White spots on tongue: causes and treatment

Healthy bumps on your tongue are called papillae or taste buds, and they should be the same colour as the rest of your tongue. You might check your tongue after experiencing discomfort or when you brush your teeth. Occasionally, you may notice a white spot or patch that isn’t usually there. Oral thrush, mouth ulcers, and leukoplakia are the most common causes of white spots or patches on the tongue. These conditions are usually harmless and should heal on their own, but can be alarming if you don’t know what they are. Below, you’ll find the four most common conditions that can cause white spots on your tongue.

Oral thrush is an overgrowth of a naturally occurring fungus that often appears when the immune system is depressed. Babies, denture wearers, patients with cancer and other immune-compromising conditions, anaemics and diabetes patients, smokers and dry mouth sufferers are all at a higher than normal risk of developing oral thrush. Certain medications, like a course of antibiotics, can also trigger an attack.

Oral thrush is rarely serious, but a long-term infection may require an antifungal medication to help clear it for good. Some of the symptoms of oral thrush include:

• Raised, white spots or patches in your mouth

• Lesions that look like cottage cheese

• Red, cracked corners of the mouth and lips

• Loss of taste

• Cotton mouth or dry mouth

Scraping oral thrush tongue spots usually removes the white coating, but this can also cause slight bleeding. See your dentist if you have a persistent problem.

A white spot on your tongue surrounded by a red, inflamed border is likely to be a mouth ulcer, also known as a canker sore. Mouth ulcers are a painful inflammatory condition that occurs on the inside of your lips and cheeks, tongue or gums. You may get one or more round, white or yellow-tinged sores surrounded by redness.

These common and recurring lesions can be small or large and appear on their own or in groups. Canker sores are often painful, and scraping doesn't remove them.

Viruses, bacteria and immune system issues are some suspected causes of mouth ulcers. Factors like trauma to the mouth, allergies, stress, smoking, taking certain medicines, hormones, iron and vitamin deficiencies can make you more at risk of developing them. Luckily, mouth ulcers usually heal within 1-2 weeks and don’t require medication.

White or greyish patches called leukoplakia usually appear on your gums, the bottom of your mouth or the insides of your cheeks, but sometimes they appear on or underneath your tongue as well. Wiping or scraping does not change their appearance or texture, which may be thick or hardened. Apart from its appearance, leukoplakia is usually symptom-free.

Smoking tobacco and drinking alcohol cause most cases of leukoplakia, and about 75% of people who chew tobacco develop the condition. Leukoplakia also carries a small risk of progressing into oral cancer - it’s therefore important to see your dentist regularly to have your mouth checked.

Fuzzy white patches that appear as ridges or folds are symptoms of a hairy leukoplakia tongue, a condition that gets its name from its appearance. These patches result from infection with the Epstein-Barr virus (EBV), which lasts a lifetime but remains dormant in the body until a weakened immune system triggers an attack. There is no oral cancer risk with this type of leukoplakia; however, it can be linked to complications with HIV.

You may be able to prevent white spots and other oral problems from developing by practising good oral hygiene and making a few simple lifestyle changes. Here are some things you can try that will improve your oral health: 

• Drink plenty of water throughout the day. Two litres (or eight glasses) is recommended daily, which will help to wash bacteria from your mouth and from the surface of your tongue.

•  Brush your tongue twice a day using a soft-bristle toothbrush. 

• Floss once a day to remove bacteria and food particles from between your teeth. 

• After brushing, scrape your tongue using a tongue scraper to remove the white film that can build up over the day. 

• Use a toothpaste and mouthwash that contains fluoride. If you suspect any infection or gum problems, try using an antibacterial mouthwash. 

• Avoid things that can expose your tongue to toxins, like smoking, vaping or chewing tobacco. 

• Avoid foods and drinks that can irritate your mouth and tongue, especially things that are particularly hot, salty, spicy or acidic. Instead, make sure you’re eating a mix of fresh fruits and veg every day. 

• Visit your dentist every six months for a checkup and professional cleaning. Make an appointment with your dentist if you suspect you have an oral health problem.

White spots on your tongue are usually harmless and should clear up without treatment within a few weeks. If your tongue doesn’t go back to normal in two weeks, make an appointment to see your dentist, even if you have no other symptoms. If your tongue is painful, itchy, you have trouble eating, speaking or swallowing or have a weakened immune system, don’t hesitate to see your dentist as soon as possible.

Here are the answers to some commonly asked questions about white spots on tongue and the difference between a leukoplakia tongue and an oral thrush tongue: