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Updated on October 3, 2022

White Spots on Tongue - Causes, Symptoms & Treatment

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White Spots on Tongue

White spots or patches may appear on your tongue as a symptom of several conditions. They are generally benign, but knowing the possible causes will help you determine when to contact a doctor.

5 Causes of White Spots on Tongue

Here are the most common causes of white spots on the tongue: 

1. Oral Thrush

Oral thrush is a fungal infection caused by Candida yeast. It often appears as white patches on the tongue, mouth, and throat and is typically harmless.

Risk Factors

Oral thrush is most common in babies. Healthy adults don’t often develop it, but factors that increase the risk include:1

  • Wearing dentures
  • Having diabetes, cancer, or HIV/AIDS (or another condition that causes a weakened immune system)
  • Taking certain antibiotics or corticosteroids, including inhalers for asthma
  • Taking medications or other conditions that cause dry mouth
  • Smoking

Other Symptoms

The white patches may be small and spotty or coat a significant portion of the tongue.

Other symptoms of oral thrush include:

  • Redness or soreness in the mouth
  • Cracking at the corners of the mouth
  • A lack of taste or bad taste
  • Pain while eating or drinking
  • A feeling of “cotton” in the mouth

Babies with oral thrush may not want to feed and can develop a rash elsewhere on their bodies.2

Treatment

Treatment usually involves an antifungal medication. The medicine is applied topically for a course of 1 to 2 weeks. 

Fluconazole may be taken orally or by injection for more severe infections. 

2. Leukoplakia

In leukoplakia, thick, white patches form on the gums, tongue, and inside of your mouth. These patches cannot be wiped off. Most instances are benign, but some can be precancerous.

The exact causes are unknown, but leukoplakia has been associated with tobacco use. Chronic irritation from sharp teeth or dentures may also play a role.

Risk Factors

Using tobacco in any form puts you at a much higher risk of developing leukoplakia. You may also increase your chances if you drink alcohol.

Between 1 and 9% of people with leukoplakia will develop mouth cancer or malignancy in the future, with an increased incidence in women.3 Signs that the lesion may be at risk of being precancerous or cancerous include: 

  • Having leukoplakia for an extended amount of time (> 2 weeks) 
  • Lesions on the tongue or bottom of the mouth
  • Lesion size greater than 200 mm
  • Changes in appearance over time 

Other Symptoms

You might notice symptoms other than the lesions, including:

  • Red patches in the mouth, which may indicate precancerous changes 
  • Pain when swallowing
  • Difficulty opening your mouth

If you notice any of these symptoms, see a doctor immediately.

Treatment

Discontinuing unhealthy habits that irritate the mouth, such as using tobacco or drinking alcohol, can resolve the issue for most people.

In more severe cases, your doctor may remove the patches with a scalpel and biopsy the tissue, and you may need routine follow-ups.

3. Oral Lichen Planus

Oral lichen planus is a common inflammatory condition affecting the mouth's mucous membranes. Lacy white patches occur on the tongue and other soft tissues in the oral cavity.

Possible causes include:

  • Hepatitis C
  • Medications
  • Reactions to metal fillings
  • An autoimmune reaction


The disease is not contagious. However, studies have shown that oral lichen planus can undergo malignant transformation, so routine follow-ups are needed to monitor for changes. 

Risk Factors

Women are twice as likely as men to develop oral lichen planus.4 It’s most commonly found in middle-aged adults; it’s unlikely to affect young children or older people. 

Other Symptoms

Some people may develop redness and sores in their mouths. You may also notice lichen planus on other parts of your skin.

Treatment

There is no cure for oral lichen planus. However, some treatments, including corticosteroids or immune response medicines, may ease symptoms.

4. Syphilis

Syphilis is a sexually transmitted bacterial infection. It can occur in the mouth as a result of oral sex. 

Bacteria enter the body through a cut in the mouth and create a chancre, or a sore, at the entry point. These chancres can be found on the tongue, lip, or inside of the mouth.

Chancres can resemble pimples or other conditions, which can delay diagnosis. One study showed that it took nearly 9 months for people with only oral symptoms to be diagnosed with syphilis.5

Risk Factors

Engaging in unprotected oral sex makes you much more likely to develop oral syphilis. Using a condom or protective barrier can prevent oral sexually transmitted infections (STIs).

Poor oral hygiene can also make your mouth more vulnerable to bacteria.

