White tongue is exactly what it sounds like, a tongue that has a white appearance or colour to it. This white colouration is often a symptom of an underlying condition. Luckily, it’s not usually a serious concern. However, it’s still important to determine the cause of your white tongue to ensure a proper diagnosis. From excess bacteria to dry mouth or gastrointestinal disorders, having a white tongue is fairly common and usually an indicator of another health condition that could use some attention. By understanding what a white coating on your tongue is, what can cause it, and the treatment options available, you’ll know when to see a dentist (or doctor) about the condition and how they can help.
White Coating on Tongue: What is it?
“White tongue,” also known as a “coated tongue,” is when the top surface of your tongue or sometimes the sides appear to have a white coating on them. This condition is often a symptom of an underlying cause, such as when bacteria or dead skin cells accumulate on the tongue’s surface.
The tongue’s surface is covered in hundreds of tiny papillae. Papillae are tiny finger-like projections that give our tongues a roughened appearance. On a microscope, these projections look like blades of grass or the fibres of a carpet. When bacteria and buildup get stuck within these projections, a white coating or visible buildup can appear. This white appearance may cover the entire surface of your tongue, or it can occur in patches that are only on certain parts of your tongue. While a coating on the tongue is usually a white colour, it can also appear off-white, yellow, and sometimes have a brown tint to it.
White Tongue Causes
There’s not a single cause of white tongue. Thankfully, the most common factors are easy to address and not anything to be too concerned about. Conditions that are often easy to address tend to include dehydration or poor oral hygiene techniques, which can be relatively simple to fix. Others can be more serious, such as oral cancer and syphilis. Due to the range of causes and severity, it is crucial to understand the causative factor to ensure more serious concerns are not ignored. The more you know about the situation, the better prepared you’ll be when it comes to knowing when to see your dentist.
Dehydration
Dehydration is one of the most common reasons for a white-coated tongue to occur. With about 60% of our bodies being made of water, it’s no wonder we need to keep hydration at an optimal level. When your body is even slightly dehydrated due to spending time outside in hot weather or vigorous exercise, you can start to see early signals you need more water. This is especially noticeable if you’re sick from symptoms of vomiting or diarrhoea. When we become dehydrated, our body will automatically reduce bodily secretions, including saliva production. When there is less saliva production, bacteria and debris in the mouth are more likely to get caught on the tongue’s rough surface. When that happens, the tongue’s surface structures are drier and can hold onto bacteria. This buildup can develop into a filmy coating of bacteria debris, known as white-coated tongue.
Symptoms of dehydration related to the oral cavity can include:
- Reddening of oral tissues (often due to inflammation)
- Dry and cracked lips
- Sticky feeling inside the mouth
- Increase in cavity occurrence due to lack of saliva
- Bleeding gums
- Bad breath
While dehydration can occur in anyone who is dehydrated or not drinking enough water, some factors can increase their risk. Those suffering from diarrhoea and/or vomiting are likely to become dehydrated much more quickly, especially young children and the elderly. Prescription medications such as diuretics can also cause a loss of water in the body, leading to dehydration. Many prescription medications, while not directly leading to dehydration, can cause side effects like dry mouth. Excessive sweating and exposure to high temperatures for prolonged periods of time can also lead to dehydration.
While there are many factors that can lead to dehydration, drinking more water throughout the day can help keep your body hydrated and reduce the chances of bacteria and debris from building up on your tongue’s bumpy surface.
Leukoplakia
Leukoplakia is a condition in which white patches form somewhere in the oral cavity. It can occur on the inner cheeks, lips, and tongue. Leukoplakia is often mistaken for other white coatings found in the mouth, such as yeast infections or debris buildup. The determining factor in diagnosing the white patches is whether they can be rubbed away or not. Leukoplakia will not wipe away like other types of buildup on a white-coated tongue usually can. This is an important screening tool to understand and pinpoint the diagnosis of your condition.
Leukoplakia will often occur in patches throughout your mouth and have a white or grey appearance. Usually, the tissue affected feels different to the touch than the soft skin around it, with a hardened or thickened, raised texture. In most cases, there are minimal symptoms with leukoplakia because there is no pain associated with this condition.
While some causes of leukoplakia are unknown (also known as idiopathic leukoplakia), there are a few risk factors that may contribute to the chances of leukoplakia lesions, including:
- Heavy smoking
- Chewing tobacco
- Heavy alcohol consumption
- Betel nut chewing
- Vitamin A and B deficiencies
- Chronic irritation from ill-fitting dental appliances or orthodontics
- Immunocompromised patients
Leukoplakia should not be ignored, as these lesions can have the potential to develop into certain forms of oral cancer. Estimates range from 3-19% of leukoplakia lesions progress into some form of cancer or precancerous tissues. Over 80% of leukoplakia cases are diagnosed in people over the age of 40, with the highest prevalence occurring between 50-80 years of age.
Oral Candidiasis
Oral candidiasis, also known as oral thrush, is a yeast infection caused by a type of fungus called candida. This fungus is often always present on our skin, in our mouth, and in many other locations throughout the body. When the environment inside of your mouth changes in some way, candida can begin to overgrow more than other types of natural bacteria, causing a yeast infection. This infection will often present itself as a white, sometimes chunky appearance on the tongue. Often, this white film will continue down the patient’s throat and can also be seen on the roof of the mouth or inside of the cheeks. It’s important to note candidiasis can be wiped away from the skin and usually leaves a raw or red surface underneath.
