White spots, patches or dots on the tongue can be harmless or be a sign of a more serious condition including oral cancer. They can affect children (babies, infants, and toddler) or adults.
Also, they could be small or big, they can be found in various parts of the tongue that include the tip, back or under or even on the side. Furthermore, they could be painful (hurt) or not painful.
In most instances. these white spots on the tongue indicate a simple harmless problem. A more serious problem such as oral cancer if is likely is prolonged for more than two weeks and accompanied by other symptoms. You might be required to see a health practitioner.
Also, dead cells, food debris, excessive mucus, bacteria, and fungi can cause this appearance.
In terms of appearance, you might have one spot on a few scattered white dots, clusters that form white patches or they could form a white coating which might take the color of the foods you eat. In most instances, they will tend to begin from the side of your tongue and spread towards the center.
Why do I have white spots on my tongue or what do they mean? Well, there are many causes that include STDs, cancer, and poor oral hygiene, among many others. Below are some of the common reasons why you might be having them including in your mouth.
1. Oral thrush
This is the most common cause. They are as a result of yeast growth in your mouth (fungus candida albicans). Although Candida is normally found in the mouth, their overgrowth might cause some symptoms such as:
- “Creamy white lesions on your tongue, inner cheeks, and sometimes on the roof of your mouth, gums, and tonsils” [mayoclinic.org].
- Cottage cheese looking like lesions that might be slightly raised (bumpy)
- Some bleeding if the lesions are scraped or rubbed
- Redness and cracks in your mouth corners
- Taste loss
- A mouth that feels cottony
Babies and the elderly are more vulnerable to oral thrush as well as people with conditions that suppress their immune system or taking some medication (diabetes, those undergoing cancer treatment). However, it can affect any person and not just children and elderly.
Smoking, poor oral hygiene, cancer, dry mouth, wearing false teeth, using asthma inhalers, and taking antibiotics could also cause oral thrush.
Having them might be an indication of a sexually transmitted disease (STD). The two common STDs that cause this problem are syphilis and HIV. Both of these will tend to cause white spots on the tongue and sore throat among other symptoms.
Syphilis is an STD which if untreated can cause death or nerve, tissue or brain damage. It begins with a painless lesion on are where it entered your body (mouth, tongue, lips, rectum, genitals, anus, etc.) that later forms an ulcer.
In its second stage, it is characterized by i.e. “white patches on the tongue or the roof of the mouth” [northerntrust.hscni.net], sore throat, fever, headache, muscle aches, swollen lymph nodes, etc.
Syphilis treatment is by antibiotics since it is a bacterial infection. It can easily be treated at its earlier stages without any complications.
Another possible cause could be HIV infection. According to drugs.com, HIV can cause “white spots or unusual blemishes on the tongue, in the mouth, or in the throat” [drugs.com].
This should be accompanied with other HIV symptoms such as dry cough, rapid weight loss, unexplained extreme fatigue, pneumonia, “red, brown, pink, or purplish blotches on or under the skin, or inside the mouth, nose, or eyelids,” [drugs.com], sore throat, red rashes on torso, swollen lymph nodes, night sweats, recurring fever, breathe shortness, prolonged diarrhea, among others.
To avoid STDs, always ensure you have protected sex, are faithful to one uninfected partner to avoid. In case you have it, get tested and treated.
Oral precancerous and cancerous condition is known to results in spots or patches in the mouth including on the tongue. These spots might be red, pinkish or whitish in color.
Oral cancer will always be accompanied by a number of signs and symptoms that include oral sores with some on the neck and face, weight loss, feeling that something is stuck in the throat, difficulties in talking, chewing and swallowing, a hoarse voice, a mouth that bleeds easily and takes long to heal ( more than two weeks) among many others.
In case you notice sores that grow fast and become hard, it could be an indication of oral cancer. Ensure this hardened sore is diagnosed.
Oral cancer is associated with tobacco chewing, smoking cigarettes and too much alcohol consumption. It has also been linked with HPV, an “infection with the sexually transmitted human papillomavirus (specifically the HPV 16 type” [nidcr.nih.gov].
Genetics, age, compromised immune systems such as in the cause of HIV AIDS victims, excessive exposure to sun, among other factors can increase someone’s oral cancer risks.
