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The tongue is not only the strongest and but also an essential muscle in the body. Some of the most basic functions, such as tasting the food, swallowing, and speech, depend on it.
Thus, it is important to ensure that it remains in the pink of health.
The appearance of your tongue is reflective of your inner health. When everything is running smoothly inside, your tongue gives off a natural pinkish hue without any signs of erratic pigmentation.
On the other hand, if your tongue appears to be covered with a grayish-white coating, either entirely or in patches, it is generally due to some underlying health issue.
This discoloration, commonly referred to as “white tongue,” may seem alarming but is mostly harmless and temporary.
In rare cases, however, this condition can be symptomatic of a more serious ailment, such as an infection or cancer.
Common Causes of White Tongue
Improper oral hygiene/care is one of the major reasons for your tongue to turn white.
Over time, bacteria, fungi, food debris, and dead cells can all get trapped between the papillae or tongue nodules, causing them to get inflamed and turning the tongue white.
Because the tongue dorsum is replete with fissures, crypts, and papillae, it is convenient for debris and microorganisms to get stuck within these anatomical niches and become resistant to getting flushed by saliva.
In fact, a single epithelial cell attached to the tongue dorsum is known to have more than 100 bacteria adhered to it, while a cell found in any other part of the oral cavity usually has no more than 25 bacteria attached to it. 
Other usual culprits that lead to white tongue include:
- Dry mouth caused by sleeping with your mouth open or breathing through your mouth
- Oral lichen planus, which is a chronic inflammatory disease that can trigger the appearance of white patches, papules, or plaques inside the mouth
- Excessive alcohol intake, smoking, or tobacco use, which can irritate the lining of your mouth and lead to the development of thick, stubborn, premalignant lesions on the gums, the floor of the mouth, inside of the cheeks, and even tongue
- Could be a case of what is known as geographic tongue
- Reaction to certain medicines
- Skipping on brushing or flossing your teeth regularly, which can lead to the buildup of bacteria, food, and other kinds of debris within the oral cavity.
- Severe diseases such as oral thrush (yeast infection) or syphilis, which can manifest as a white tongue and call for immediate medical attention.
Conditions Related to White Tongue: Signs and Symptoms
Poor oral hygiene is primarily responsible for plaque accumulation in the oral cavity, including the surface of the tongue. A white tongue is, thus, often the result of inadequate brushing, flossing, and rinsing of the mouth.
However, a white tongue can also manifest as a symptom of other oral problems rather than as a condition by itself.
A specific set of accompanying symptoms characterizes each oral condition that can lead to this type of tongue discoloration.
Thus, you can identify the underlying cause responsible for your white tongue by considering the symptoms that come along with it.
Here are the common signs and symptoms of the white tongue according to its cause:
Leukoplakia: If the white/gray striations in your mouth are caused by leukoplakia. They are usually very stubborn in the respect that they cannot be removed by scraping.
The patch tends to appear raised and is usually painless.
Most cases of leukoplakia are non-threatening and tend to resolve once you limit your alcohol intake, quit smoking, and adhere to a stringent oral hygiene routine.
However, if the lesions fail to subside despite the recommended care, you are advised to visit your dentist to rule out the risk of oral cancer or any other serious concern.
Oral Lichen Planus: A mild case of oral lichen planus is characterized by the appearance of white discoloration on the gums, tongue, or insides of the cheeks, which may go unnoticed at first as it usually develops painlessly.
However, when the degree of underlying inflammation is more severe, the patient may experience considerable symptomatic discomfort in the mouth, especially when eating or drinking.
The most noticeable symptoms include:
- The appearance of sore patches on the inner walls of the cheeks.
- Burning sensation in the mouth
- Unusual redness in the gums which may be tender to touch
Geographic Tongue: The patches associated with a case of geographic tongue characteristically appear on the upper surface of the tongue or along its sides in the form of red, inflamed lesions surrounded by an uneven white-colored border.
In some cases, the patches may develop on the underside of the tongue, as well. This condition has no permanent cure. However, cutting down on spicy, acidic foods may reduce the sensitivity and provide some relief.
Oral Thrush: In a typical case of oral thrush, your oral cavity is covered with superficial white patches that can usually be scraped away, leaving the underneath skin exposed and sometimes even bloody.
This kind of yeast infection makes your mouth or tongue feel like they are on fire and often leads to a blunted sense of taste or an unpleasant taste in the mouth.
You may even notice red areas inside your mouth and throat and cracking of the skin around the corners of your mouth.
Syphilis: If you contract syphilis through oral sex, a tiny painless sore may appear on the tongue, anywhere between 10 days to 3 months after initial exposure to the infection-causing bacteria.
If the condition is left untreated, it can advance to syphilitic leukoplakia, which is characterized by the formation of white plaques on the tongue.
Syphilis-induced tongue discoloration may be accompanied by other discomforting symptoms such as:
- Joint pain
- Swollen glands
The signs and symptoms of the white tongue, regardless of the cause, tend to continue until the condition is treated.
