Why You Get Spots On Tongue And How To Get Rid Of Them

Why You Get Spots On Tongue And How To Get Rid Of Them
July 19, 2017 1:40 PM

Having spots on the tongue is more common than you think. They may appear as bumps, pimples, blisters, lumps or other pigmented or color free lesions and may be accompanied by discharge of pus, mucus, blood, etc. Some spots on the tongue may be painful, while others do not cause any pain and you may just notice them by accident.

Contents

  1. Causes of spots on tongue
    1. Black hairy tongue syndrome (lingua villosa nigra)
    2. Geographic tongue (benign migratory glossitis)
    3. Transient lingual papillitis (lie bumps)
    4. Eruptive lingual papillitis
    5. Fungal infection (oral thrush)
    6. Canker sores
    7. Tongue cancer
    8. Linea alba
    9. Burning tongue syndrome
    10. Oral lichen planus
    11. Fissured tongue
    12. Dehydration
    13. Hand-Foot-and-Mouth Disease
    14. Scarlet fever
    15. Kawasaki disease (syndrome)
    16. Other underlying diseases associated with tongue lesions
    17. Medications
    18. Tongue piercing
  2. Differential diagnosis for lesions on tongue
    1. Causes of white tongue
    2. Causes of red or strawberry tongue
    3. Causes of red and white tongue
    4. Causes of swollen tongue and tongue discoloration
    5. Causes of black hairy tongue
  3. Treatment options for spots on tongue
  4. How to prevent spots on the tongue?
    1. Check the appearance of your tongue regularly
    2. Clean your tongue with a toothbrush or special tools
    3. Brush your teeth
    4. See a dentist regularly
    5. Stop smoking
    6. Avoid drinking alcohol excessively
    7. Avoid eating spicy foods
    8. Drink plenty of fluids
  5. Things to remember

Usually, no particular treatment is necessary, and the spots on the tongue will heal on their own.

On the other hand, some bumps or pimples can be serious and require immediate medical attention.

Here is a detailed, evidence-based post in which you will learn about causes, symptoms, treatment options and prevention of spots on the tongue.

We also added some pictures to help you understand the difference between various types of lesions.

Causes of spots on tongue

Your tongue is a mirror to your health and it is quite common to have lesions, bumps, spots or patches on it.

While many disorders are associated with spots on your tongue, the bumps or discoloration may also appear as a result of tongue injury by acidic or alkaline chemicals or foods.

Some foods, such as berries or foods containing artificial dyes, may also cause tongue discoloration or lesions.

Here is a picture of some of the most common lesions on the tongue:

Here is an overview of the most common causes of lesions on the tongue:

Black hairy tongue syndrome (lingua villosa nigra)

Having hairy or furry spots or patches on your tongue may seem alarming, but usually, it is a temporary, harmless condition. The reason for tongue discoloration is an impaired abrasion (e.g. removal) of dead cells from the surface of your tongue due to elongated filiform papillae (1).

This results in dead cell build up on your taste buds. When mouth bacteria digest these dead cells and food you eat, brown, black or gray hairy patches appear on the surface of your tongue (2).

Furry patches on your tongue may occur from certain medication (mainly the long-term use of antibiotics), poor oral hygiene, heavy tea or coffee drinking and tobacco use. It sometimes develops in people on a soft or liquid diet (e.g. individuals with no teeth, etc.), which contributes to dead cell build up on your tongue.

Although the black hairy tongue is usually not harmful, you should see your doctor in the following cases:

  • if your tongue discoloration persists despite brushing your teeth and tongue twice a day for a week
  • if you have altered or metallic taste in your mouth
  • if you are concerned about the appearance of the spots or feel pain or tingling sensation.

Geographic tongue (benign migratory glossitis)

Have you ever stuck your tongue out and saw some map like red lesions on it. This condition is called a geographic tongue (alternative names: benign migratory glossitis, erythema migrans lingualis or glossitis areata exfoliativa or migrans) (3).

These red "islands" often migrate, and they can appear anywhere on your tongue, including its tip, body or sides.

