1 way to help prevent a white tongue is to use a tongue scraper every day. This handy-dandy tool removes more residue off of your tongue than a toothbrush will. And in my experience, people are usually flabbergasted by the amount of gunk that comes off with it.
To use a tongue scraper, place it as far back as you’re physically comfortable with (definitely not past the larger round bumps on the back of your tongue, though). Press down firmly, but not too hard. Then, slowly pull the scraper forward—toward the tip of your tongue—as you continue to place pressure against your tongue. Rinse the tongue scraper off and then repeat the process 2-3 more times. Do this daily. It will also help with bad breath!
If you wear removable appliances like dentures, make sure you’re cleaning those prosthetics as directed and never sleeping in them overnight. Otherwise, you’re setting yourself up for an oral infection.
The two most common reasons children have white tongues are because of thrush or inadequate oral hygiene.
Thrush is especially common in infants, whether they’re bottle-feeding or breastfeeding, and it can affect nursing mothers as well. This type of yeast infection can be painful for babies and nursing moms alike. The best way to prevent it is to clean the baby’s mouth with a clean, damp cloth after every feeding. Be sure that anything going into the baby’s mouth, whether it’s a pacifier, bottle nipple, etc., is cleaned routinely.
Toddlers and older children with a white tongue will want to start learning how to clean their tongue whenever they brush their teeth. Since some children have sensitive gag reflexes, this can take a bit of time and practice. Brushing from the back to the front of the tongue is ideal; as kids get older and more comfortable, they can use a tongue scraper.
Your dentist is—hands down—absolutely the best person to see if you have something weird going on with your tongue. They can help assess the situation and make a quick diagnosis to put your mind at ease and get you on the road to recovery.
Even if your dentist can’t figure out what’s going on or why your tongue is white, they know what to do next. They could order a biopsy to have those tissues looked at under a microscope for a 100% accurate diagnosis done from a lab. Or, they could send you to an oral surgeon, who is a specialist when it comes to treating disorders related to the mouth, head, and neck (your tongue included.)
In most cases, having something white on your tongue is going to be manageable under the direction of your dentist. Especially since they know what else is going on inside of your mouth that might be contributing to it. Even if you were to see your normal family physician, there’s a good chance they would send you to your dentist for an oral exam.
If you’re trying to figure out, “Why is my tongue white?” it’s important to note any co-existing conditions going on. What is the state of you oral health? What type of environment is in your mouth? Is it dry? Infected? Do you have some type of active sore or a habit of rinsing with hydrogen peroxide? Anything that pops up and doesn’t go away needs to be seen by your dentist. The most important thing is to rule out anything too serious. And if it’s because of thrush or something similar, your dentist can easily prescribe medication and home care techniques to help it go away.
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