Spots on tongue: Causes and when to see a doctor

In this article, we look at what healthy spots on the tongue do, and the causes of unusual spots. We also cover diagnosis, treatment, and prevention tips.

Healthy tongue spots

There are four kinds of healthy spots or bumps that typically appear on the tongue. The medical term for these spots is papillae.

• Fungiform papillae are the small spots that appear all over the tongue. A person usually has 200 to 400 of these, mostly at the tip and edges of the tongue. Each of these papillae contains three to five taste buds.
• Circumvallate papillae are bigger spots that appear at the back of the tongue. They are slightly raised and are arranged in a ‘v’ pattern. A person usually has 7 to 12, with each one containing thousands of taste buds.
• Foliate papillae appear on the back of the tongue and at the edges. A person usually has around 20, with each one containing hundreds of taste buds.
• Filiform papillae are found in the center and at the front of the tongue. There are more of this type of papillae than any other. They do not contain taste buds.

Papillae help people to sense and taste with the tongue. Nerves that send messages about flavor to the brain are connected to taste buds. Papillae are also important for giving information about temperature, chewing food, and speaking.

The medical term for geographic tongue is benign migratory glossitis.

Geographic tongue causes inflammation on the sides or top of the tongue and usually appears as a blotch or spot of redness surrounded by a white border.

Doctors are not sure what causes geographic tongue, but it may be related to stress, allergies, or diabetes. The condition does not usually cause any other symptoms and should heal without treatment.

Oral yeast infection

A yeast infection known as oral thrush can affect the mouth and tongue. Symptoms include:

• white spots, bumps, or patches on the inside surfaces of the mouth
• a bad taste
• pain or soreness inside the mouth

If a person scrapes off a white patch on the tongue, they will usually see a red, inflamed patch underneath.

Oral thrush results from an overgrowth of yeast that occurs naturally in the mouth. Certain groups of people are more at risk of developing the infection, including:

• newborn babies
• people who wear retainers or dentures
• people with diabetes
• people receiving chemotherapy
• people with a dry mouth due to medication or a medical condition
• people living with HIV

A person can usually treat oral thrush using OTC antifungal medications. A doctor may also recommend:

• changing a person’s dentures
• changing how a person cleans their mouth or teeth
• trying a different medication that does not dry out the mouth

Scarlet fever

Scarlet fever is a bacterial infection in the nose and throat. One of the key symptoms is a red, bumpy tongue that people often refer to as “strawberry tongue.” Other symptoms include:

• a red, sore throat
• fever
• a red, blotchy rash that usually starts on the chest and stomach
• headache
• stomach pains

Doctors treat scarlet fever with antibiotics. Following antibiotic treatment, scarlet fever usually goes away in around one week, but the rash can last for longer.

Scarlet fever most commonly affects children and is contagious. The infection can be passed on through:

• coughing and sneezing
• sharing or using contaminated objects, such as cups, foods, towels, baths, and clothes

Oral allergy syndrome

An allergy to certain raw fruits and vegetables can cause itching and swelling in the mouth or on the tongue. Swollen patches on the tongue may appear red and irritated.

The reaction is often mild, and a person can avoid it by cutting out the foods that cause the allergy. Cooking or peeling the fruit or vegetable can often prevent a reaction.

Tongue cancer

Tongue cancer is a form of head and neck cancer. Drinking alcohol, smoking, and infection with the human papillomavirus (HPV) can increase a person’s risk of developing tongue cancer.

A bump or spot on the side of the tongue, or a red patch on the tongue, is usually harmless. But if it does not go away, it could be a symptom of tongue cancer. Other symptoms include:

• a sore throat that lasts for a long time
• pain when swallowing
• numbness in the mouth

Anyone who has a painless sore, lump, or red or white patch on the tongue that does not go away should see a dentist or doctor.

When to see a doctor

People should consider seeing a dentist or doctor for:

• unusual spots on the tongue last longer than a week
• spots that bleed, become more painful, or spread

A doctor will usually ask about any other symptoms, when the spots appeared, and any pain a person is feeling. This information can help a doctor give a diagnosis and offer further advice or treatment.

Prevention tips

Practicing good oral hygiene can help to prevent oral yeast infections and may help the tongue to heal after an injury or illness. To keep the mouth, teeth, and tongue healthy, dentists usually recommend:

• brushing teeth twice per day
• flossing daily
• avoiding too much sugar

It is not possible to prevent all spots on the tongue, particularly those due to infections and canker sores.

Taking medication correctly, keeping the mouth clean, and avoiding irritating the mouth when eating or cleaning teeth can promote healing and prevent spots from reoccurring.

Outlook

People have many tiny spots on their tongues that are crucial for taste and sensation. But spots that are unusual in color, size, or appearance could be the signs of a health problem.

Unusual spots can have a range of causes, from tongue injuries to an infection. They often go away without treatment but can sometimes be a symptom of a more serious medical condition, such as scarlet fever or tongue cancer.

People may wish to see a dentist or doctor if tongue spots do not go away on their own within a week. If a person has other symptoms, or if the spots bleed or become more painful, they may need treatment.

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