It is an inflammatory disease, but despite its "alarming" appearance it is quite harmless and not associated with cancer or severe infection.

Its symptoms include increased sensitivity to salt, spices and other food (4).

The cause of this disorder is unknown, and people with a family history or fissured tongue tend to be more at risk. Some experts claim that geographic tongue may be linked to psoriasis and lichen planus.

You should see a doctor if the red patches do not heal within ten days. 

Transient lingual papillitis (lie bumps)

Lie bumps are usually white spots on the upper surface of your tongue. The condition affects fungiform papillae (e.g. swollen taste buds) (5).

The exact cause of this disorder is unknown but some possible causes may be stress, smoking, tongue irritation by acidic or sour food, gastrointestinal issues (pyrosis, constipation, nausea) and menstruation.

Lie bumps may look like lingual spots caused by HPV (human papillomavirus) infection. Therefore a biopsy is sometimes performed to make the final diagnosis.

Transientlingual papillitis does not require any medical treatment and the problem usually resolves in a matter of days.

However, these bumps on the tongue can be painful so you should avoid irritating spicy or acidic food and brush your teeth at least two times a day or after every meal.

You should avoid irritating spicy or acidic food and brush your teeth at least two times a day or after every meal. You may also use topical treatments, which cover the lesions and protect them from further irritation (e.g. Zilactin).

You should see a doctor if the problem persists for 10 days or if the pain gets worse.

Eruptive lingual papillitis

Another condition associated with pimples and spots on your tongue is eruptive lingual papillitis. It is similar to transient lingual papillitis and usually occurs in children. It is an infection of the fungiform papillae on the tongue. It is sometimes accompanied by other issues in the oral cavity, including angular cheilitis and enlarged cervical and submaxillary lymph nodes. It usually resolves

It is an infection of the fungiform papillae on the tongue. It is sometimes accompanied by other issues in the oral cavity, including angular cheilitis and enlarged cervical and submaxillary lymph nodes. It usually resolves spontaneously in 2 weeks. If not, see a doctor.

Fungal infection (oral thrush)

Oral candidiasis is another disorder, which may cause spots on tongue.

It occurs when the fungus Candida albicans accumulates and grows on the lining of your tongue and mouth.

When your tongue is affected, you will see some creamy white patches, which may spread to other areas of your mouth, including gums, tonsils, back of throat, lips, and roof of the mouth.

The lesions on your tongue may look similar to "cottage cheese" and may bleed slightly when scratched or irritated (6).

Sometimes they may be associated with red spots or patches on your tongue or throat lining and cause difficulty

The condition mostly affects people with a weak immune system (e.g. HIV/AIDS, cancer, etc.), babies and elderly.

Children sometimes get infected by their breastfeeding mothers (e.g. the infection is passed from nipples to baby's mouth).

It is also quite common in people taking certain medications.

Canker sores

Canker sores (aphthous ulcers) may occur on any soft tissue in your mouth, including the tongue. Mostly, they affect the gums, soft palate and tongue (the tip, sides or bottom of your tongue).

Aphthous ulcers are round or oval lesions with a white central area surrounded by a red border (7, 8).

They may come in clusters and tend to be extremely painful.

There are three types of canker sores, minor ones, major ones and herpetiform ones. The minor ones are small oval shaped lesions, which heal without scarring in about two weeks. The major ones are very large and deep ulcers, which heal with a scar in about 6 to 10 weeks.

Herpetiform canker sores are the pinpoint size and usually occur in clusters of 10 to 100 and merge into a large ulcer. They have irregular borders and heal without scarring in about 2 weeks. Despite their name, they are not caused by herpes virus infection.

