Q: This question was from a woman who did not want her letter printed
here and wanted me to reply to her directly. I cannot personally reply
to letters, but most of the answers will eventually appear in this
column. Here is a shortened version of the question.
“I have had a white coating on my tongue for a year. The doctors tried
treating me for thrush (Candidiasis) but it didn’t work. I have tried
everything to get rid of it and nothing works.”
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A: Although thrush is one of the most common reasons for a white,
patchy coating on the tongue and inside the cheeks, it is not the only
cause. Thrush is more prevalent in children and people who have been on
antibiotics for any length of time and is due to an infection with a
yeast known as Candida albicans. It responds to antifungal medications.
In older patients or those with a weakened immune system, there is a
condition called leukoplakia, which causes white patches on the tongue
and sometimes in the mouth. The lesions are slightly raised and hard.
They are often confused with thrush.
Leukoplakia is also sometimes known as smoker’s keratosis, as it is
common in chronic smokers. Pipe smoking and chewing tobacco create the
highest degree of risk. Other causes of chronic irritation to the mouth
and tongue, such as rough teeth or badly fitting dentures, should also
be
eliminated.
About three percent of cases can turn into oral cancer, so it is
important that a biopsy is performed and examined for cancerous cells.
The patches can be surgically removed under a local anesthetic, but
removal of the source of irritation may eliminate the leukoplakia.
Another possible cause of a chronically coated tongue is Reiter’s
syndrome, an autoimmune disorder that causes other symptoms such as
painful swelling and redness of the joints, red eyes and sometimes
urethritis. It usually starts with an infection by a
sexually transmitted disease or an intestinal bacterium such as
salmonella.
Reiter’s syndrome can also lead to a red-coloured tongue. Other causes
are scarlet fever streptococcal infections, pernicious anemia and
vitamin B deficiencies.
A black tongue can be due to tobacco, penicillin or some arthritis
drugs, or some rarer types of bacterial infections. A blue tongue is a
serious symptom showing a lack of oxygen due to heart or lung disease.
Clare Rowson is a medical doctor with a practice near Belleville, Ont.
Her columns are intended for general information only. Individuals are
encouraged to also seek the advice of their own doctor regarding
medical questions and treatments.
