Why Are There Spots on Your Tongue?

Spots on the tongue can be irritating, but most aren’t dangerous. Many clear up on their own, though some may point to a more serious condition.

Some causes are easy to recognize, while others require further evaluation. Continue reading to learn about common types of tongue spots, how they present, and when you should consult a healthcare professional.

What can cause spots on the tongue?

A wide range of conditions can lead to a spot, bump, or lesion on the tongue. A few examples include:

Black hairy tongue

This condition shows up as black, gray, or brown discolorations that can look like hair-like filaments.

Black hairy tongue may begin as a small patch and expand to cover much of the tongue’s surface. It results from accumulation of dead cells that aren’t shed properly, often tied to poor oral hygiene, certain medications, or tobacco use.

Older adults are more likely to develop black hairy tongue, and it’s more common in men than women.

Anything introduced into the mouth can affect the coloration, including foods, coffee, and some mouthwashes. Bacteria and yeast may colonize the area, giving the appearance of hair.

Other signs include a ticklish or burning feeling on the tongue or palate and sometimes halitosis.

Daily brushing of the tongue or using a tongue scraper can treat black hairy tongue at home and typically resolves it within a few weeks. Most cases improve without medical care. If it persists, a dentist or physician can remove the buildup with special instruments. Regular tongue cleaning with a toothbrush and tongue scraper helps prevent recurrence.

Geographic tongue

Geographic tongue is characterized by smooth, red patches with irregular outlines on the top or sides of the tongue. The lesions may shift in size, shape, and position. The exact cause is unknown. It’s benign and often resolves without treatment, but episodes can last weeks or even months, and occasionally years.

Some people experience pain or a burning sensation, particularly after consuming foods that are:

• spicy
• salty
• acidic
• very hot

Leukoplakia

Leukoplakia produces irregular white or gray patches on the tongue. Its origin isn’t always clear, but it’s strongly linked to smoking, use of smokeless tobacco, and heavy alcohol use. Repeated trauma to the tongue — for instance from ill-fitting dentures — can also contribute.

Most leukoplakia lesions are benign. However, some contain precancerous or cancerous cells, so evaluation by a clinician is important. A biopsy can determine whether there’s cause for concern.

Leukoplakia may also occur on the gums and inside the cheeks.

Lie bumps

Also called transient lingual papillitis, lie bumps are small white or red spots or bumps on the tongue. You might see one or several on the tongue’s surface. Their exact cause is unknown.

No specific treatment is required; lie bumps generally disappear within a few days.

Thrush

Oral thrush (candidiasis) is caused by the fungus Candida and presents as creamy white patches, sometimes alongside red areas. These plaques can affect the tongue and may spread elsewhere in the mouth and throat.

Infants, older adults, people with weakened immune systems, and those taking certain medications are more prone to thrush.

Other possible symptoms include:

• raised, cottage cheese-like plaques
• redness
• tenderness
• bleeding
• reduced taste sensation
• dry mouth
• difficulty eating or swallowing

Often diagnosis is made by visual inspection. Treatment typically involves antifungal medications, though management can be more complex when the immune system is compromised.

Aphthous ulcers

Aphthous ulcers, commonly called canker sores, are frequent tongue lesions that appear as shallow, pale ulcers. The cause is unclear, but possible associations include:

• minor trauma to the tongue
• toothpaste and mouthwashes containing sodium lauryl sulfate
• deficiencies of vitamin B12, iron, or folate
• an immune reaction to oral bacteria
• hormonal changes during the menstrual cycle
• emotional stress
• celiac disease
• inflammatory bowel disease
• HIV
• AIDS
• other immune-related disorders

Sensitivity to certain foods can also trigger canker sores, including sensitivities to:

Canker sores are not caused by the herpes virus, which is responsible for cold sores. For information about triggers for those, see cold sore triggers.

Canker sores typically resolve within one to two weeks without treatment. A variety of over-the-counter and prescription options can ease symptoms in severe cases. Your clinician may recommend other therapies depending on the underlying cause.

Tongue cancer

The most common tongue cancer is squamous cell carcinoma. It often looks like a nonhealing ulcer or scab. It can arise on any part of the tongue and may bleed if irritated.

Other warning signs include:

• pain in the tongue
• ear pain
• difficulty swallowing
• a lump in the neck or throat

Treatment depends on how advanced the cancer is and may include surgery, chemotherapy, or radiation.

Who develops spots on the tongue?

Anyone can get spots on the tongue. Most are temporary and harmless. Your risk of oral problems increases if you use tobacco, drink heavily, or have a weakened immune system.

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

• smoking
• alcohol use
• infection with human papillomavirus (HPV)

How is the cause diagnosed?

Dentists are trained to inspect the mouth and tongue for signs of oral cancer and other disorders. Regular dental checkups, typically twice a year, help ensure thorough exams.

If spots on your tongue persist for more than a few weeks and the cause is unclear, consult your dentist or physician.

Many tongue lesions, such as thrush and black hairy tongue, are diagnosed by appearance alone. You should still inform your clinician about:

• other symptoms, such as pain or lumps in the mouth, neck, or throat
• all medications and supplements you take
• whether you currently smoke or used to smoke
• whether you currently drink alcohol or drank in the past
• any immune system problems
• your personal and family cancer history

Although most spots are benign and resolve without therapy, any persistent spot or bump in the mouth could indicate cancer.

If your clinician suspects tongue cancer, imaging studies like X-rays or positron emission tomography (PET) scans may be ordered. A biopsy of suspicious tissue is often needed to confirm whether it’s cancerous.

Prevention tips

You can’t entirely prevent tongue spots, but you can lower your risk by:

• avoiding smoking or chewing tobacco
• drinking alcohol in moderation
• attending regular dental examinations
• reporting unusual tongue or mouth symptoms to your clinician promptly
• if you’ve had recurrent tongue issues, asking your clinician for tailored oral care advice

Good daily oral hygiene includes:

• brushing your teeth
• rinsing
• flossing
• gently brushing your tongue