The main causes of canker sores on your tongue or in the mouth are as follows:

  • Minor injuries of soft tissues in your mouth (e.g. teeth brushing, accidental cheek bite)
  • Use of toothpaste and mouth rinses containing irritating substances (e.g. sodium lauryl sulfate)
  • Food allergies and sensitivities (coffee, berries, eggs, nuts, cheese) and spicy and acidic food
  • Lack of vitamins (B12, folic acid) or minerals (zinc, iron) in your diet
  • Hormonal shifts (e.g. menstruation) and emotional stress
  • Gut infection (Helicobacter pylori)
  • Diseases increasing the risk of canker sores (celiac disease, IBS, ulcerative colitis, Crohn's disease, Behcet's disease, HIV/Aids, cancer)
  • Faulty immune system attacks of healthy cells

You should see a doctor:

  • if you have recurring sores
  • if the pain is unbearable and does not respond to OTC painkillers
  • if you have a canker sore outbreak with high fever
  • if the sores do not heal within two weeks
  • if the ulcers cause difficulty in swallowing, eating or drinking.

Tongue cancer

Tongue cancer is the most serious cause of spots and lesions on your tongue (9).

Depending on tumor location, there are two types of tongue cancer - oral tongue cancer (e.g. when the tumor is located in the mouth part of the tongue) and hypopharyngeal tongue cancer (e.g. when the tumor is located deeper in the throat in the hypopharyngeal portion of the tongue) (10).

Oral tongue cancer lesions are more visible and are more readily available for surgical removal than deeper hypopharyngeal tongue tumors. They are also diagnosed earlier, and therefore the prognosis is better than in hypopharyngeal tongue cancer.

Tongue cancer is associated with smoking, HPV (human papillomavirus) infection and alcohol drinking.

You should see a doctor if you see any unusual lump or lesion on your tongue, which is not painful and does not heal in two weeks.  

Linea alba

Linea alba (e.g. white line) is thickening of lateral borders of your tongue lining due to an injury or irritation from chewing.

Tongue trauma results in overgrowth of epithelium cells and development of thin white lines on the sides of your tongue (11).

The problem usually heals without any treatment in about two weeks but you must see a doctor as linea alba is a precancerosis, which means that it can turn into cancer later (11).

Burning tongue syndrome

Glossodynia (burning tongue syndrome, also called glossopyrosis) is another possible cause for a swollen or spotted tongue. Its causes include vitamin B12 deficiency, oral yeast infection, irritation from dentures and menopause. Its symptoms are tongue burning and swelling, dry mouth and/or metallic taste in your mouth (12).

See a doctor to get proper treatment recommendations.  

Oral lichen planus

This rare autoimmune condition causes a chronic inflammation of your tongue. It may appear as white lesions, red patches or open sores on your tongue or other mouth tissues (13).

These lesions are usually painful, and their irritation by food or toothpaste may worsen the pain.

If you think your tongue lesions may be oral lichen planus you should see your doctor as soon as possible.

You need to be regularly monitored as oral lichen planus is a precancerosis (e.g. increases the risk of tongue cancer) (13). 

Fissured tongue

Fissured tongue (also called scrotal tongue or lingua plicata) presents with deep grooves in the upper surface (dorsum) of your tongue (14).

It is a benign and usually painless condition. When the fissures get irritated by acidic or spicy food or injured when brushing your teeth, you may feel some pain.

Fissured tongue is a widespread condition, affecting about 40% of people after the age of 40.

The cause is unknown, and some disorders (Melkersson-Rosenthal syndrome, Granulomatous cheilitis, Down syndrome, Geographic tongue, psoriasis, etc.) increase the risk of fissured tongue (14).

No treatment is necessary, but if food gets stuck in the grooves and causes bad breath (halitosis), you should improve your oral hygiene routine and brush your tongue regularly.

Dehydration

Not drinking enough liquids may also cause spots on your tongue. The tissues get dry, and your tongue may get coated with some white to yellow stuff, made of dead cell debris and oral bacteria.

The best prevention of dehydration is regular drinking of plain water. Every person should drink between 2.5 - 3 liters of liquids a day.

Hand-Foot-and-Mouth Disease

This condition causes sores and lesions on your mouth, tongue, buttocks, hands, and feet and is common in children.

However, it may also occur in adults at any time of the year.

Hand-Foot-and-Mouth disease is caused by an enterovirus, which spreads very easily. It is a community condition and its incubation period is 3 to 6 days.

Symptoms of this disease include a sore throat, blisters in the mouth and on the tongue, hands, and feet, which usually resolve in a week.

