White Tongue: What It Means and How to Fix It

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Have you ever noticed a white tongue? There are many reasons why a tongue can start to look white instead of pink and moist.

It might be a sign that you're dehydrated or that you need to improve your oral hygiene habits. A white tongue can also be a side effect of some common medications. In rare cases, it can be caused by an infection, an underlying skin disease, or something even more serious.

Most of the time, a white tongue is nothing to worry about, but it can be a clue to your overall health. Let's take a closer look at what causes a white tongue, what you can do about it, and when to see a healthcare professional.

What is a white tongue?

It may seem obvious, but a white tongue is when the color of the tongue is pale or white instead of its usual pink or salmon color. There may be other features alongside a change in tongue color too. You may also notice symptoms like:

• A dry tongue or mouth

• Sore or swollen taste buds

• Bad breath

The overall health and appearance of your mouth can give some important clues as to the cause of a white tongue. So it's definitely worth taking a close look at your mouth and tongue.

What are the most common causes of a white tongue?

A white tongue is usually caused by a white coating over the tongue. The coating can be due to a buildup of dead cells on the surface of the tongue, food residue, or an overgrowth of bacteria. It can also be from dried and caked saliva, damaged tongue tissues, or a combination of all of these things.

Here's the important thing to know: Saliva keeps the tongue lubricated and stops bacteria in the mouth from building up on the tongue. Any situation that reduces the amount of saliva in the mouth or increases the number of dead cells or bacteria on the tongue can cause a thick, white coating.

Here are some common reasons and risk factors for why this can happen.

Dry mouth or dehydration

Dry mouth means there are low levels of saliva. This is more common if you're hospitalized or have a fever. It's also common if you have certain autoimmune diseases (like lupus or Sjögren's syndrome). Being dehydrated and taking certain common medications can also cause dry mouth (more on that below).

Poor oral hygiene

Not brushing your teeth regularly allows a buildup of bacteria on the tongue. Poor oral hygiene can lead to more serious issues like cavities, mouth ulcers, and even heart disease. A white tongue from poor oral hygiene is more common if you:

• Are currently hospitalized

• Have long-term care needs

• Live in nursing homes

• Are experiencing homelessness

Mouth breathing

Breathing through your nose gives your body a chance to warm, clean, and moisten air before it reaches your delicate lungs. When you breathe through your mouth instead of your nose, it causes saliva to dry up and form a coating on your tongue. A white tongue from mouth breathing is more common if you have sinus problems or a deviated septum.

Damage to the tongue

Your tongue is the first step in processing food and drinks that enter your body for digestion. And it can be easily damaged by what you put in your mouth. Things that can injure your tongue include:

• Tongue biting

• Mouth appliances (like braces or bite guards)

• Hot foods or drinks

Damage to salivary glands

Salivary glands are required for good oral hygiene. When the salivary glands are damaged, they may not make enough saliva to keep the mouth and tongue healthy. Damage to the salivary glands can occur from:

• Radiotherapy treatment to the head and neck

• Autoimmune conditions (like Sjögren's syndrome or rheumatoid arthritis)

• Chronic infections (like HIV)

Smoking

Smoking reduces natural saliva production. It also increases the coating of bacteria and dead cells on the surface of your tongue. Smoking and chewing tobacco are also shown to cause changes in the cells covering the tongue, cheeks, and gums. This increases your risk for oral cancer. If you use tobacco and notice a white buildup on your tongue, talk to your dentist or primary care provider.

Heavy alcohol use

Heavy alcohol use affects the quality and amount of saliva in the mouth. It also disturbs the normal balance of bacteria there. Bacteria can become trapped in the increased dead cells covering the tongue. People who drink alcohol heavily are also more likely to have poor oral hygiene, putting them at even further risk of complications.

A low immune system

A weakened immune system makes it possible for "bad" bacteria and yeast to build up in the mouth. This is more common if you:

• Have diabetes

• Have organ transplants

• Have HIV/AIDS

• Are taking immunosuppressant medications

It's important for people living with immune system conditions to maintain good oral hygiene.

Medications

Some common medications can also cause a white tongue. Some may cause dry mouth, making a white tongue more likely. Other medications tend to promote the overgrowth of yeast and can lead to a white tongue.

Medications most likely to cause a white tongue include:

• Antidepressants

• Antihistamines

• Diuretics

• Antibiotics

• Steroids

When a white tongue is a sign of a more serious health condition

Most cases of white tongue aren't serious and improve with some simple fixes. But there are some serious health problems that cause white patches on the tongue, rather than a simple white coating. White patches are usually a sign of an underlying condition.

White patches on the tongue tend to be irregular, rather than an even white coating over the tongue. And these patches tend to stay even after brushing, scraping, or rehydration.

If you think your white tongue could be caused by white patches, don't delay getting it checked by a healthcare professional.

Here are some common conditions that could cause white patches on your tongue.

1. Oral thrush

Oral thrush, or oral candidiasis, is a fungal infection of the mouth. It's caused by an overgrowth of Candida - a yeast that can coat the tongue and other surfaces of the mouth.

A tongue with oral thrush may have white or sometimes yellow patches, versus a normal tongue that's pink. The patches can sometimes be scraped away, but this often causes bleeding. Oral thrush can also cause a burning sensation in the mouth, a loss of taste, and difficulty eating and drinking.

Certain medications like antibiotics and steroids make oral thrush more likely, as do health conditions like diabetes and HIV/AIDs. Oral thrush is more common in anyone with an underactive immune system. This includes people taking immunosuppressive medications and undergoing treatment for cancer.

Antifungal medication can easily treat oral thrush. These medications come as pills, oral mouthwashes, and gels - or a combination of these.

