Small white spots on tongue

What Your Tongue Says About Your Health

Medically Reviewed by Evan Frisbee, DMD on November 04, 2021

Bumps, patches, and spots in your mouth can be harmless. But sometimes, they can give clues to what’s going on with your overall health. Infections, stress, medication issues, and even aging can make their marks on your tongue. Find out what your tongue is telling you and when you should see your doctor or dentist.

Creamy white spots could be thrush, a fungal infection (shown here). It often happens after an illness or medications throw off the balance of bacteria in your mouth. White patches that look lacy could be lichen planus, which means your immune system is attacking the tissues in your mouth. If you see hard, flat, white areas that can’t be scraped away, it could be leukoplakia, which is linked to cancer. Let your dentist know about any white patches you see.  

If your tongue has a coating that looks like black, brown, or white fur, you might have hairy tongue. Those “hairs” are proteins that turn normal, small bumps into longer strands, where food and bacteria get caught. It should go away when you brush or scrape your tongue. If you have hairy, white patches that you can’t scrape off, it might be oral hairy leukoplakia. It can happen to people infected with viruses like Epstein-Barr or HIV.  

Hairy tongue can be black in color. But your tongue can also go dark after you take an antacid with an ingredient called bismuth. For some people, it stains the tongue black when it mixes with saliva. It’s harmless and goes away once you stop taking the medicine.

A strawberry-red tongue could be an early sign of Kawasaki disease, a rare, serious illness that inflames blood vessels all over the body, most often in children. It’s also a symptom of scarlet fever. If your red tongue is also smooth and you have pain in your mouth, it might be a sign that your body doesn’t have enough vitamin B3.

If your tongue feels like you scalded it with hot coffee and tastes metallic or bitter, you may have burning mouth syndrome. It might mean a problem with the nerves in your tongue. Some health problems, like dry mouth, infections, acid reflux, and diabetes may cause it, too. For some people, acidic foods like pineapple as well as toothpaste, mouthwash, candy, or gum also make their mouth burn.

A tongue without any small bumps on the top may look glossy red. You may get it if you don’t get enough of some nutrients like iron, folic acid, or B vitamins. Infections, celiac disease, or some medications can also cause it. If you have patches of smooth areas next to bumpy ones, it could be geographic tongue. The spots can come and go, and sometimes they hurt or burn. It's harmless, but it could be linked to psoriasis or lichen planus.

Under the tongue is a common spot for canker sores (shown here) -- small, painful, reddish bumps that come and go on their own. A single, painful bump at the tip could be transient lingual papillitis, “lie bumps,” which can pop up if your tongue gets irritated. A virus can also cause lots of little bumps on the tip and sides. If you have a lump on or under your tongue that hurts and doesn’t go away, let your doctor or dentist know. They’ll want to check you for oral cancer.  

Your tongue has lots of nerve endings, so it can really hurt if you bite or injure it.  Canker sores, lichen planus (shown here), thrush, and geographic tongue can cause pain. Some medications and infections can make your tongue sore, too. Sometimes pain in your tongue can be a sign of cancer, especially if you also have a lump or red or white patches. Bring those problems up with your doctor or dentist.  

It’s when your tongue is too big compared to the rest of your mouth. It can take up so much room that your doctor might find imprints of your teeth on its sides. Your doctor will try to figure out and treat the underlying condition, which may be hypothyroidism, an infection, or allergies, among others.

Deep grooves can form on your tongue as you age. They also are linked to Down syndrome, psoriasis, and Sjögren's syndrome. They’re harmless, but you should gently brush your tongue to clear food and bacteria. The grooves might get better when your doctor treats the condition that’s causing them, if there is one.

Many spots, bumps, and colors on your tongue are harmless. But it’s good to know the signs that might point to cancer: Sores that don’t heal, lumps, tongue pain, and trouble chewing or swallowing. If these symptoms last more than 2 weeks, see your doctor or dentist. 

