What’s that white coating on your tongue? How to tell if you’re healthy or not

When it comes to oral health, most people don’t go beyond brushing and flossing their teeth. But it may be a good idea to, once in a while, take a good look at your tongue.

Other than giving you an idea why your breath stinks (if it does), in some rare cases, changes in your tongue’s appearance may be telling you something about your health – such as mouth or tongue cancer, or syphilis.

The tongue's appearance can tell a lot about one's health. Does it look like raw meat or have “hair”? Experts tell CNA Lifestyle what these all mean. Fair warning: Graphic images ahead.

For starters, a healthy tongue is pink and covered with small, short, bristly nodules known as papillae, according to Cleveland Clinic, a non-profit academic medical centre in the US. Any deviation from this appearance or any pain may be a cause for concern.

IS IT NORMAL TO HAVE A WHITE COATING ON THE TONGUE?

What about the thin white coating on the tongue? Does that count as a deviation? In most cases, they are harmless and transient, said Dr Lim Keng Hua, an ear, nose and throat (ENT) specialist at Mount Elizabeth Hospital’s Dr Lim Keng Hua Ear Nose Throat Head & Neck Surgery.

“The white coating is caused by the accumulation of debris, bacteria and dead cells between the enlarged and sometimes, inflamed papillae on the surface of the tongue,” he said, adding that bleeding is rare but if it does occur, you’ll need to see a doctor to rule out cancerous growths.

The coating “may be removed by brushing your tongue with a soft toothbrush or using a scraper,” said Dr Lim, who also advised keeping yourself hydrated.

Other ways of lessening the coating is to simply avoid tobacco and alcohol, added Dr Anna See, an associate consultant in otorhinolaryngology with Singapore General Hospital’s Head & Neck Surgery department.

She also pointed out that a thick coating is “not normal.” The causes can include fungal infection, syphilis infection, lichen planus, the early stages of mouth and/or tongue cancer, or HIV. “A thick white coat, which is sometimes associated with chronic ulcers, mouth bleeding and odorous breath, should be investigated by a specialist doctor to rule out underlying causes,” said Dr See.

OTHER APPEARANCES OF THE TONGUE

Other than the usual white coating, your tongue can also take on other appearances. Here’s a look at the various ways it may present itself, and whether you need to seek medical attention.

• My tongue looks like it has grown hair

The build-up of food debris and dead cells – along with poor oral hygiene – can create these brown or black hair-like protrusions on the surface of your tongue, said Dr See.

Dr Lim added: “Other than its appearance, it may result in a metallic taste, bad breath or a tingling sensation”.

A toothbrush or tongue scraper would remove the “hairs”. However, oral hairy leukoplakia, a condition where the brown or black patches cannot be scraped off, is due to Epstein Barr viral infection, which is commonly associated with HIV infection, said Dr See. If the hairiness cannot be eliminated or keep recurring, see a doctor.

• My tongue looks like raw meat

If your tongue feels tender, and looks red and swollen, you may have glossitis. It’s an inflammation of the tongue that causes the papillae to disappear, making your tongue look like raw beef, said Dr See, who associates it with nutritional deficiencies in Vitamin B12 and iron.

According to Healthline, certain hypertension medications, eating spicy food and even toothpaste may also bring about this allergic reaction. 

Topping up on iron and Vitamin B12, as well as avoiding the triggers that cause the reaction should help. But if the swelling and tenderness don’t improve or they keep recurring, see a doctor.

• There are bumps/sores/ulcers on my tongue

Bumps on the tongue can be caused by general inflammation, said Dr See, which can be due to medication use, nutritional deficiencies or constant irritation of the mouth.

But a small, painless sore on the tongue may be a sign of syphilis, said Dr Lim. “When untreated, it becomes syphilitic leukoplakia. Other symptoms may include headache, joint pain and fever.”

When it comes to sores and ulcers, these can be painful or painless. “Painful sores may be due to viral infections. They should resolve in a couple of weeks. If ulcers or sores persist beyond two weeks, medical attention should be sought,” said Dr See.

• White patches on my tongue look strangely like the world map

You have geographic tongue, said Dr Lim. Yes, that’s what it’s called. The appearance is caused by the tongue’s patchy cell turnover. “No treatment is needed and there is no cancer risk,” he said. Just avoid food and drinks that cause discomfort, he added.

• My tongue is cracked but there’s no pain

There may be a single or multiple painless cracks in your tongue. Should you worry? “This is a benign condition where deep grooves or fissures form on the tongue’s surface,” said Dr See. “It is usually painless and harmless.”

Dr Lim noted that no treatment is needed but beef up your oral hygiene to remove food debris trapped within the furrows.

• My tongue looks like it's covered in cottage cheese

These creamy, white and slightly raised lesions on the tongue or inner cheeks can be a sign of oral thrush, which is an infection caused by candida yeast, said Dr Lim.

“The overgrowth of yeast occurs from the overuse of antibiotics, diabetes, iron and Vitamin B12 deficiencies, poor oral hygiene, weak immune system, smoking, hypothyroidism and cancer treatment.”

Although oral thrush is a common condition, it is less likely to occur in adults than in babies, according to Mayo Clinic. Adults who are infected do not report major problems in most instances. But if you have a weakened immune system, it is best that you see a doctor about the oral thrush.


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What’s that white coating on your tongue? How to tell if you’re healthy or not