Tongue Problems (cont.)
Donna S. Bautista, DDS
Donna S. Bautista, DDS
Dr. Donna S. Bautista, DDS, completed her undergraduate studies at the University of California, San Diego with a bachelor of arts in biochemistry and cell biology. During her time at UC San Diego, she was involved in basic research including studying processes related to DNA transcription in the field of molecular biology. Upon graduation, she went on to attend dental school at the University of California, San Francisco. In addition to her formal dental training, she provided dental care for underserved communities in the Bay Area through clinics and health fairs. She also worked toward mentoring high school students interested in the field of dentistry.
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
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 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.
There are obvious causes of red color change, such as something you ate (strawberries or red-colored foods). Some acidic foods can cause temporary redness and discomfort. However, a red tongue can be a sign of an underlying medical condition. Some red color changes on the tongue ("strawberry tongue") could be related to a vitamin deficiency, Kawasaki disease, or a strep infection (scarlet fever).
Erythroplakia is a red patch or lesion that cannot be rubbed off on the tongue (except for the color, it is similar to leukoplakia). A lesion with a combined white and red appearance is called erythroleukoplakia. These lesions are all considered to have premalignant potential. Erythroplakia and erythroleukoplakia have an increased risk of premalignancy compared to leukoplakia. In addition to appearance, cause for concern can be if the lesion or sore does not go away or grows in size. A biopsy is recommended by an oral surgeon or an ENT specialist to rule out oral cancer.
A black tongue is usually a harmless condition that can be caused by medications, smoking, poor oral hygiene, soft diet, or dry mouth. A black tongue is usually associated with elongated tongue papillae and thus, it is called "black hairy tongue" (lingua villosa nigra). The cause is thought to be a change in the normal bacteria in the mouth after antibiotic treatment or use of products that contain bismuth such as Pepto-Bismol. ("Hairy tongue" by itself can also be white or tan.) Treatment may involve improving one's diet, smoking cessation, and improved oral hygiene (including gently brushing or scraping the tongue).
Medically Reviewed by a Doctor on 10/21/2014
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