If you have any of the above symptoms, you need to ensure you see a professional healthcare personnel for diagnosis by oral tissue biopsy, MRI, PET, and CT scans and early treatment. Treatment will include “surgery, radiation therapy, and/or chemotherapy” [medicinenet.com].
Another possible cause is leukoplakia, to be specific flat, painless and smooth spots and patches. The white patches or spots are painless and cannot be removed by scraping or brushing. This problem is caused by excessive cell production by mouth lining and keratin protein deposits in the mouth and/or tongue.
Leukoplakia is associated with excessive drinking, smoking, and inflammatory tongue conditions. In some few instances, it can become cancerous after years or decades. Unless it is growing, leukoplakia is not dangerous. It is good to see a dentist determine that your leukoplakia is not growing since it can end up being cancerous.
Proper oral hygiene and avoiding the irritants (smoke and alcohol) is a way of dealing with this condition. Treatments might include oral surgery, antiviral medications to stop patch growth, retinoic containing tropical ointments to reduce patch sizes among others
5. Oral lichen planus
This “is a long-term disorder of the immune system that causes white lacy streaks and white patches in the mouth, including on the tongue” [nhs.uk]. The cause is still unknown, it does not spread from one person to another or run in families. Some medical professionals have associated this problem with stress and spicy foods.
Most lichen planus of the mouth conditions when mild do not cause any pain i.e. they do not hurt. However, in some cases, it can “can cause burning sensations and discomfort in the mouth, painful red gums and sore patches in the lining of the mouth” [nhs.uk].
Most oral lichen planus might not need any treatment. However, severe cases can be treated using steroid sprays or tablets in addition to an antiseptic mouthwash. Furthermore, ensure good oral hygiene, avoid stress, stop very spicy foods and alcohol consumption as well as quit smoking.
6. Streptococcus Pyogenic infection
This is a bacterial infection that can be responsible for the white spots on red tongue i.e. Streptococcus pyogenes could this problem and sore throat.
Its main symptoms include fever, sore throat, inflamed red or swollen tonsils, and “white patches or spots on the tonsils (tonsillar exudate)” [emedicinehealth.com], tender and swollen lymph nodes on the upper neck, headache, nausea, and vomiting, skin rashes, among others.
Infection by acute streptococcus pyogenes can present itself “as pharyngitis (strep throat), scarlet fever (rash), rheumatic fever, acute glomerulonephritis, impetigo (infection of the superficial layers of the skin) or cellulitis (infection of the deep layers of the skin)” [textbookofbacteriology.net].
Patients might bad breath i.e. stinking tonsils when they have whitish deposits on their tonsils. Coughing might dislodge the deposits.
Proper hand hygiene and use of penicillin antibiotics can help deal with this infection. Common prescription includes amoxicillin, penicillin, cephalosporin, macrolides, etc.
7. Tongue piercing
Tongue piercing can lead to these spots near the piercing especially if it is infected. It is easy to know that the white bump is caused by the piercing since it will always be close to the piercing site.
8. Low water intake or dehydration
Dehydration is known to cause temporary ones that will disappear if you take adequate amounts of water. When caused by dehydration, you need no medical attention. The white patches should not have a fuzzy texture or increase in volume
9. Other causes
Besides the above causes, you can have this problem due the use of certain antibiotics, prolonged alcohol consumption, spleen disorders, canker sores, mouth ulcers, cold sores, common cold, use of steroid inhalers (one might develop white patches on tongue due to fungal infections especially among people with a compromised immunity or those with chronic asthma).
White spots on toddler, infant or baby could be small or big and located in various parts including under, on the tip, side or back of the tongue. They could be accompanied by other symptoms such as a sore throat, fever, headache, feeding difficulties, etc. depending on what causes them.
The most common cause is oral thrush. You should see creamy lesions that resemble cheese cottage accompanied with fever, swallowing difficulties, sore mouth etc. check for them on the gums, roof of the mouth, inside of cheeks and on the tonsils. Furthermore, the baby will start crying when they begin breastfeeding even dummy or feeding bottles.
Mothers who have thrush while breastfeeding can infect their children. This problem can be treated with nystatin suspension or miconazole gel.
What if you have a baby with this problem and it is not thrush? Well, they could be due to other reasons we have already seen. To know what the cause is, look at other symptoms associated with them.
