White tongue is a symptom where your tongue grows a thick white coating on part or all of its top. You might also experience bad breath, a hairy tongue and irritation. White tongue can look unattractive but it’s usually harmless and temporary.
What is white tongue?
A “white tongue” is a common symptom when your tongue is coated by a thick white film. This coating can cover the entire surface of your tongue, the back part of your tongue or it might show up in patches. You might also notice a bad taste in your mouth, bad breath or redness.
White tongue sometimes happens along with a related symptom called hairy tongue. But the thick furlike coating you see isn’t actually hair, it’s your papillae – small bumps containing your taste buds.
White tongue can build up over time or it might show up suddenly if you irritate your tongue or get an infection. You can get white tongue from many different causes but it usually goes away in a few weeks. You can also use an anti-fungal mouthwash. But if your white tongue lasts longer than a few weeks — or if you have pain or problems eating and talking — you should see your provider for diagnosis and treatment.
Why is my tongue white?
White tongue is usually caused when bacteria, debris (like food and sugar) and dead cells get trapped between the papillae on the surface of your tongue. These string-like papillae then grow large and swell up, sometimes becoming inflamed. This creates the white patch you see on your tongue.
Having a white tongue can also be caused by a number of different conditions:
Leukoplakia: Leukoplakia is a common condition caused by an overgrowth of cells in the lining of your mouth. These cells combine with the protein keratin (found in your hair) to form a white raised patch on your tongue. In many cases, you can get this condition by irritating your mouth and tongue when you drink alcohol or smoke tobacco. Sometimes there’s no obvious cause. Leukoplakia usually isn’t serious but sometimes it can turn cancerous (mouth cancer) years or even decades after it first shows up.
Oral lichen planus: Oral lichen planus is a chronic (long-term) inflammatory mouth condition. It’s caused by a disorder of your immune system (your body’s defense against germs) and other microscopic threats. You can’t pass this condition on to others.
Geographic tongue: Geographic tongue happens while the skin on your tongue is regrowing. Parts of the upper layer of skin on your tongue shed too quickly, leaving tender red areas that often get infected. Meanwhile, other parts of your tongue stay in place too long and turn a white color. You can’t pass geographic tongue on to anyone else.
Oral thrush: Oral thrush is an infection in your mouth caused by the Candida yeast (fungus). Although Candida is normally found inside your mouth, it becomes a problem when it grows too much.
Syphilis: Syphilis is a bacterial infection and a sexually transmitted infection (STI). It’s a serious condition with many symptoms including white tongue.
Who is most at risk for white tongue? Is white tongue genetic?
Certain health issues, substances and habits can put you at higher risk to get white tongue or oral thrush (an infection causing a white patch on your tongue). These risk factors include:
Being very young or very old. Oral thrush is most common in infants and toddlers.
Using antibiotics (they can cause a yeast infection inside your mouth).
Eating a diet with a shortage of fruits and vegetables (iron or vitamin B12). Eating a diet of mostly soft foods can also cause it.
Having a fever or a weak immune system.
Wearing dentures or damaging your tongue with sharp objects.
Having poor oral hygiene.
Breathing through your mouth.
Being dehydrated, having a dry mouth caused by a medical condition or by using medications (like muscle relaxers).
Smoking or chewing tobacco.
Drinking more than one beverage containing alcohol a day.
Undergoing cancer treatments.
Having hypothyroidism (an underactive thyroid gland causing poor metabolism).
Do tongue piercings cause white tongue?
If you (or your teenager) have just had a tongue piercing, you might see a white coating on your tongue. It’s normal bacterial growth that you can reduce with antifungal mouthwash, like Nystatin (like Nystop®). You might also notice a white ring of tissue around both sides of your piercing, but it’s just the way your tongue normally heals from a wound.
What are the symptoms of white tongue?
Depending on your symptoms, your white tongue might be just that. Or it could show up with other symptoms.
Since your papillae (those small bumps on your tongue) are raised, they create a large surface area for debris and micro-organisms (food, plaque and bacteria) to collect inside your mouth. This buildup almost certainly causes bad breath and can leave a bad taste in your mouth. White tongue can also lead to poor gum health (like gum disease).
How is white tongue treated? Will my white tongue come back?
You might not need treatment for your white tongue. Usually, it should go away on its own in a few weeks. But you might want to get treated if it lasts longer than that, or if you want to get rid of it sooner. Treatments for common symptoms of white tongue include the following:
Hairy tongue: Your provider probably won’t directly treat your hairy tongue. Instead, they’ll focus on treating your weakened immune system. In rare cases they can prescribe you with antiviral medications like valacyclovir or famciclovir. Or they might apply a treatment (like podophyllin resin or retinoic acid) directly to your white patch.