If the condition is allowed to go out of hand without proper and timely treatment, a case of the white tongue can just as easily escalate into a more serious infection and spread to other areas of the body.
Standard Medical Treatment for White Tongue
The treatment for the white tongue is determined according to its cause. For instance, if your white tongue is due to a yeast infection such as oral thrush, antifungal medicines are the way to go.
Doctors usually recommend oral drops to arrest the fungal growth in your mouth. These antifungal meds should be taken for at least 1 to 2 weeks until the infection has run its course.
Oral lichen planus is a chronic inflammatory condition that is commonly treated with corticosteroids if it acquires a severe form.
A physician may be consulted to determine if there is an underlying health condition that triggered the lichen planus. However, in most unthreatening cases, it is simply monitored by a doctor or dentist.
If the white patches are a manifestation of leukoplakia, your healthcare professional will keep a close eye on your oral cavity to make sure that the symptoms are not getting any worse.
The health professional may identify and advise you to eliminate any possible irritants that may contribute to this condition, such as tobacco.
The standard treatment for syphilis involves the use of antibiotic penicillin, which eliminates the bacteria from which the infection springs.
People with a white tongue, regardless of the origin, are usually suggested to reduce irritants in the mouth, such as alcohol and tobacco, to promote unimpeded recovery.
Ways to Treat a White Tongue at Home
Here are some safe remedies to help get rid of a white tongue.
1. Self-Care Tips
- Regularly gargle with warm water, especially after meals, to flush out the remnant food particles on your tongue.
- Include more crunchy fruits and vegetables in your diet.
Chewing these hard foods gives your oral cavity a bit of additional cleaning to eliminate plaque buildup. Apples, strawberries, guavas, celery, and carrots are all good options to naturally clean a white-coated tongue.
- Given that alcohol abuse, tobacco consumption, and cigarette smoking are some of the prime culprits for the development of white plaque on the tongue, it is essential to eliminate these unhealthy habits.
- Visit your dentist every 6 months for a checkup to ensure optimal oral health and so that corrective measures can be undertaken if needed.
Professional dental cleaning will help you stave off a whole range of oral health issues.
- You must be completely committed to your oral hygiene routine, which stipulates that you brush your teeth at least twice a day with a fluoride-containing toothpaste. It is recommended that you use a soft-bristled, angled brush, which enables you to clean the inner surfaces of your teeth.
- Flossing can help you dislodge the food particles stuck in the hard-to-reach corners of your mouth and the crevices between your teeth. Thus, flossing your teeth once a day can help deep clean your oral cavity.
- Another important but often neglected step that completes your oral hygiene regimen is rinsing your mouth with a fluoride-containing mouthwash every day.
- Avoid dairy products and sugary foods that trigger mucus production and coat the tongue.
- Certain oral hygiene products can be too harsh for your already irritated tongue and must be avoided. These include alcohol-containing mouthwash and toothpaste that contain sodium lauryl sulfate. Similarly, rinsing your mouth with undiluted hydrogen peroxide can further aggravate your condition and is strictly ill-advised.
- Limit your intake of spicy foods to avoid any further irritation to your oral cavity.
- Keep yourself sufficiently hydrated by drinking at least 8 glasses of water in a day.It is best to meet your daily fill of fluids by drinking water throughout the day. This keeps your mouth moist at all times and thereby helps prevent bad breath and other oral issues.Water helps flush away the food debris from your mouth, which is otherwise used by the oral bacteria as fodder to grow.
2. Practice Regular Tongue Cleaning
Maintaining proper oral hygiene is vital to a healthy tongue. In addition to brushing and flossing your teeth, one complementary step that you should include in your oral hygiene regimen is tongue scraping. 
This method is especially effective in reducing and removing any debris and bacteria that settle in the oral cavity.
A randomized examiner-blind crossover study published in BMC Oral Health found that tongue cleaning reduced the amount of bacterial accumulation in the tongue coating. 
- Scrape your tongue gently but thoroughly, from back to front using a tongue cleaner or a soft toothbrush.
- Do not overdo it by applying too much pressure, which can lead to open wounds, making you susceptible to infection.
- Also, do not insert the scraper so far back that it causes a gag reflex.
While there are specific tools manufactured for this function, some toothbrushes have an inbuilt tongue scraper at the back of their brush head.
Complete oral hygiene should include regular scraping of your tongue along with the standard brushing, flossing, and rinsing routine. Your tongue accumulates food debris, dead cells, bacterial plaque, and other impurities overtime unless cleaned properly. This oral care measure carries a lot of scientific support and is a highly recommended practice to address conditions such as the white tongue.
3. Gargle with Salt Water
You can make your own chemical-free mouthwash at home by simply mixing salt in water.
When you rinse your mouth with a saline solution, the coarse granules of sea salt or kosher salt provide a gentle scrubbing action against the tongue.
Swishing this solution in your mouth helps dislodge the plaque, food particles, and dead cells that have accumulated on your tongue, which are eventually spit out.
