Why Are There Spots on Your Tongue?

Medically reviewed by Graham Rogers, MD on July 22, 2016Written by Ann Pietrangelo

Overview

Spots on the tongue can be uncomfortable, but they’re usually not serious. They often resolve without treatment. Some spots on the tongue, though, might signal a serious underlying problem that needs prompt medical attention.

You may be able to identify the cause of some spots easily, but others need further examination. Read on to learn about different types of spots, what they look like, and when you should see your doctor.

What are some causes of spots on the tongue?

There are dozens of conditions that may cause a spot, bump, or lesion on your tongue. Here are a few:

ConditionAppearance
black hairy tongueblack, gray, or brown patches; may look like they’re growing hair
geographic tonguesmooth, red spots of irregular shape on the top and sides of the tongue
leukoplakiairregularly shaped white or gray spots
lie bumpssmall white or red spots or bumps
thrushcreamy white patches, sometimes with red lesions
aphthous ulcers (canker sores)shallow, whitish ulcers
tongue cancerscab or ulcer that doesn’t heal

Black hairy tongue

This condition will appear as black, gray, or brown patches that look like they’re growing hair.

Black hairy tongue can start out as a small spot and grow to coat most of the top of the tongue. It’s a buildup of dead skin cells that fail to shed as they should. This could be due to poor oral habits, medications, or tobacco use.

The risk of developing black hairy tongue increases with age and men get it more often than women.

Anything you put in your mouth can alter the color of the spots, including food, caffeine, and mouthwash. Bacteria and yeast can take hold causing the spots to begin to look like hair.

Other symptoms include a tickling or burning sensation on your tongue or the roof of your mouth. You may also have bad breath.

Use your toothbrush on your tongue or a tongue scraper every day to treat black hairy tongue at home. That should help clear it up within a few weeks. Most of the time, black hairy tongue goes away without medical intervention. If not, a dentist or doctor can use special tools to scrape your tongue. Consistent use of a toothbrush and tongue scraper should prevent it from returning.

Geographic tongue

Geographic tongue appears as smooth, red spots of an irregular shape on the side or top of your tongue. The spots can change size, shape, and location. The cause is unknown. It’s harmless and usually clears up on its own, but it can take weeks or months. In some cases, it can last for years.

You may have pain or a burning sensation, especially after eating foods that are:

  • spicy
  • salty
  • acidic
  • hot

Leukoplakia

This condition causes irregularly shaped white or gray spots to form on your tongue. The cause is unknown, but it’s highly associated with smoking tobacco or using smokeless tobacco. It’s also associated with alcohol abuse and can be related to repetitive trauma to your tongue, such as trauma associated with dentures.

Most of the time, leukoplakia is benign. Leukoplakia can sometimes contain precancerous or cancerous cells, so it’s important to see your doctor. A biopsy can determine if there’s any cause for concern.

Leukoplakia can also appear on the gums and cheeks.

Lie bumps

Lie bumps are also known as transient lingual papillitis. They’re small white or red spots or bumps on the tongue. You may have one or more bumps on the surface of the tongue. Their cause is unknown.

No treatment is necessary for lie bumps. They usually clear up on their own in a matter of days.

Thrush

The fungus Candida causes thrush, or oral candidiasis. It appears as creamy white patches, sometimes with red lesions. These patches can appear on your tongue, but they can also spread to anywhere in your mouth and throat.

Infants and older people are more susceptible to thrush. So are people with weakened immune systems or those who take certain medications.

Other symptoms may include:

Most of the time, diagnosis can be made based on appearance. The treatment may include antifungal medication but may be more complicated if your immune system is compromised.

Aphthous ulcers

Aphthous ulcers, or canker sores, are common lesions on the tongue that appear as shallow, whitish ulcers. The cause is unknown but may be associated with:

Sensitivity to certain foods can also cause canker sores, including sensitivity to:

food sensitivity

Canker sores aren’t caused by the herpes virus, which causes cold sores.

Canker sores usually go away in one to two weeks without treatment. Several over-the-counter and prescription medications can treat the symptoms in severe cases. Your doctor may also recommend other treatments or medications depending on the cause of the ulcers.

Cancer of the tongue

The most common form of tongue cancer is squamous cell carcinoma. It usually appears like an ulcer or a scab that doesn’t heal. It can develop on any part of the tongue and may bleed if you touch it or otherwise traumatize it.

Other symptoms include:

Depending on how advanced the cancer is, you may need surgery, chemotherapy, or radiation therapy.

Who gets spots on the tongue?

Anyone can develop spots on the tongue. Spots are usually temporary and not harmful. You’re at increased risk for oral problems if you use tobacco products, abuse alcohol, or have a weakened immune system.

The risk of tongue cancer increases with age and is more common in men. African-American men have tongue cancer more often than Caucasians. Other risk factors for tongue cancer include:

Diagnosing the cause

Dentists are trained to examine your mouth and tongue for signs of oral cancer and other conditions. It’s a good idea to see your dentist twice per year for a thorough exam.

If you have spots on your tongue for more than a few weeks and you don’t know the cause, see your dentist or doctor.

Many tongue spots and bumps, such as thrush and black hairy tongue, can be diagnosed on appearance alone. You’ll still want to tell your doctor about:

  • other symptoms, such as pain or lumps in your mouth, neck, or throat
  • all of the medications and supplements you take
  • whether or not you smoke or have smoked in the past
  • whether or not you drink alcohol or have done so in the past
  • whether or not you have a compromised immune system
  • your personal and family history of cancer

Even though most spots are harmless and clear up without treatment, spots and bumps on your tongue or anywhere in the mouth can be a sign of cancer.

If your doctor suspects tongue cancer, you may need some imaging tests, such as X-rays or positron emission tomography (PET) scans. A biopsy of the suspicious tissue can help your doctor determine for sure if it’s cancerous or not.

Tips for prevention

You can’t completely prevent tongue spots. However, there are some ways to cut down on your risk, including:

  • not smoking or chewing tobacco
  • drinking alcohol only in moderation
  • getting regular dental checkups
  • reporting unusual symptoms of the tongue and mouth to your doctor
  • if you’ve had problems with tongue spots before, ask your doctor for special oral care instructions

Good daily oral hygiene includes:

  • brushing your teeth
  • rinsing
  • flossing
  • gentle brushing of your tongue
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