Symptoms can include:
- White coatings throughout the mouth, sometimes chunky in appearance
- Red, raw, or sore oral tissues under the filmy coating
- Discomfort when chewing and swallowing
- People at the highest risk of developing candidiasis include those who wear oral appliances such as dentures and partials, immunocompromised patients, people who use inhalers, diabetics, and smokers. Treatment often includes some form of antifungal treatments or corticosteroids, including creams, lozenges, and rinses.
Syphilis Tongue
Syphilis is a common sexually transmitted bacterial infection caused by the bacteria treponema pallidum. Symptoms of syphilis vary significantly, depending on what stage of the disease sufferers are experiencing. Typically, the four different stages of syphilis occur in progressing levels of severity. While syphilis can occur anywhere throughout the body, oral syphilis is what causes a white-coated tongue appearance. In the early stages, oral syphilis can present as sores or chancres throughout your mouth. If the infection goes untreated for an extended period of time, chances can make it harder to clean your mouth or lead to changes in papillae on your tongue, contributing to syphilitic leukoplakia, which is a thick coating on the top surface. Syphilis can usually be treated successfully with a round of antibiotics; however, if left untreated, it can lead to serious health conditions.
Oral Lichen Planus
Lichen planus, known for its lacy white appearance inside of your cheeks or lips, is classified as a chronic inflammatory condition. Unfortunately, we really don’t know what causes it. The population with the highest risk for developing lichen planus is middle-aged men and women. While lichen planus can appear in several different spots throughout the mouth, it can sometimes show up as a white-like coating on the tongue.
Symptoms can include:
- Burning or swelling of the tongue
- Discomfort when chewing or swallowing
- Discomfort when eating spicy or hot foods
- Redness and swelling of the tongue and gum tissues
While there is no real cure for lichen planus, there are treatments to help with oral lesion discomfort. Steroids, topical anaesthetic, homoeopathic remedies, and dietary restrictions may be recommended.
Oral Cancer
Oral cancer can present itself in a multitude of ways. Lesions, ulcerations, and a white-coated tongue are some of the most common. A white coating on the tongue or sores that do not heal within a few weeks should be evaluated and biopsied by your dentist or an oral surgeon to ensure a proper diagnosis. Often oral cancer on the tongue can present itself as white patches that may or may not bleed. Symptoms can also include:
- Painful sores that do not heal in a timely manner
- Numbness of the tongue
- Spontaneous bleeding
- Difficulty swallowing or speaking
While a white-coated tongue is a common occurrence, the odds that it is cancer are still rare. It’s still best to check with your dentist to ensure proper diagnosis and treatment. Like other types of oral cancer, early diagnosis and intervention are crucial to a higher recovery rate.
White Tongue Treatment
While a white-coated tongue can come from various causes, there are also an array of treatment options to consider.
How to Get Rid of White Tongue
If you have a white-coated tongue, there are several steps you can take at home to try to treat the situation. Some are extremely easy, while others may require seeing a doctor or dentist for further diagnosis.
If your coated tongue is due to dehydration and dry mouth (also called “xerostomia”), increasing your water intake can make a world of difference! By hydrating, you will reduce the likelihood of bacteria and food debris getting trapped on the bumpy surface of your tongue. Sometimes moisturising products like mouth sprays, lozenges, and rinses can help to soothe dry, irritated tissues while you work on rehydrating yourself. These products may also help to stimulate salivary flow and reduce any discomfort that your dry mouth is causing.
Cleaning your tongue with a tongue scraper can also limit filmy white buildup caused by plaque or food debris. Use your tongue scraper by sweeping from the back of your tongue toward the front.
If your coated tongue is due to a vitamin A or B deficiency, speak to your doctor about dietary options as well as supplementing with a multivitamin to help get your oral microbiome back on track.
If your coated tongue is due to a yeast infection, see your dentist or doctor for a proper diagnosis. Often an antifungal treatment will be prescribed. Depending on the prescription, your medication can come in forms such as mouth rinses, lozenges, and chewable tablets. The most common antifungal medication for oral yeast infection is called Nystatin.
Leukoplakia treatments may also include reducing or eliminating alcohol consumption and smoking tobacco. Often, people will see a significant decrease in leukoplakia lesions in the mouth when they eliminate risk factors such as these. Stubborn leukoplakia lesions can also be removed by an oral surgeon when necessary. Occasionally, antiviral medications will be prescribed, as well as topical anaesthetics, for people experiencing pain or discomfort.
Oral cancer treatments can vary significantly depending on the diagnosis. A biopsy will be required to determine the true cause of the tissue abnormality, followed by removal of cancerous tissues when needed. If the removal of cancerous lesions is significant, reconstruction of your tissues may also be required.
While a white-coated tongue is not usually a serious condition, it should never be ignored. If you are experiencing any symptoms of white tongue, it’s important to notify your dentist. Usually, a white tongue signals an underlying health condition or oral hygiene issue that needs attention. While it’s often treatable and not serious, conditions should be ruled out to ensure proper treatment. If you have a white-coated tongue, schedule a dental appointment to work on determining the cause behind your condition.