Other Symptoms

Syphilis symptoms depend on the stage of the infection:

  • Primary syphilis – chancres in the mouth
  • Secondary syphilis – skin rashes, swollen lymph nodes, fever, sore throat, larger mouth sores, headaches, weight loss
  • Late syphilis – severe issues such as organ failure

These stages can happen in a different order for different people. Some people may only experience some of these symptoms. 

Treatment

Oral syphilis is highly treatable if you catch it early. Antibiotics are the most common treatment, administered by injection.

The chancres may go away on their own, but that doesn’t mean the infection has. Seeking treatment is vital to avoid lasting consequences.

5. Mouth Ulcers

Mouth ulcers, also known as canker sores, are painful lesions that can occur for a variety of reasons. They are most common on the tissues surrounding the teeth, but they can also occur on the tongue.

Many things can cause a mouth ulcer to form, including:

  • Injury to the inside of the mouth
  • Bacterial, viral, or fungal infection
  • Food sensitivities or allergies
  • Hormonal changes
  • Stress and lack of sleep
  • Cancer 

Ulcers are not contagious and typically heal on their own after 1 to 2 weeks. If you have an ulcer that is not healing after two weeks, seek care from a dentist or doctor as soon as you can. 

Risk Factors

You may be more prone to developing canker sores if you have one or more of the following:

  • Autoimmune disease
  • Vitamin deficiencies
  • Health conditions such as Celiac disease
  • Braces or dentures that irritate your mouth
  • Mouth cancer

Maintaining a balanced diet, practicing good oral hygiene, and using stress management skills can help prevent mouth ulcers from developing.

Other Symptoms

In addition to the sores themselves, you may also notice the following symptoms:

  • Swollen skin around the sores
  • Trouble chewing or brushing teeth
  • Irritation from salty, spicy, or hot foods
  • Appetite loss

Treatment

Most canker sores will resolve independently. Some may need treatment to prevent complications and relieve symptoms as they heal.

Treatment involves using an antiseptic gel, keeping your mouth clean, and avoiding certain foods. Some severe cases may require immunosuppressant medication.

When to See a Dentist or Doctor

Contact a healthcare professional if you experience:

  • Excessive white spots or patches that don’t resolve after a week or two
  • Pain eating, swallowing, or opening your mouth
  • Redness, soreness, or pus
  • Fever
  • Skin rashes
  • Bleeding in the mouth
  • Ear pain while swallowing

Your doctor can conduct a full examination and run tests if needed.

Diagnosis

The method of diagnosis will vary depending on the condition your doctor suspects. They may perform a biopsy, run blood tests, or examine your mouth. 

Determining Treatment

Your diagnosis will determine your treatment. Habit change and practicing better oral hygiene can resolve some issues entirely.

Other conditions may have no cure, but their symptoms may be treatable using topical gels, oral medications, or injections.

Outlook

Most causes of white patches are benign. Generally, they will resolve on their own or can be treated by a healthcare professional.

Some underlying conditions may have the potential to become precancerous. Mouth cancer can occur at any age, with 20% of all cases appearing in adults under 55.

Catching any issues early can improve your outlook.

Preventing White Patches on Tongue

The best way to prevent issues with your tongue is to practice excellent oral hygiene. Medical professionals suggest:

  • Brushing and flossing daily
  • Maintaining a healthy diet
  • Reducing tobacco and alcohol use
  • Visiting your dentist and doctor regularly

These tips can help prevent complications in the future.

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Summary

White spots on your tongue are a common symptom of many conditions. They are usually benign, non-contagious, and treatable. However, they can sometimes indicate a more severe condition, so it’s important to visit your doctor early.

6 Sources Cited
Last updated on October 3, 2022
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. Candida infections of the mouth, throat, and esophagus.” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 25 Feb. 2021
  2. Oral thrush (mouth thrush).” National Health Service UK, Crown Copyright, 08 July 2020
  3. Mohammed, F. et al. “Oral Leukoplakia.” National Library of Medicine, StatPearls Publishing LLC, 01 May 2022
  4. Lampros, A., et al. “Oral forms of secondary syphilis: An illustration of the pitfalls set by the great imitator.” Journal of the American Academy of Dermatology, Elsevier Inc, 24 Apr. 2020
  5. Lichen Planus.” Johns Hopkins Medicine, The Johns Hopkins University, 2022
  6. Key Statistics for Oral Cavity and Oropharyngeal Cancers.” American Cancer Society, 12 Jan. 2022
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