IMAGES PROVIDED BY:

1) Thinkstock

2) Medical Images

3) Science Source

4) Medical Images

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8) Getty

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12) Medical Images

SOURCES:

American Academy of Oral Medicine: “Hairy Tongue.”

American Family Physician: “Common Tongue Conditions in Primary Care.”

American Academy of Family Physicians: “Canker Sores.”

Canadian Cancer Society: “Signs and symptoms of oral cavity cancer. ”

Cancer Research UK: “About tongue cancer.”

Cleveland Clinic: “Burning Mouth.”

DermNet New Zealand: “Transient lingual papillitis.”

Mayo Clinic: “Canker Sores,” “Leukoplakia,” “Oral lichen planus,” “Geographic Tongue,” “Oral Thrush,” “Mouth Cancer.”

Merck Manual: “Tongue Discoloration,” “Tongue Injury,” “Kawasaki Disease.”

NHS: “Sore or painful tongue.”

UpToDate: “Patient education: Intravenous immune globulin (IVIG) (Beyond the Basics).”

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Causes and when to see a doctor

The tongue has lots of small spots on it for taste and sensation. They are not usually very noticeable. If spots are an unusual color, cause irritation, or other symptoms accompany them, they can be the sign of a health problem.

In this article, we look at what healthy spots on the tongue do, and the causes of unusual spots. We also cover diagnosis, treatment, and prevention tips.

Tongue spots that are unusual in color, size, or appearance or are accompanied by other symptoms could signal a health problem.

Causes of unusual tongue spots include:

Lie bumps

Transient lingual papillitis is a condition more commonly referred to as lie bumps. A key symptom is small red or white bumps on the tongue. These bumps are enlarged or inflamed papillae.

Lie bumps can affect one or several papillae. Other symptoms can include:

• pain
• a burning or itching sensation
• greater sensitivity to heat

Lie bumps commonly result from injury to the tongue, for example, when a person accidentally bites their tongue.

Viruses, psychological stress, and poor nutrition can also cause the condition.

Lie bumps usually heal without treatment within a week. If treatment is necessary, a person can try a medicated mouthwash or antihistamines to help them reduce the swelling.

A person with lie bumps can quicken the healing of the tongue by:

• avoiding spicy foods
• avoiding hot liquids or food
• not sucking sweets
• brushing teeth with care

Tongue burn

If a person burns their tongue on hot food or liquid, it can cause blisters. These can appear as small, fluid-filled spots on the tongue.

Blisters will heal more quickly if they remain unbroken. A person can promote healing and prevent blisters from breaking by taking care when brushing the teeth and eating and drinking.

A burn on the tongue does not usually require treatment. Keeping the mouth clean by using mouthwash can help to prevent an infection.

Canker sores

Canker sores are very common. These small ulcers look white or yellow and can appear on the tongue, inside of the mouth, and on the lips. The cause of canker sores is not clear.

Canker sores usually go away without treatment. Directly applying an over-the-counter (OTC) medication, such as benzocaine, to the ulcer can relieve discomfort and promote healing.

In some cases, canker sores can be a sign of an underlying health condition. If a person has other symptoms, they may wish to seek medical advice. These symptoms include fever, stomach pain, and a rash elsewhere on the body.

Geographic tongue

The medical term for geographic tongue is benign migratory glossitis.

Geographic tongue causes inflammation on the sides or top of the tongue and usually appears as a blotch or spot of redness surrounded by a white border.

Doctors are not sure what causes geographic tongue, but it may be related to stress, allergies, or diabetes. The condition does not usually cause any other symptoms and should heal without treatment.

Oral yeast infection

A yeast infection known as oral thrush can affect the mouth and tongue. Symptoms include:

• white spots, bumps, or patches on the inside surfaces of the mouth
• a bad taste
• pain or soreness inside the mouth

If a person scrapes off a white patch on the tongue, they will usually see a red, inflamed patch underneath.