Usually, no treatment is necessary but if the symptoms persist for longer than 7 days you should go and see a doctor.

Scarlet fever

Scarlet fever or scarlatina is a disease caused by group A streptococcus (GAS). The same bacteria cause a strep throat.

The main symptoms of the scarlet fever are the red rash on the face and neck, which eventually spreads to other parts of the body (trunk, arms, and legs). It feels like sandpaper and may look like a sunburn.

But what does scarlet fever have to do with spots on the tongue?

Another prominent symptom of scarlatina is a so called "strawberry tongue," e.g. red and rough tongue, often covered with a white coating (15).

Other symptoms of scarlet fever are a headache, enlarged lymph nodes, difficulty swallowing, sore throat and nausea or vomiting.

If you have a strawberry tongue and any of the symptoms above, see your physician as soon as possible as you will have to take antibiotics to cure the disease.

Kawasaki disease (syndrome)

Kawasaki syndrome is a vessel disease. The disease has several stages, and its symptoms comprise red strawberry tongue, fever, red eyes with no discharge or red swollen feet and hands.

The disease has several stages, and its symptoms comprise red strawberry tongue, fever, red eyes with no discharge or red swollen feet and hands (16).

It mostly affects children under five years of age.

Doctors do not know what causes this disease.

Kawasaki syndrome can be dangerous as one of its complications is the inflammation of vessels (vasculitis), which may be fatal.

So if you have a red strawberry tongue associated with any of the symptoms above, you should see your doctor immediately to avoid permanent damage to your vessels. 

Other underlying diseases associated with tongue lesions

Spots, patches, ulcers, bumps and other non-specific lesions on the tongue are commonly caused by diseases, such as diabetes, anemia or psoriasis (17, 18, 19). If you have any of these disorders make sure to see your doctor immediately to get a proper treatment.

Medications

Use of some drugs may be associated with tongue lesions or swelling (20).

Here is a brief overview of some medical drugs, which may cause lesions or discoloration of the tongue.

Medicines causing tongue swelling

Penicillins, aspirin, ACE inhibitors and sulfonamides (sulfa drugs).

Medicines causing tongue ulcerations and inflammation

Medications used in the treatment of cancer (e.g. doxorubicin, melphalan, methotrexate, 5-fluorouracil), barbiturates, tetracyclines, sulfa drugs, NSAIDs (naproxen sodium, salicylates), immunomodulators (gold salts, etc.), diuretics (thiazides, spironolactone), aspirin, hydrogen peroxide, phenytoin, phenols, etc.

Medicines causing bumps on the tongue

Antibiotics (tetracyclines, streptomycin, isoniazid, rifampin, etc.), antidiabetics (insulin, glipizide, chlorpropamide, etc.), diarrhea treating drugs (bismuth), antifungals (amphotericin, ketoconazole), antihistamines, antihypertensives, diuretics (furosemide), immunomodulators (dapsone), chemotherapeutics, NSAIDs, antirheumatics (phenacetin, ibuprofen, etc.).

Medicines causing tongue pigmentation or discoloration

Amiodarone, antimalarials (chloroquine, quinidine), cyclophosphmide, estrogen, antifungals (ketoconazole), zidovudine, etc.

Tongue piercing

Tongue piercing is a small hole made in your tongue so that you can wear jewelry. It comes with certain risks, including tongue bleeding or inflammation, which may result in the formation of spots, bumps and other lesions on your tongue.

Tongue piercing is a common cause of spots, bumps and inflammation of the tongue

Tongue piercing is a common cause of spots, bumps and inflammation of the tongue

Make sure you have your piercing done by an expert (or a doctor) and in the case of any complications seek immediate medical attention. 

The summary: Some of the most common causes of tongue spots, bumps and discoloration include medical disorders, such as black hairy tongue syndrome, geographic tongue, lie bumps, oral thrush, canker sores, tongue cancer, linea alba, oral lichen planus, burning tongue syndrome, fissured tongue, scarlet fever or Kawasaki syndrome, as well as side effects of medicines (e.g. antibiotics, ACE inhibitors, sulfa drugs, diuretics, NSAIDs, etc. Your tongue may also get coated when you are dehydrated. Make sure you see a doctor if the problem persists for more than 2 weeks or if your tongue lesion is accompanied by other symptoms, like fever, swollen lymph nodes or difficulty swallowing or eating.

