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What Causes a White Tongue with Red Spots

What Causes a White Tongue with Red Spots

Oral thrush and leukoplakia are medical conditions that are characterized by the development of white patches on the tongue. This HealthHearty write-up provides information on the contributing factors for white tongue with red spots.
Dr. Sumaiya Khan
Last Updated: May 13, 2018
In healthy individuals, the tongue is pink in color, and has a smooth texture. The change in the color and texture of the tongue could be indicative of certain health problems. At times, sores or bumps might develop on the tongue due to an infection. Trauma due to ill-fitting dentures or a chipped tooth could also cause canker sores. Smoking or chewing tobacco is a common contributing factor for oral problems. Medical assistance must be sought, if ulcers or bumps are accompanied by symptoms such as pain, tongue swelling, or difficulty in swallowing and chewing. The following sections provide information on the circumstances under which one might end up with a white tongue with red spots.

Contributing Factors and Treatment Options
Oral Candidiasis
Also known as oral thrush, oral candidiasis is an infection that causes a change in the color of the tongue. The causal organism for this infection is a fungus called Candida albicans. This is generally viewed as an opportunistic infection that affects individuals who are immunocompromised. It is more likely to occur in individuals who have been taking antibiotics for a long period. The microbial balance in the mouth could get disturbed as antibiotics might also destroy the beneficial bacteria. Wearing ill-fitting dentures for a long period could also make one susceptible to this condition. The common symptoms of oral thrush include:

Large or irregularly shaped velvety white spots on tongue
A raw, red bleeding portion on dorsal surface of the tongue after the white coating is scraped off
White bumps on the tongue
Burning sensation
Bad breath
General discomfort and pain on eating spicy food

If left untreated, the affected individual might end up with a white tongue and sore throat.

Since oral thrush is a yeast infection, the treatment involves the use of antifungal drugs. One must also follow a healthy diet and stay hydrated.

Geographic Tongue
Medically referred to as benign migratory glossitis, geographic tongue is a condition that occurs due to the shedding of normal filiform papillae that are responsible for the normal, velvety appearance of the tongue. This gives rise to the appearance of bald patches. These patches are well-demarcated from the rest of the surface of the tongue. The filiform papillae eventually regrow and shed in another region of the tongue (restricted to the dorsal surface of the tongue though), which is why this condition is also known as benign migratory glossitis. The exact cause of geographic tongue is not yet known, although heredity and vitamin B complex deficiency have been implicated in many studies. This condition is generally asymptomatic. However, the affected individual might sometimes experience symptoms such as:

Red, irregular patches on the dorsal surface of the tongue
Changes in the size, shape, or the location of these lesions
Pain, sensitivity, or burning sensation, especially while consuming hot, acidic, or spicy food items

More often than not, the treatment involves the use of painkillers, topical application of corticosteroids rinses, use of anesthetic or corticosteroid rinses, etc.

Oral Lichen Planus
The exact cause of this condition is not known, but it is believed that it might be triggered by genetic factors and immune response. Drug therapy (drugs recommended for the treatment of hypertension, heart disease, or arthritis), reaction to dental fillings, or poorly-fitted dentures could worsen the condition. Oral lichen planus affects the mucous lining of the mouth. Its symptoms include:

White, lace-like patches on the insides of the cheeks, lips, gums, and tongue
Red, swollen patches of tissues
Open sores that cause pain, discomfort, or a burning sensation
Change in taste
Sensitivity to hot and spicy food items

Topical application of corticosteroids or aloe vera might provide relief. Avoidance of the triggers is suggested.

Besides the aforementioned conditions, irritation of the tongue by ill-fitting dentures, rough teeth, or crowns, or consumption of chewing tobacco or betel leaves could lead to a condition called leukoplakia. This condition is characterized by white bumps or patches on the mucous membrane of the oral cavity. Infectious mononucleosis (Infection caused by the Epstein-Barr virus) can also be the reason behind a white tongue with red spots. Erythroplakia refers to a lesion with a combined white and red appearance.

On a concluding note, practicing good oral hygiene, abstaining from smoking or chewing tobacco, and staying well-hydrated can help lower the risk of some of these conditions. Also, one must consult a dentist to correct issues related to dentures or crowns. Medical assistance must be immediately sought, if spots or bumps on tongue persist, and are accompanied by other symptoms.

Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.