Why is your tongue white? Doctors talk about the causes - TODAY

Posted: 20 Dec 2019 03:03 PM PST

From a dry, sticky coating to small round lesions, discolored taste buds to pockets of pus, there are many reasons why the tongue can appear white.

The fade from pinkish-red can occur overnight or develop slowly over time. Sometimes there's soreness, but not always.

But paying attention to surface color changes and accompanying signs and symptoms is critical because, in certain cases, a white tongue could be an indication of something much more serious.

What is the sticky, white film?

"The most common cause is buildup of debris, bacteria and dead cells all of which can become stuck between finger-like projections on the tongue's (tasted buds called) papillae," Benjamin Bradford, assistant professor of Otolaryngology at Loma Linda University Health told TODAY.

In addition to the tongue's surface, taste buds are located in the esophagus, cheek mucosa and the epiglottis. These areas, depending on the amount of build-up, may also turn white, he said, since they are all major structures responsible for swallowing.

Improving oral hygiene should help the tongue return to its normal color. The National Institute on Aging recommends the following:

Brush not only the teeth, but also the gums, cheeks and tongue with fluoride toothpaste.
Gently scrape the entire tongue's surface with toothbrush bristles or a tongue scraper.
Perform small circular motions, brush back and forth, as well as up and down.
Floss afterwards not only between the teeth, but also around them. This helps remove additional plague, bacteria and food a toothbrush might not catch.
Once finished, rinse the mouth with water.

Oct. 23, 201904:57

What's causing the round, white patches on my tongue?

Round white patches are often caused by dehydration and a diet high in sugar, says New York City-based registered dietician, Natalie Rizzo. These patches typically go unnoticed because there's no discomfort.

"When a person's water intake is insufficient, they don't produce enough saliva," Rizzo added. "Saliva keeps the mouth clean by pushing down food boluses into the digestive tract. Without it, leftovers remain on the tongue's surface causing the tongue to look white."

An imbalanced diet can increase this discoloration. Foods high in refined sugars including candy, soda and sweetened coffee drinks alter the mouth's acidity.

Rizzo recommends staying hydrated. She believes women should aim for approximately 8 cups of water per day, whereas men should aim for approximately 12 cups. And try alternatives to sugar-laden foods that can help satisfy one's sweet tooth.

"If you really crave something sweet, try eating dried fruit instead of candy, unsweetened flavored water instead of soda or a latte instead of a caramel macchiato," she said.

Tobacco products can also contribute to white spots on the tongue.

"Smoking, chewing tobacco and excess alcohol cause long-term trauma to the oral tissues," said Bradford. "If you notice suspicious white patches on the tongue's surface that don't go away with lifestyle changes, you're going to want a dental examination and a possible biopsy. These white patches could be a sign of oral cancer."

When there's also pain

"Most of the time a white tongue is a harmless variant," Abhigyan Banka, a family medicine doctor for Franciscan Health Indianapolis, told TODAY. "It can happen for no reason at all and is usually nothing to worry about."

But if the whole tongue, or even just a patch, doesn't improve over time, it could be a sign of a compromised immune system. This is especially true if the change in surface color is accompanied by pain and soreness.

Everyone has normal, unhealthy bacteria in their systems, added Banka. When a person is healthy, the immune system can fight it off. However, when the immune system is not working properly, the person may not be able to fight off bacteria that would otherwise be benign.

"Cancer, diabetes and HIV are the three big players responsible for immunosuppression," he said. "A collection of uncomfortable, raised white lesions called thrush appear with these diseases. Beneath the lesions is a red inflamed base, which is the source of the pain."

What else could be causing a white tongue?

Inhalers, excessive gum chewing and poorly fitted dentures are all possible suspects.

"People with asthma or chronic obstructive pulmonary disease (COPD), rather than inhaling the steroid, end up swallowing it," Banka said. "In this instance you'll see temporary whiteness."

Constant gum chewing irritates the tongue's surface area causing it to appear white. The same goes for extreme use of throat lozenges. Dentures that don't fit right can also lead to the change in color.

Sometimes it's just a question of temporary oral hygiene.

"I've had first-time moms bring in toddlers saying 'Hey, my kid's tongue is coated in this white film. What's going on?'" he said. "I'll do an examination and realize the kid just had a lot of ice cream the previous night and didn't brush their teeth before they went to bed."

Regardless of what the cause may be, Banka said its always best to ask a doctor, even if it's just to relieve anxiety.

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Mary Elizabeth Gillis

TODAY.com contributor Mary Elizabeth Gillis is a health, medical and science reporter for national media outlets.

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