Differential diagnosis for lesions on tongue

The color of a healthy tongue is pink, and its surface is covered by taste papillae (small nodules). The lesions on the tongue look different, and it is crucial to recognize bumps that are benign from changes that may indicate a serious illness, such as cancer.

The picture below shows different presentations of spots, bumps, patches and other lesions on the tongue.

Spots and lesions on tongue: different common presentations

Spots and lesions on tongue: different common presentations

You can see some canker sores (1), black hairy tongue (2), a geographic tongue (3), white coating of the tongue (4), tongue cancer (5) and a strawberry tongue (6).

Other lesions, like oral thrush or HPV infection, may look very similar.   

Here is an overview of some common tongue lesions according to their shape and color.

While we try to provide as accurate information as possible do not rely on any information you find on the web and always see a doctor to get proper diagnosis and treatment for lesions, spots, bumps or discoloration of your tongue.

Causes of white tongue

The most common causes of white spots or coating on your tongue include leukoplakia, oral thrush, oral lichen planus, lie bumps, HPV infection.

White patches on sides of your tongue may be caused by a condition called linea alba linguae. You may also have a white coating on your tongue if you do not drink enough liquids (e.g. dehydration).

Causes of red or strawberry tongue

Possible causes of red or strawberry tongue include vitamin deficiencies (mainly folic acid or vitamin B12 deficiency make your tongue red), geographic tongue, scarlet fever or Kawasaki syndrome. Inflammed grooves in tongue (e.g. fissured tongue) may also cause red spots or patches.

Causes of red and white tongue

Some spots on your tongue may be both red and white. The most common cause of red and white tongue are canker sores, which present as oval or round lesions with white central part surrounded by a red border.

Causes of swollen tongue and tongue discoloration

A swollen tongue is usually caused by medicines (e.g. some antibiotics, heart disease drugs, diuretics, NSAIDs, etc.) or by an allergic reaction (anaphylaxis). See your doctor immediately or call 911 if you have difficulty swallowing or breathing.

Other causes of swollen tongue include burning tongue syndrome, smoking, certain medical conditions (anemia, diabetes), oral cancer, swollen taste buds (enlarged papillae), canker sores and trauma (e.g. when accidentally biting or scalding your tongue).

Some medicines (e.g. amiodarone, antimalarials, estrogen, antifungals, etc.) may change the color of your tongue. Tongue discoloration is also caused by foods (berries), coffee, tea, and tobacco.

Causes of black hairy tongue

While having a black hairy tongue usually means nothing serious it does not look good. A furry tongue is commonly associated with poor oral hygiene, extensive or prolonged treatments (e.g. antibiotics, chemotherapy or diabetes). Also, HIV/AIDS patients are more likely to have a condition called oral hairy leukoplakia, which causes a black furry tongue. 

The summary: Spots on the tongue may look different. The common presentations include red, white and black hairy spots on tongue. See a doctor if your tongue lesion does not heal within 2 weeks or if you have additional symptoms, such as fever, swollen lymph nodes or difficulty breathing or swallowing.

Treatment options for spots on tongue

The actual treatment of spots, bumps, and other lesions on your tongue depend on the underlying disease. While poor oral hygiene is one of the most common causes of tongue spots and coating, sometimes the best cure would be an improvement of your hygiene routine (e.g. brushing your tongue regularly while cleaning your teeth).

Some conditions, such as geographic tongue, do not require any treatment and will self-heal in a matter of days or weeks.

On the other hand, if you have a strawberry tongue you may need antibiotic treatment, because it may be associated with scarlet fever.

Bumps or lumps on your tongue, which are not painful and do not heal in 2 weeks must be checked by your doctor to rule out a severe disease, such as tongue cancer. The treatment options for tongue cancer include surgery, chemotherapy, and radiotherapy.