Using a saline gargle to flush out the impurities from your oral cavity may help improve your overall oral well-being in general, making you less prone to problems such as the white tongue.
According to a 2015 single-blinded, randomized, parallel-group clinical trial conducted on 45 children, saltwater may work as an antiseptic solution that can help eliminate the oral bacteria responsible for foul breath when used as a mouth rinse. 
Another double-blind, stratified comparative study suggested that a saltwater rinse can be used as an additional curative measure along with the traditional mechanical plaque control techniques to curb oral diseases. 
- Mix a few teaspoons of salt in a glass of warm water.
- Gargle with this salt water thoroughly and then spit it out.
- Repeat several times a day until you are satisfied with the results.
Note: Salt water rinses are not indicated for people with hypertension unless they first consult with their general physician.
Saltwater can serve as a safe, non-toxic, and naturally antiseptic mouthwash that can help preserve and improve your oral health. ENT specialists routinely recommend it as a self-care measure to relieve the discomforts associated with the white-coated tongue.
4. Consume Probiotics
Probiotics are generally considered important agents for the improvement of gut health as they aid digestion, but they are also a good remedy for a white-coated tongue.
According to the findings of one literature review, probiotics may help improve your oral health by inhibiting the growth or colonization of disease-causing pathogens in the mouth. 
This beneficial effect can be attributed to the presence of L.acidophilus and B. lactis cultures in fermented products such as probiotics, but such an effect needs to be verified by further scientific investigation. 
A number of dietary sources can supplement your probiotic needs, which largely include fermented foods such as yogurt, kefir, sauerkraut, kimchi, miso, and tempeh.
You can also speak with your doctor about starting on a probiotic supplement if you fail to meet your requirement of good bacteria through food.
Substantial research is available that supports the use of probiotics as a means to better oral health, but the extent and efficacy of its antibacterial function need to be examined further by way of additional randomized clinical trials with long-term follow-up periods.
When to Consult Your Doctor
Seek medical help if you experience any of the following as these may indicate a more serious underlying cause of white tongue:
- Pain or burning sensation in the tongue
- Development of open sores
- Difficulty in chewing, swallowing, or talking
- Sudden weight loss
- Skin rashes
- The white plaque coating persists for longer than 2 weeks
Expert Answers (Q&A)
Answered by Dr. Wessam Atteya, BDS, FRACDS (Dentist)
Yes, long-term use of broad-spectrum antibiotics could lead to white-coated tongue.
No. However, chronic conditions require some investigations, as in rare cases they can be precancerous.
Yes, it is the most common cause of a white tongue.
A white tongue may not always require treatment. In most cases, it tends to clear up on its own. To get rid of the problem, you can gently brush your tongue with a soft toothbrush.
Or you may even run a tongue scraper on your tongue. Also, drink ample amounts of water to flush out the bacteria and debris from your mouth. It may, however, still require more treatment if caused by issues such as:
– dry mouth
– breathing through the mouth
– irregular or improper brushing and flossing
– eating a lot of soft foods
– irritation to the tongue from sharp tooth edges or wearing dental instruments
– smoking or tobacco use
– drinking alcohol
Yes. However, regular hygiene is more important.
– Basic oral hygiene, such as brushing teeth twice daily and using floss at least once daily, can help prevent white coating on the tongue in many cases. Nevertheless, in some cases, it is not possible to avoid the problem.
– Clean the tongue with a tongue scarpers or gently run the toothbrush through the tongue.
– Avoid tobacco and alcoholic beverages to help prevent a white tongue.
– Eat a nutrition-rich diet.
– Get a dental check-up by your dentist every 6 months. Report any bothersome symptoms to your dentist early on.
A white-coated tongue may be distressing to see but in most cases, it is harmless and can be treated easily.
You may not find instant relief though, so a continued emphasis on maintaining oral hygiene and lifestyle choices is important.
In rare cases:
– The white tongue could be a symptom of a serious hidden condition. In such cases, the best course of action is to follow the specific treatment plan set by your doctor.
– For white tongues caused by oral thrush, take antifungal medicines preferably in the form of oral drops for a couple of weeks or as prescribed. Take the full course of your medication.
– For oral lichen planus, it is simply to be monitored by your doctor or dentist. In some cases, corticosteroids may be needed.
– Leukoplakia also needs to be monitored by an expert professional to keep it in check.
If it is the result of a syphilis infection, treatment would include the use of antibiotic penicillin to kill the bacteria.
About Dr. Wessam Atteya, BDS: Dr. Atteya has almost 20 years of experience treating patients which he gained in public and private practices both in Melbourne and in Cairo. He practices almost all facets of dentistry with a special interest in Implant Dentistry and Oral Surgery, as well as Cosmetic Dentistry.
Dr. Atteya worked at the Royal Dental Hospital of Melbourne and lectured for the Clinical Training Unit of the Dental Health Services of Victoria. He is also a Mentor for the Royal Australasian College of Dental Surgeons – Sydney and serves on the Continuing Professional Development Committee of the Australian Dental Association – Victorian Branch.