Oral thrush results from an overgrowth of yeast that occurs naturally in the mouth. Certain groups of people are more at risk of developing the infection, including:

• newborn babies
• people who wear retainers or dentures
• people with diabetes
• people receiving chemotherapy
• people with a dry mouth due to medication or a medical condition
• people living with HIV

A person can usually treat oral thrush using OTC antifungal medications. A doctor may also recommend:

• changing a person’s dentures
• changing how a person cleans their mouth or teeth
• trying a different medication that does not dry out the mouth

Scarlet fever

Scarlet fever is a bacterial infection in the nose and throat. One of the key symptoms is a red, bumpy tongue that people often refer to as “strawberry tongue.” Other symptoms include:

• a red, sore throat
• fever
• a red, blotchy rash that usually starts on the chest and stomach
• headache
• stomach pains

Doctors treat scarlet fever with antibiotics. Following antibiotic treatment, scarlet fever usually goes away in around one week, but the rash can last for longer.

Scarlet fever most commonly affects children and is contagious. The infection can be passed on through:

• coughing and sneezing
• sharing or using contaminated objects, such as cups, foods, towels, baths, and clothes

Oral allergy syndrome

An allergy to certain raw fruits and vegetables can cause itching and swelling in the mouth or on the tongue. Swollen patches on the tongue may appear red and irritated.

The reaction is often mild, and a person can avoid it by cutting out the foods that cause the allergy. Cooking or peeling the fruit or vegetable can often prevent a reaction.

Tongue cancer

Tongue cancer is a form of head and neck cancer. Drinking alcohol, smoking, and infection with the human papillomavirus (HPV) can increase a person’s risk of developing tongue cancer.

A bump or spot on the side of the tongue, or a red patch on the tongue, is usually harmless. But if it does not go away, it could be a symptom of tongue cancer. Other symptoms include:

• a sore throat that lasts for a long time
• pain when swallowing
• numbness in the mouth

Anyone who has a painless sore, lump, or red or white patch on the tongue that does not go away should see a dentist or doctor.

There are four kinds of healthy spots or bumps that typically appear on the tongue. The medical term for these spots is papillae.

• Fungiform papillae are the small spots that appear all over the tongue. A person usually has 200 to 400 of these, mostly at the tip and edges of the tongue. Each of these papillae contains three to five taste buds.
• Circumvallate papillae are bigger spots that appear at the back of the tongue. They are slightly raised and are arranged in a ‘v’ pattern. A person usually has 7 to 12, with each one containing thousands of taste buds.
• Foliate papillae appear on the back of the tongue and at the edges. A person usually has around 20, with each one containing hundreds of taste buds.
• Filiform papillae are found in the center and at the front of the tongue. There are more of this type of papillae than any other. They do not contain taste buds.

Papillae help people to sense and taste with the tongue. Nerves that send messages about flavor to the brain are connected to taste buds. Papillae are also important for giving information about temperature, chewing food, and speaking.

People should consider seeing a dentist or doctor for:

• unusual spots on the tongue last longer than a week
• spots that bleed, become more painful, or spread

A doctor will usually ask about any other symptoms, when the spots appeared, and any pain a person is feeling. This information can help a doctor give a diagnosis and offer further advice or treatment.

Practicing good oral hygiene can help to prevent oral yeast infections and may help the tongue to heal after an injury or illness. To keep the mouth, teeth, and tongue healthy, dentists usually recommend:

• brushing teeth twice per day
• flossing daily
• avoiding too much sugar

It is not possible to prevent all spots on the tongue, particularly those due to infections and canker sores.

Taking medication correctly, keeping the mouth clean, and avoiding irritating the mouth when eating or cleaning teeth can promote healing and prevent spots from reoccurring.

People have many tiny spots on their tongues that are crucial for taste and sensation. But spots that are unusual in color, size, or appearance could be the signs of a health problem.

Unusual spots can have a range of causes, from tongue injuries to an infection. They often go away without treatment but can sometimes be a symptom of a more serious medical condition, such as scarlet fever or tongue cancer.

