White spots on the tongue may be a harmless sign of moderate dehydration that requires no intervention or it may also appear as an alarming feature of an underlying organic condition. Most cases of white spots on the tongue are due to collection of cellular debris, dead cells and bacteria that gives tongue a white appearance. Serious organic conditions that may also present with white spots on the tongue include a variety of fungal or bacterial infections or in some cases pre-cancerous conditions of tongue or oral cavity. There are a number of infectious conditions that may present with changes in the appearance of tongue. Treatments differ with causative conditions.
Causes and Treatments of White Spots on Tongue
Drinking plenty of water and maintaining high hydration can help in removal of temporary white spots. However, if your white spots are not disappearing with homer remedies or is associated with pain, swelling or discomfort in the tongue, or your white tongue lasts for more than 2 weeks, you should see a healthcare provider at earliest convenience.
1. Oral Thrush
Description: Oral thrush (also known as oral candidiasis) is a fungal condition caused by Candida albicans. The creamy cottage cheese like spots are hard to remove with scarping and may bleed on forced removal. The infection mostly involves tongue but may also spread to sides of the cheek, roof of palate, tonsils and other parts of oral cavity. It is also reported in babies born to mothers with infected birth canal (with vaginal candidiasis). In all such cases breast feeding should be stopped until the infection is controlled in the baby with the help of anti- fungal creams.
Treatments: Maintaining oral hygiene helps in the management of most cases. Other helpful home remedies include frequent gargling with warm saline, use of lozenges and oral anti-fungal creams. Increasing the intake of probiotics supplements or yogurt also helps. In case of infantile oral thrush, make sure to frequently wash pacifiers and water bottles of the baby and avoid breast feeding to prevent re-infection.
Home remedies for oral thrush: yoghurt, garlic and clove oil
2. Oral Lichen Planus
Description: A condition seen mostly in middle aged individuals and is characterized by lacy white patches that can spread to adjacent structures of oral cavity like gums and teeth. Oral Lichen Planus may respond significantly to diet modification and lifestyle changes. It is mostly a chronic condition with a possible waxing and waning course. Some healthcare providers suggest that it may also have an association with stress and spicy foods.
Treatments: Most cases resolve spontaneously without requiring a medical intervention with good oral hygiene and maintaining abstinence from alcohol consumption and smoking. Healthcare providers also suggest stress management and decreasing the intake of spicy foods for control of symptoms. You can also consult your healthcare provider for evaluation of cause and management of symptoms.
Oral Lichen Planus treatment:
3. Syphilis
Description: Syphilis is a sexually transmitted disease that is seen most frequently in individuals who perform unprotected oral sex on someone with positive symptoms of genital syphilis. The primary lesion may start within 10 to 90 days post exposure and start off with the development of small painless oral ulcer that may erode and develop white or dirty yellow spots in the oral cavity and tongue.
Treatments: It is recommended to speak to a healthcare provider for management of symptoms via oral penicillin. Avoid sexual intercourse during active infection to prevent transmission to your sex partner.
4. Oral Cancer
Description: Precancerous or cancerous conditions of mouth may also present with oral spots or patches that may also be associated with an outgrowth, weight loss, pain symptoms, frequent bleeding and difficulty in performing oral functions (like chewing, swallowing or talking). Most cases are associated with consumption of oral tobacco and cigarette smoking. Other essential factors that may also play a role in pathogenesis include positive family history of cancer, excessive alcohol consumption and immuno-compromised conditions like HIV.
Treatments: If you are developing symptoms like weight loss, frequent bleeding from mouth without any gum disease and progressive hoarseness of voice, it is recommended to see your healthcare provider at earliest convenience for detection of precancerous lesions.
5. Leukoplakia
Description: Leukoplakia is a trivial condition seen mostly in the setting of tobacco exposure that causes tongue cells to divide at a higher rate to produce white patches. It may also be associated with other immune mediate or inflammatory conditions of the tongue and may be refractory to ordinary brushing or scarping. Although trivial to begin with, if proper management is not done, it can evolve into a pre-cancerous condition over time due to abnormal cell division that may accumulate mutations over time.
Treatments: It is recommended to speak to your healthcare provider about these lesions and besides maintaining oral hygiene, make sure to avoid all irritants that may lead to this condition, like tobacco chewing and smoking.
6. Other Causes
Other possible causes of white patches on tongue include Streptococcus Pyogenes infection, a bacterial infection that may develop in the setting of sore throat, white spots on red tongue or red spots on white tongue. Most cases are identified by bacterial culture and serum tests. In order to avoid complications like rheumatic fever or streptococcal induced glomerulonephritis, it is recommended to timely manage every case of sore throat. Other common causes include dehydration or low water intake, long history of alcohol consumption and certain antibiotics. Most people who are on steroid inhalers are also at risk of developing white patches due to possible fungal infection (fairly common in chronic asthmatics or immuno-compromised patients).