White patches appearing on the tongue, cheeks, or gums can stem from a variety of causes, ranging from minor irritation to more serious conditions. The appearance and ability to remove the white material are often the first clues to the origin. Understanding the differences between these causes is the first step toward appropriate care.
White Stuff Caused by Fungal Infections
The most frequent infectious cause of white patches is oral candidiasis, commonly referred to as thrush. This condition results from an overgrowth of the Candida albicans fungus, which is normally present in the mouth in small amounts. When the balance of microorganisms is disrupted, the fungus can multiply uncontrollably.
Oral thrush typically presents as creamy white or yellowish deposits that often resemble cottage cheese. These patches can appear anywhere, but they are frequently found on the inner cheeks, tongue, and the roof of the mouth. A distinguishing feature of this infection is that the deposits can usually be gently wiped away, which may reveal a raw, reddish, and sometimes bleeding surface beneath.
Factors that allow the fungus to flourish include prolonged use of broad-spectrum antibiotics, wearing dentures, or using inhaled corticosteroids for asthma. A weakened immune system or uncontrolled diabetes are also predisposing factors. Treatment generally involves the use of antifungal medications, such as topical suspensions or lozenges like nystatin or clotrimazole.
Patches Caused by Inflammation and Trauma
White patches that are non-infectious often arise from chronic physical irritation or an underlying inflammatory disorder. These patches are a protective response by the body’s tissues and are characteristically non-wipable. This group includes localized trauma and systemic inflammatory disease.
Frictional Keratosis
Frictional keratosis is a benign patch of thickened tissue that develops in response to chronic, low-grade mechanical trauma, similar to a callus forming on the skin. This white lesion occurs where the oral tissue is repeatedly rubbed or chewed, such as along the inner cheek, tongue borders, or beneath ill-fitting dental appliances. The appearance is usually a distinct, localized white plaque with a rough or slightly corrugated surface.
This type of patch is not precancerous and typically resolves once the source of the mechanical irritation is identified and eliminated. For example, repairing a fractured tooth cusp or adjusting a rough denture edge often leads to the disappearance of the keratosis.
Oral Lichen Planus
Oral Lichen Planus (OLP) is a chronic inflammatory condition believed to be immune-mediated, meaning the body’s immune system mistakenly attacks cells in the oral lining. OLP lesions frequently appear as fine, white, lacy lines or threads known as Wickham’s striae. These lesions are often found symmetrically on both sides of the inner cheeks, but they can also affect the tongue and gums.
While the reticular (lacy) form is often painless, other presentations of OLP may include red, inflamed areas or painful open sores. OLP is a long-term condition that waxes and wanes and is generally non-wipable.
Patches Associated with Cellular Changes
A white patch that cannot be clinically identified as any other known disease, such as a fungal infection or traumatic injury, is clinically termed leukoplakia. This definition is one of exclusion, meaning all other causes must first be ruled out. Leukoplakia is considered a potentially malignant disorder, indicating that the cells have undergone changes that increase the risk of developing oral cancer over time.
The appearance of leukoplakia can vary significantly, ranging from a thin, uniform white patch to a thick, rough plaque firmly attached to the tissue. A more concerning variant is speckled leukoplakia, which features a mix of both white and red areas, sometimes called erythroleukoplakia. The presence of a red component significantly raises the possibility of more severe cellular changes.
The strongest risk factors are heavy tobacco use, including smoking and chewing, and chronic, excessive alcohol consumption. These substances introduce chemical irritants that damage the oral lining and promote abnormal cell growth. Because of the malignant potential, the definitive diagnostic procedure is a biopsy, where a tissue sample is examined for abnormal cells, or dysplasia.
When to Seek Professional Diagnosis
While many white patches are harmless, any persistent change in the mouth warrants a professional examination by a dentist or doctor. Seek evaluation for any white patch or sore that does not heal or disappear within two weeks, as a longer duration suggests the issue is not a simple, self-limiting irritation.
Immediate professional attention is required for patches that present with specific red flags:
- Any patch that is firm, thick, or hard to the touch.
- Patches accompanied by areas of redness or ulceration.
- Difficulty swallowing or pain when chewing.
- Ear pain or restriction in the ability to move the jaw.