What if you saw a thin white coating over your tongue in the mirror when you woke up or noticed a milky film while brushing your teeth? Chances are, something like this has happened to you at least once. There are a wide variety of factors that can change the way your tongue looks and feels. While changes in color can be alarming, there are many causes for this condition, most of them relatively harmless and easily remedied.
The most important thing is that when you notice a difference in your dental appearance, you contact a dentist for assistance. Left ignored and untreated, many oral health conditions can dramatically worsen. Seeking assistance early on can save you time, money, hassle, and discomfort. Many people mistakenly believe that dentists only care about teeth, but we’re actually dedicated to making sure every aspect of your mouth is well cared for. At Dr. Cindy Flanagan’s Houston dental practice, we’re here to help our patients with all manner of oral health concerns. In the following blog, we answer the common question, “What does it mean if my tongue is white?” If you have or ever had a white tongue, you probably want to know what caused it and how you can fix it.
What Causes the White Color?
On a basic level, your tongue looks white because the papillae (fleshy raised portions of tissue lining your tongue) have become swollen for some reason. Since they are more raised, the papillae can trap tiny particles of food, dead cells from within your mouth, or bacteria between them, creating a paler hue. In certain cases, the papillae may not be inflamed, but excess debris still collect in your mouth for some other reason. You may be able to return your tongue to its normal pink by rinsing with water or brushing it to remove these substances, but it will likely become white again if you do not address the underlying cause.
Dry Mouth: It’s Nothing to Spit At
Dry mouth, or xerostomia, occurs when the salivary glands in your mouth do not generate enough saliva. This may seem like a relatively minor issue, but it can have important oral health consequences. The water in your saliva functions as your own personal mouthwash, clearing away debris. In addition, human spit contains antibacterial compounds and enzymes to break down food, further protecting your teeth and gums from decay or infection. As the Harvard Medical School Family Health Guide points out, saliva also “contains bicarbonate, which acts as a buffering agent that offsets the enamel-corroding acid produced by bacteria.” In short, your spit is the savior of your mouth, fending off danger at every turn.
In addition to making your mouth more vulnerable to disease, xerostomia can cause your tongue to turn white. When your mouth becomes too dry, the papillae on your tongue can become inflamed, collecting debris without enough spit to rinse it away. Approximately ten percent of Americans suffer from dry mouth. It’s often caused by simple dehydration, which is an alarmingly prevalent condition in the United States. According to the University of Florida, “studies show that…up to three-fourths of Americans drink well below the recommended levels,” which are “13 ounces of fluid” daily for men and “nine ounces per day” for women. If you don’t drink sufficient water and your tongue turns white, this could very well be why.
Xerostomia can also come about as a side effect of certain medications such as antidepressants, antihistamines, decongestants, and others. Uncontrolled diabetes and radiation therapy can increase your risk for dry mouth, as well. In some rare cases, it may be the result of Sjögren’s syndrome, in which your body’s immune system attacks the salivary and other glands.
If you have a white tongue due to dry mouth, you can usually resolve this condition by drinking more water, using a humidifier, or rinsing with special mouthwash. You can also chew sugar-free gum or suck on sugarless lozenges to stimulate saliva production. You should avoid smoking and reduce your alcohol consumption.
While dry mouth is the most common cause of white tongue, this symptom could also result from a condition known as leukoplakia. Mayo Clinic describes it: “leukoplakia usually occurs on your gums, the insides of your cheeks, the bottom of your mouth – beneath the tongue – and, sometimes your tongue. It usually isn’t painful and may go unnoticed for a while.” This condition often manifests as “white or grayish…patches that can’t be wiped away.” These can be “irregular or flat-textured, thickened or hardened in areas” and may come up “along with raised, red lesions.” Leukoplakia may also occur in a “hairy” form, which “causes fuzzy, white patches that resemble folds or ridges, usually on the sides of your tongue.”
