A spotted tongue can be a source of concern. While the appearance of spots, which can manifest as changes in color, texture, or raised or depressed areas, might initially be alarming, many factors can cause these changes, and most are harmless and temporary. This article explores the various reasons behind a spotted tongue, from common benign conditions to those that may warrant professional evaluation.
Common Reasons for Spots
Geographic tongue, also known as benign migratory glossitis, is a frequent cause of tongue spots. This condition appears as smooth, red patches on the tongue’s surface, often surrounded by slightly raised, whitish borders, creating a map-like appearance. These patches can change in location, size, and shape over time. While often painless, some individuals experience a burning sensation, especially after consuming spicy or acidic foods. The exact cause is unknown, but triggers can include stress, certain foods, and vitamin deficiencies.
Oral thrush, or candidiasis, is another common cause of tongue spots. It presents as creamy white patches resembling cottage cheese on the tongue and inner cheeks. These patches may be scraped off, sometimes revealing red, tender areas underneath. Oral thrush is a yeast infection caused by an overgrowth of Candida albicans, a fungus naturally present in the mouth. It often occurs in individuals with weakened immune systems, those taking antibiotics or corticosteroids, infants, and the elderly.
Canker sores, medically termed aphthous ulcers, are small, painful sores that can develop on the tongue, inner cheeks, or lips. They appear as white or yellow lesions with a red border. Triggers include minor mouth injuries, such as accidental biting, stress, certain acidic or spicy foods, and nutritional deficiencies. These sores are not contagious and heal on their own within one to two weeks.
Trauma or irritation can also lead to temporary spots or sores on the tongue. Accidental biting, burns from hot food or liquids, or irritation from sharp teeth or dental appliances can create localized areas of redness, soreness, or small bumps. These minor injuries resolve as the tissue heals.
Certain foods and drinks can temporarily stain the tongue, leading to dark or discolored spots. For example, consuming berries, coffee, or tea can leave transient pigmentation on the tongue’s surface. This discoloration is harmless and fades with good oral hygiene practices.
Benign pigmentation is another reason for spots on the tongue, similar to freckles on the skin. Some individuals naturally have darker spots, known as oral melanotic macules, due to localized melanin deposits. These flat, brown to black spots are harmless and often found in people with darker skin tones.
When Spots Might Be Concerning
While many tongue spots are benign, certain characteristics can indicate a more serious underlying condition, necessitating professional evaluation. Persistent white or red patches that do not scrape off, such as leukoplakia and erythroplakia, can be concerning. Leukoplakia appears as irregularly shaped white or gray spots, while erythroplakia is abnormal red spots. Both are considered potentially pre-cancerous or cancerous lesions, and their persistence is a warning sign.
Any sore or spot on the tongue that lasts for more than two weeks without healing warrants prompt medical attention. This is especially true if the lesion is growing, bleeding, or accompanied by numbness, as these can be early indicators of oral cancer. Oral cancer can manifest as a painful lump or sore that bleeds easily and resists healing.
Systemic health issues or nutritional deficiencies can also manifest as changes in tongue appearance. For instance, vitamin B12 deficiency can cause the tongue to appear smooth, red, and beefy, a condition known as atrophic glossitis. Other conditions, like certain autoimmune diseases, can lead to oral manifestations including tongue changes.
Beyond common infections like thrush, less common infections can also cause unusual spots or lesions on the tongue. Syphilis, a bacterial infection, can lead to oral manifestations at various stages, including chancres (painless sores) in the primary stage or white patches and ulcers in the secondary stage. In later stages, it can cause inflammatory sites called ‘gummas’ on the tongue.
What to Do About a Spotted Tongue
If you observe spots on your tongue, it is important to know when to seek professional medical advice. See a doctor or dentist if a spot or sore on your tongue persists for more than two weeks without healing. Other warning signs include severe or unexplained pain, bleeding, rapid growth of a spot, difficulty swallowing or speaking, or if the spots are accompanied by fever or persistent numbness. Early evaluation helps ensure timely diagnosis and appropriate management.
During a medical evaluation, a healthcare provider will perform a visual examination of your mouth and tongue, review your medical history, and ask about any associated symptoms. Depending on their findings, further tests may be necessary, such as blood tests to check for nutritional deficiencies or a biopsy of the suspicious area to examine cells for signs of disease. This diagnostic process helps pinpoint the underlying cause.
Maintaining good oral hygiene can help prevent some common tongue issues. This includes regularly brushing your tongue with a soft-bristled toothbrush or using a tongue scraper to remove bacteria, food debris, and dead cells. Staying hydrated and avoiding excessive consumption of sugary or acidic foods also supports overall oral health.
It is always recommended to seek professional evaluation for any persistent or concerning changes on your tongue to rule out more serious conditions and receive appropriate guidance. This proactive approach helps ensure good oral and overall health.