Tongue rash: You shouldn’t need treatment for a tongue rash (oral lichen planus). But sometimes it can last in your mouth for several years. Your healthcare provider can prescribe steroidal mouthwashes (steroid pills dissolved in water) and steroid sprays that can reduce your discomfort from symptoms like burning or sore gums.
Mouth fungus: If you have a mouth fungus (oral thrush), your provider will prescribe you with antifungal medications such as Diflucan. These come in pills you can take, or gels or liquids you can apply to the patches inside your mouth. You’ll usually need several applications a day for one or two weeks.
White patches: There are no special treatments for having several white tongue patches (called geographic tongue because it looks like a map outline). Avoid any food and drink that causes you discomfort. Topical applications used to treat mouth fungus can give you some relief from any discomfort you feel. There’s no risk of this condition becoming cancerous.
Syphilis: If syphilis is causing your white tongue, it won’t go away on its own. If you don’t get it treated, it can eventually damage your nervous system and cause serious long-term health problems. Syphilis is treated with a single injection of antibiotics (penicillin). If you’ve had syphilis for over a year, you might need up to three injections.
Mouth cancer: If your provider tells you you’re at high risk of getting mouth cancer, they will likely remove your white patch with surgery. Your surgeon might use a scalpel, laser or (rarely) another method like cryotherapy (freezing it with liquid nitrogen). This surgery will help make sure that your tongue cells don’t turn cancerous. You can choose to be either numbed or asleep for this operation. Usually, you’ll heal soon after this procedure.
What can I do at home to treat white tongue?
Usually white tongue is easy to treat. White tongue caused by a buildup of debris in the mouth is treated by regularly practicing good oral hygiene. Simple ways you can treat white tongue include:
Drinking more water, up to eight glasses a day.
Brushing your teeth using a soft toothbrush.
Using a mild fluoride toothpaste —one that doesn’t have sodium lauryl sulfate (a detergent) listed as an ingredient.
Using fluoride mouthwash. If your child has white tongue, your provider can prescribe an antifungal mouthwash, so you can swab your child’s tongue.
Brushing your tongue or using a tongue scraper to remove the white coating. If you don’t have a tongue scraper, you can turn over a teaspoon.
Using a straw when having cold drinks.
Avoiding substances that can irritate your tongue like alcohol mouthwashes that contain alcohol and cigarettes. Also avoid food and drinks that are spicy, salty, acidic or very hot in temperature.
Taking over-the-counter painkillers if you have discomfort.
How can I prevent white tongue?
Sometimes you can’t prevent getting white tongue. But you can help avoid it by practicing good oral hygiene. Get a checkup and a tongue cleaning at your dentist’s every six months. Always brush your teeth at least twice a day. Floss once a day and eat healthy with a good mix of fresh fruit and vegetables.
If your provider tells you that your white tongue symptoms are serious, consider quitting alcohol or tobacco (or using less of either). Schedule regular follow-up visits with your dentist or provider. This will help make sure your white patch doesn’t grow or become cancerous.
Your provider can also help you find out if you have a food or drink allergy and also help you find which medications are right for you.
Should I see a doctor if I get white tongue?
Usually white tongue is harmless and temporary. Depending on your white tongue symptoms, you might wait to see if it goes away on its own. If white tongue is the only symptom you notice, you should be fine.
But if your tongue hurts or itches, you should have it looked at. Sometimes it can be a sign of a developing health risk like an infection or oral (mouth or tongue) cancer. In severe cases when white tongue isn’t treated, serious infection could spread to other areas of your mouth and body.
If your white tongue doesn’t go away after a few weeks, you might want to see your provider or dentist. You should also get checked if your tongue hurts or if you have trouble eating or speaking. Your provider can help you to clear it up. Or they can help you to be sure it’s not a more serious condition. You should also make an appointment if you have a weak immune system or HIV.
Who should I see if I (or my child) have white tongue?
You should see your dentist or provider if your white tongue doesn’t return to a normal color after a few weeks. You can get help from one or more healthcare professionals, including:
Dentist: Your dentist can clean your tongue using a tongue scraper. They can also prescribe medications to treat your white tongue.
General practitioner: Your provider can diagnose your white tongue, prescribe medications (if needed) and tell you if your symptoms point to a more serious condition.
Pharmacist: You can ask your pharmacist if they have any products that help treat white tongue. They might suggest seeing your healthcare provider.
A note from Cleveland Health Library:
Your oral hygiene is important, so be sure to get regular dental checkups to spot any problems early. White tongue usually isn’t harmful, but you should make sure to see your dentist or provider if your tongue (or even just its appearance) is bothering you or you’re having any pain. This way they can find any health risks early and treat you before it can get worse.