As Mayo Clinic reports, “doctors don’t know what causes leukoplakia but consider chronic irritation from tobacco – whether smoked, dipped or chewed – to be the main culprit in its development.” The “hairy” form of leukoplakia “primarily affects people whose immune systems have been weakened by disease, especially HIV/AIDS.” In addition, while the growths of leukoplakia itself are frequently “noncancerous (benign)… some show early signs of cancer.” So, in addition to being irritating, leukoplakia can be a warning sign for oral cancer. If you notice white patches, you should schedule an appointment to see Dr. Flanagan for a more comprehensive diagnosis. We regularly perform oral cancer screenings at patients’ routine cleanings and exams.
Yeast naturally lives in your body, but if it becomes imbalanced and begins to grow out of control, this can cause a yeast infection in your mouth. A fungus called Candida albicans can infect your mouth and accelerate the yeast growth process. As in leukoplakia, oral thrush causes white cells to collect on your tongue, typically in thick splotches. Mayo Clinic describes these as “creamy white lesions on your tongue” or “slightly raised lesions with a cottage cheese-like appearance.” Oral thrush can also result in “a cottony feeling in your mouth.”
An important difference between leukoplakia and oral thrush is that oral thrush patches can be wiped off of the tissue, while leukoplakia cannot. The United Kingdom’s National Health Service (NHS) cautions, however: “when you wipe off the white patches they leave red spots that can bleed.” The NHS points out that “oral thrush is usually harmless” and is “common in babies and older people with dentures.” You can get oral thrush if your immune system is weakened for some reason or if you have recently been taking antibiotics, which can disrupt your body’s bacterial balance. To combat this issue, you can take probiotic supplements, eat yogurt, or take antifungal medications, as recommended by your doctor.
If you do not practice proper oral hygiene, including flossing your teeth, bacterial infection can develop within your gums. According to a recent report from the Centers for Disease Control and Prevention (CDC), “half of American adults have periodontal disease,” with “64.7 million adults [suffering from] mild, moderate, or severe periodontitis, the more advanced form of periodontal disease.” These sobering statistics indicate that if you have a white tongue, it could very well be from gum disease. Periodontal disease can discolor your tongue if bacteria run rampant and collect there. Even if you’re not struggling with a white tongue, periodontal infection could make your gums tender or compromise the tooth they hold if left untreated, potentially necessitating a dental implant or another restorative treatment to replace it. To prevent a white bacterial film from coating your tongue and keep your gums healthy, make sure you brush twice a day, floss once per day, rinse with mouthwash, and use a tongue scraping tool, if necessary. Dr. Flanagan will assess your gums for disease at your next preventive care appointment.
Another potential cause for a white tongue is lichen planus. This condition results in the development of small, grayish white lesions, which can occur throughout the body but commonly appear on the tongue. The American Academy of Oral Medicine notes that “lichen planus can appear in the mouth in several different patterns,” as “lacy web-like, white threads that are slightly raised,” an “erosive (atrophic) [degenerative] pattern,” or, “in severe cases,” as “ulcerations.”
As a 2016 article in the medical journal, Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology notes: “despite being one of the most common mucosal diseases and recognized as early as 1866, oral lichen planus (OLP) is still a disease without a clear etiology [cause] or pathogenesis [development].” The American Academy of Oral Medicine explains that although “the cause of lichen planus is not completely understood…genetics and immunity may be involved.” Some suggest that it is “an allergic type reaction” or an “autoimmune disorder in which the skin cells lining the mouth are attacked by white blood cells.” In any case, however, lichen planus typically resolves with time. Dr. Flanagan can help you manage this condition and alleviate your discomfort.
Is Your Tongue White? Our Houston Dental Practice Can Help
If you ever observe any strange symptoms on your tongue, teeth, or gums, we would be happy to see you for an appointment to diagnose your condition. Contact Cindy Flanagan, D.D.S. to learn more about proper oral hygiene or schedule an appointment.