If vitamin or mineral deficiencies are the cause of the spots on the tongue (in particular vitamins B12, folic acid and iron deficiency), make sure you eat plenty of foods containing these vitamins and minerals.

In the case of tongue swelling, you may try melting an ice cube in your mouth to ease the swelling.

If you have spots or discoloration on your tongue, see your doctor for proper diagnosis and treatment.

The summary: The treatment for spots on tongue depends on the underlying disease. See a doctor to get proper medical care.

How to prevent spots on the tongue?

"An ounce of prevention is worth a pound of cure."

Can you remember this saying?

Many tongue problems, such as leukoplakia, white coating or tongue cancer, are associated with poor oral hygiene and unhealthy lifestyle.

Make sure you follow a good oral (tongue) hygiene routine.

The following tips will help you:

Check the appearance of your tongue regularly

Check out your tongue every evening before you go to bed. Its color should be pink, and there should be no visible spots, patches or lesions. The tongue should also be coating free.

See a doctor:

  • If you have any concerns regarding the appearance of your tongue.
  • If the tongue spots, bumps, discoloration, coating or other lesions do not self-heal in two weeks.
  • If you feel a persistent tongue pain.
  • If you have other symptoms, such as fever, swollen lymph nodes or difficulty swallowing or breathing.

Clean your tongue with a toothbrush or special tools

You should clean or brush your tongue regularly to get rid of coating (e.g. dead cells and oral bacteria) and prevent spots and other serious bumps or lesions.

There are various "tongue cleaners" available on the market. Ask your dental hygienist or dentist to recommend the best one for you.

If you do not have a unique tool for cleaning your tongue, just use a soft toothbrush to scrape your tongue from the back to the front.

Scraping and cleaning your tongue with a cleaner is a good prevention of tongue issues

Scraping and cleaning your tongue with a cleaner is a good prevention of tongue issues

Clean your tongue every morning!

Rinse your mouth with your mouthwash after scraping the tongue, to get rid of debris.

Brush your teeth

Clean your teeth two times a day (in the morning and before going to bed). Learn how to brush your teeth from a dental hygienist.

See a dentist regularly

Make sure you see your dentist every six months to check the health of your teeth and mouth.

Stop smoking

Tobacco smoking not only stains your teeth and tongue but also increase the risk of halitosis (bad breath) and tongue cancer. Quit smoking to maintain good oral health and prevent tongue lesions.

Avoid drinking alcohol excessively

Alcohol may also cause spots on your tongue. What is more, excessive alcohol consumption is associated with increased risk of cancer, liver and mental problems.

Avoid eating spicy foods

Spicy foods may worsen the irritation of tongue lesions and make them more painful. Avoid them if you have any unusual spots or grooves on the tongue.

Drink plenty of fluids

Dehydration is a common cause of tongue coating. Make sure you drink plenty of fluids (still water is the best drink for you) every day. An adult should drink between 2.5 to 3 liters of fluids each day.

The summary: Prevention of spots on the tongue include good oral hygiene, avoiding alcohol and tobacco use, drinking enough fluids and more.

Things to remember

Causes of spots on the tongue include medical disorders, medicines and unhealthy lifestyle habits, such as smoking or excessive alcohol drinking.

Some underlying diseases also increase the risk of spots, bumps or other lesions on the tongue. These include, for example, diabetes or anemia.

The best prevention of tongue spots, swelling or discoloration is proper oral hygiene and adherence to the principles of a healthy lifestyle.

See a doctor if your tongue lesion does not heal within two weeks or if you are concerned about the appearance of your tongue spots.

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Written by: Michal Vilímovský (EN)
Education: Medical student, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
Article resources:

See numbered references in the article

Image resources:

Stockphotosecrets.com

Picture collage made using pictures from Richard P. Usatine, MD. (Aphthous ulcer), Dentistsays.com (Oral cancer), Dentagama.com (Strawberry tongue), Webmd.com (Black hairy tongue), Ladycarehealth.com (Coated tongue) and Odyssey (Geographic tongue).

Published: July 19, 2017 1:40 PM
Last updated: August 16, 2017 10:00 PM
Next scheduled update: August 16, 2019 10:00 PM
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