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Color changes related to the tongue can range from a benign concern to one that requires medical attention. Often, a white tongue could be caused by a removable coating of food debris or bacterial plaque. Otherwise, the following are some common causes of white tongue -- a fungal infection referred to as oral thrush, leukoplakia, oral lichen planus, hairy leukoplakia, and linea alba.
Oral thrush (or candidiasis) is a caused by an overgrowth of yeast in the mouth. The white patches can be scraped off to expose a red surface on the tongue. Illnesses, medications, stress, and antibiotic treatment can cause oral thrush by throwing off the balance of natural bacteria in the mouth. Lozenges, tablets, or liquid antifungals are used for treatment.
Leukoplakia is characterized by white patches that cannot be scraped off and may be related to chronic irritation in the mouth, although the cause is not always known. Tobacco use is the most common factor that contributes to leukoplakia. The condition may resolve after smoking cessation. Sometimes the patches are on the sides of the tongue and could be related to constant rubbing next to the lower teeth. Although leukoplakia is usually benign, it can be the precursor to oral cancer. The risk of cancer increases with the age of the individual, size of the lesion, and number of lesions present. A biopsy may be recommended after clinical evaluation by the doctor. Sometimes, the area can be monitored for changes by the doctor. Monitoring is usually performed during routine dental visits or during visits with an ear, nose, and throat (ENT) specialist.
Oral lichen planus on the tongue is a chronic inflammatory condition caused by an autoimmune response (the body's immune system attacking its own tissue). It is characterized by a white lace-like pattern called reticular lichen planus. (There is an erosive form that presents as shallow ulcerations and can be treated with topical steroids.) Regular monitoring of this condition is recommended for any changes that (although rare) could lead to oral cancer. A biopsy may be recommended.
Hairy leukoplakia is a white patch on the side of the tongue that appears hairy or rough. This condition is caused by the Epstein-Barr virus and is usually related to immunocompromised individuals. HIV testing should be considered if hairy leukoplakia appears without a known immunocompromising condition. Antiviral medications such as acyclovir (Zovirax) may be used. Recurrence of hairy leukoplakia is common.
Linea alba is a benign condition that is characterized by a thin white line at the lateral borders of the tongue. It is caused by the thickening of the epithelium due to trauma or irritation from chewing. No treatment is necessary for linea alba.