For instance, if you have a baby, toddler, or child with feeding problems (due to swallowing difficulties), nasal discharge, sore throat, little fever, and patches or spots of tongue and tonsils, it could strep throat caused by Streptococcus pyogenes. However, the problem is uncommon in infants.
As we mentioned earlier, they can be painful or not painful. In case your they are painful or hurt, some of the common possible causes include the following:
1. Canker sores
These painful type of mouth ulcers that “are white or yellow and surrounded by a bright red area” [nlm.nih.gov] caused by mouth injury, teeth cleaning, tongue biting, stress, food allergies, hormonal variations, and lack of nutrients such as vitamin B12, folic acid or iron. They might be accompanied by fever, malaise, and swollen lymph nodes.
Other conditions that can cause painful ones include:
- Oral thrush – if you scrap or try to wipe it, it can bleed slightly and be painful
- Cold sores or herpes - If you have blisters that could also be on your lips, mouth, and other parts, they could be caused by cold sores.
- Oral lichen planus -Although not common, infection with oral lichen planus might result in burning and painful white spots on tongue mouth.
- Oral cancer
- Mouth ulcer
The above conditions are known to cause pain, soreness or the kinds that hurt much but not always.
Small or tiny ones
They little or tiny, they could be due to pimples characterized by “small, soft, white or reddish tongue bumps that appear on your tongue” [newhealthguide.org], oral thrush, mouth ulcers (especially aphthous ulcers), swollen taste buds, small injuries, canker sores among other conditions. Check for the other related symptoms for a hint on what could possibly cause them.
These small spots could be on the tip, under, on the side or back of the tongue and they can be sore (hurt much, painful or sting) depending on the cause. The can affect infants, toddlers, children or adults.
On tip, side, under or back of tongue
As already mentioned, the spots can appear anywhere on your tongue. Some of the common places you expect them and what could be causing them include:
1. On the side of tongue
What does it mean? Having a bump on either side of your tongue, left or right can mean or be caused by a number of diseases and conditions including oral cancer, canker sores, biting, oral thrush, irritation from dental appliances, tooth infection, or any of the many causes we have already discussed.
The spot or dots might be painful (hurt), not painful, little, large, many or just one. You need to study other symptoms associated with the spots or dots to be able to tell what is behind them.
2. On the tip
Sometimes, you can have them in this part and they could be painful (hurts or sore) or painless. The dots can be small, big, clustered, multiple or just one spot.
The most common causes are tongue biting and injuries. You will tend to have white bumps or spots as you begin to heal. Sometimes, injuries can be infected and thus swell, be red, painful and cause fever.
If you have multiple ones, it could be oral thrush which caused by yeast overgrowth. This could be common in children (infants, babies, and toddlers).
Finally, a lumpy, hard white spot on tip of the tongue could be a precancerous spot. It is good to ensure you get diagnosed if it lasts for more than two weeks to reduce any chances of developing oral cancer without your knowledge.
3. On back of your tongue
Sometimes you might have them in this part. These could be caused by a number disease and conditions that include swollen circumvallate papillae (taste buds), canker sores, lichen planus, oral thrush or allergic reactions.
It is common to have white spots on the back of tongue and throat, tonsils, bad breath (with some white deposits on tonsils), swollen glands, fever or a sore throat. These symptoms are common when you have a Streptococcus pyogenes, tonsil or throat infections.
4. Under tongue
If you have them beneath your tongue, they could be as a result of a number of causes that include canker sores, body heat (causes very painful large or small ones), oral lichen planus, mucocele growth, oral cancer, cold sores, among other conditions.
White spot on the bottom of the tongue can affect infants, children (babies, toddlers) or adults. You can have just one little spot, clustered and patchy with varying sizes (little or bigger).
Always check for related symptoms such as them being painful, cause soreness or hurts, fever, sore throat, diabetes symptoms, weight loss, etc. as they can easily point out what the cause could be.
To rid of them, there are a number of home remedies and medications which will depend on what is behind them. Go for home remedies to suit soreness while you get a diagnosis to know what is behind them.
While looking at most of the causes, we mentioned something about treatment options. In case you are not sure on the cause, see a medical expert for further advice.
References and sources