People may wish to see a dentist or doctor if tongue spots do not go away on their own within a week. If a person has other symptoms, or if the spots bleed or become more painful, they may need treatment.

What to do if a white spot appears on the tongue

The state of the tongue can be used to judge the health of many internal organs of a person. Changes in its color and structure, plaque or spots indicate a malfunction in the body. How the tongue normally looks, what causes white spots and when to see a doctor - in this article.

What a healthy tongue looks like

When a person is healthy, his tongue is even, soft, pale pink in color. Movement does not cause discomfort. The papillae on the tongue are not smoothed: small at the tip, closer to the middle - larger. Plaque - white in a small amount, easily removed with a toothbrush. Taste sensations are not disturbed ^[1] .

In order not to miss the development of unpleasant diseases, regularly conduct an independent examination of the tongue. To do this, follow a few rules:

• Examine the tongue in the morning before brushing your teeth.

• Use natural light.

• Do not strain your protruding tongue.

• Keep in mind what you ate the day before. For example, beets or blueberries stain the tongue.

You can comprehensively assess the state of the language by honestly answering a number of questions:

• The color of the tongue.

• How smooth it is.

• Is there any plaque, what color and density.

• Is the language homogeneous in its structure.

• Have teeth been imprinted on the tongue.

• Cracks in the tongue, sores, sores.

• Do you have bad breath.

Causes of white spots

Harmless causes of white spots on the tongue can be dehydration, smoking, poor diet, poor hygiene, taking certain medications. But behind this symptom, unpleasant diseases can also be hidden, for example, such as stomatitis, leukoplakia, lichen planus, disorders in the digestive tract ^[2] .

1. Candidal stomatitis - inflammation of the oral cavity, which is caused by the fungus Candida. White spots are located on the tongue, cheeks, or completely cover the entire mucous membrane up to the throat and tonsils. There is also a feeling of dryness and burning. The disease is not dangerous, but requires treatment.

Stomatitis occurs due to prolonged use of antibiotics, metabolic disorders. Infection is also possible through objects, products or from another person. Predisposing factors include alcohol use, smoking, dentures, high carbohydrate diet, poor oral hygiene ^[3] .

2. Leukoplakia are white patches or plaques that are not scraped off during examination. Most often located on the mucous membrane of the cheeks along the line of closing of the teeth, they can occur on the back or lateral surfaces of the tongue, on the lips. Tobacco is a common cause of leukoplakia. It has a traumatic thermal and chemical effect on the mucous membrane. Sometimes leukoplakia appears due to an allergy to materials used in restoration and prosthetics of the teeth ^[4] .

3. Lichen planus is a chronic inflammatory disease that targets mucous membranes, skin, and, more rarely, nails and hair. You can find white spots on the tongue, on the surfaces of the cheeks, gums. Usually they are not painful, in some cases redness and rare blistering are noted. Most often, the disease occurs in women aged 40 to 65 years ^[5] . The cause of lichen planus in the mouth is rarely known. The disease may indicate a weakening of the human immune system. It is not contagious and is not inherited.

4. Diseases of the gastrointestinal tract. One of the causes of stomach diseases is the microorganism Helicobacter pylori. Its vigorous activity leads to stomach ulcers, duodenal ulcers, cancers and tumors of the digestive system. The gastrointestinal tract and tongue are closely related. Studies show that spots on the tongue, changes in its color and relief, the appearance of plaque and cracks may indicate diseases of the gastrointestinal tract.

When to see a doctor

Visit your dentist if stains do not go away within a week. White dots, fissures, ulcers and leukoplakia can cause oral cancer. In this case, the sooner a dangerous disease is recognized, the more favorable the outcome awaits the patient ^[6] .

“According to the WHO, in the Russian Federation alone in 2015, 589,341 cases of malignant neoplasms were detected (including 270,046 and 319,335 in male and female patients, respectively). The increase in this indicator compared to 2014 was 4.0%, and these figures are growing.”