2. Leukoplakia

Leukoplakia literally means "white patches." It looks like oral thrush, but you can't rub the patches away. Usually the patches aren't painful. They're irregular, sometimes slightly red, and can be anywhere over the tongue, gum, or inside of the cheek.

Oral hairy leukoplakia is a type of white tongue that can occur in people who're immunocompromised. It's most common in people with HIV/AIDS or those who've had an organ transplant. It tends to affect the edges of the tongue most. It's caused by the Epstein-Barr virus (EBV) - the same virus that causes mononucleosis. Usually it goes away by itself, but sometimes treatment with an antiviral medication can help.

It's important to get checked out if you have white patches in the mouth, because some types of leukoplakia are considered precancerous. That means they can turn into mouth or tongue cancer. Leukoplakia is more common in people who smoke or chew tobacco and people who drink alcohol. These habits also increase the risk for mouth and tongue cancer.

3. Mouth ulcers

Mouth ulcers - like canker sores - can cause white patches on the inside of the mouth or tongue. Causes include trauma, like if you bite yourself by accident, or dentures that don't fit well. And most people have experienced a mouth ulcer when they're unwell or stressed. Some people are more likely than others to have them, and this tends to run in families.

But mouth ulcers can be a sign of bowel disease like Crohn's or celiac disease. They can also be a feature of some autoimmune illnesses, like lupus and Behçet's. And sometimes mouth ulcers can be an early sign of tongue cancer. Be sure to get checked if you get a lot of mouth ulcers or you have one that doesn't go away.

4. Geographic tongue

Geographic tongue is inflammation of the tongue that causes a map-like appearance over the surface of the tongue. Researchers aren't sure what causes it. But they've linked it to:

• Stress

• Allergies

• Hormonal disturbances

• Genetics

It's also more common if you have psoriasis. It can cause discomfort and loss of taste. But it usually improves with time (and sometimes treatment).

5. Oral lichen planus

Oral lichen planus is inflammation of the lining of the mouth and tongue that typically causes a white, scaly pattern. It can also cause bleeding or large scales. It's not clear what causes oral lichen planus, but it's most likely an autoimmune disease. Oral lichen planus can also appear along with symptoms affecting other areas, like your:

• Skin

• Genitals

• Nails

• Scalp

Lichen planus is more common in women between 30 and 60 years old. There isn't a cure for oral lichen planus. In very rare cases, it can lead to mouth cancer. Treatments can ease the discomfort of mouth sores.

6. Lupus

Lupus can affect the skin in your mouth, just like it affects skin elsewhere in your body. It can cause changes similar to oral lichen planus. But it can also cause mouth ulcers and discoid lupus - a specific type of round lesion.

Mouth lupus is a sign of "active disease." In other words, it means you need to see your lupus specialist to get checked out and review your treatment plan.

7. Syphilis

Syphilis is another infection that can cause white patches on the tongue. In syphilis, the tongue lesions tend to be painless. Unlike with EBV, syphilis tongue lesions won't go away on their own. Syphilis needs treatment with antibiotics to get better and prevent the infection from spreading to other people.

8. Tongue cancer

Cancer is the most serious cause of white tongue lesions. Mouth cancer is rare. But certain risk factors make it more likely to occur, including smoking and drinking alcohol.

If you see a dentist for regular checkups, you might remember that they look at the gums and tongue as well as the teeth. This is to check for early signs of cancer. That's why it's important to try and see a dentist twice a year.

Treatments to fix a white tongue at home

If the cause of your white tongue is dry mouth, dehydration, or oral hygiene habits, there are a few remedies you can try at home:

• Change up your mouth-care habits. Follow some basic tips on oral hygiene. Make sure you brush your teeth twice every day. When brushing, go in circles around the gumline. And brush your tongue to help get rid of any coating that might have developed during the day. And don't forget to clean between your teeth with floss.

• Keep your mouth moist. Drink water regularly throughout the day to help your symptoms.

• Try to increase your saliva production. You can rinse your mouth with cold water, use mouthwash, suck on ice chips, and try chewing sugarless gum.

• Consider saliva substitutes. Gels, aerosols, gums, and other products can supplement or replace your saliva.

• Change your diet. Avoid foods that are salty, acidic, or dry, as these can worsen symptoms. Alcohol, caffeine, and tobacco also make dry mouth worse.

• Review your medications. Talk with a healthcare professional if you think your medication may be the cause of your white tongue. They can help you stop taking the medication or recommend an alternative if needed.

• Give your tongue some time to heal. White tongue due to a burn, medication, or viral illness will usually get better within a few days or a couple of weeks with good oral hygiene and treatment of the root cause. It may take longer to see results in people who smoke or chew tobacco, or eat a diet high in sugar.

How can you prevent a white tongue?

You may not be able to completely avoid getting a white tongue if you have certain medical conditions or take certain medications. But you can reduce the likelihood of getting a white tongue by following these tips to maintain your oral health:

• Brush your teeth at least twice a day and floss between your teeth every day.

• Rinse your mouth every time you use any type of steroid treatment.

• Don't use any type of tobacco products.

• Limit your alcohol use. If you have alcohol use disorder, get help to stop drinking.

• Keep your blood sugar under control if you have diabetes.

• Take your medications for dry mouth or thrush as prescribed.

• If a medication you're taking is causing dry mouth or white tongue, ask your prescriber if there's another effective alternative.

• See your dentist at least once a year - and more often if you're at risk for oral conditions.

When should you seek medical attention about a white tongue?

You should see a dentist or primary care provider if you notice:

• A white tongue that doesn't improve with better brushing

• A white patch on the tongue that doesn't improve within a few weeks

• A white patch on the tongue that changes over time

• Tongue pain or itching that doesn't go away

A healthcare professional can check for a more serious underlying cause and help with treatment recommendations.

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