Reviewed June 2019
Five common tongue conditions often mistaken for thrush
If you develop symptoms in your mouth that include white patches or soreness, it will be highly likely that one of the conditions you may come across if you’re searching your symptoms will be oral thrush, also known as oral candidiasis.
This is a fungal infection in the mouth, which causes the development of white patches or plaques on the tongue and through the mouth. The condition can be quite uncomfortable, for example it may make eating and drinking difficult, or cause alteration in taste.
Oral thrush occurs when someone has an overgrowth of fungi that naturally occurs in the mouth and on the skin. Typically the condition is caused by a fungi called candida, of which there are many different types.1 It is relatively common in babies, the elderly, or those with certain medical conditions such as diabetes or a weakened immune system. It can also occur in those who have had a recent course of antibiotics, or in heavy smokers2 and those with poor oral hygiene.3
However, symptoms of oral thrush may also be a sign of something else. If you think you have thrush, it is important to see your doctor to rule out other causes of the symptoms, as it may well not be thrush.
Here, we look at five conditions that can present with similar symptoms to oral thrush, and that you may find yourself being diagnosed with if you visit your GP. Many of them are harmless and don’t need any treatment, but it is important to get lesions that do not disappear within 14 days checked out by a doctor.
Coated or white tongue
This is where your tongue’s surface becomes colonised by dead cells and bacteria. These become trapped between small nodules on the tongue producing a white, coated appearance of the tongue. The nodules (papilla) on your tongue can, in turn, get a little enlarged and inflamed, making them trap more debris as well. White tongue may also cause bad breath (halitosis). Usually, a white or coated tongue is not a sign of anything to be concerned about.
You are more likely to suffer from white tongue if you smoke or have poor oral hygiene. Other things that can increase the risk are having a dry mouth or dental problems. You can try gently brushing it with a tongue scraper and improving your general dental hygiene to help this resolve more quickly. Cutting down on your alcohol intake and stopping smoking can make a big difference too.
Occasionally a coated tongue can indicate an infection or another condition, so check with your doctor if you are concerned or the symptoms last longer than 2 weeks. That being said, coated tongue can last longer than two weeks, but if it lasted that long you should see your doctor to rule out of diagnoses.
Geographic tongue is a condition in which white patches that have a map-like appearance are found on the tongue, and it is often confused with thrush. The tongue develops smooth red patches with an irregular light (or white) coloured border. These patches can vary in size and location and can move to different locations every few days rather than remaining in one place.
Some individuals may find them sensitive, or even sore, but others have no other symptoms. We don’t know exactly what causes it, so there is no specific treatment. Some individuals find that it settles quickly, but others find that the problem can persist for a while. It is not normally anything to be concerned about, and usually settles on its own. However, if it persists for more than two weeks, it is worth being reviewed by a doctor to confirm that this is the condition you have. It usually settles over time.
If the patches are uncomfortable when eating certain foods, such as anything salty or spicy, it is best to avoid them until the symptoms settle. As the patches are not caused by a fungal infection, treatment for oral thrush will not help get rid of them.
Oral lichen planus
This is a long-term condition that can cause white, almost lacy, streaks and patches in the mouth. The cause of this condition is unknown, but it is not thought to be infectious. It is, however, much longer lasting than oral thrush, and for some individuals it is a condition that they live with long term.
Many cases of oral lichen planus are mild and don’t require any treatment, but more severe cases can be managed using a combination of antiseptic mouth washes, and steroid sprays or tablets to use as a mouth rinse. Oral lichen planus can be quite uncomfortable for some, but for most people the symptoms are relatively mild.
Lichen planus can occur in other areas of the body as well, but often it is just the mouth that may be affected. Very occasionally it can be caused by a reaction to medicines such as some painkillers and blood pressure medications,4 so your doctor may wish to review any medication you may be taking. If you suspect you have oral lichen planus, you must see your doctor to diagnose the condition.
Put simply, oral leukoplakia (OL) means a white patch or plaque in the mouth. This usually forms on the tongue but can also occur inside the cheeks, lower lips, gums and the back of the mouth (soft palate). Usually it is smooth, but can feel slightly rough, raised, or thickened in some people. The patch is often persistent and can’t be removed by brushing or scraping. Sometimes there is also redness around the affected area, but it is usually painless.
OL is rare in people under the age of 30, but it is more common in smokers than in non smokers.5 It is linked, in some people, with an increased risk of a type of mouth cancer called a squamous cell carcinoma, so it is important to get it checked by a doctor.
Occasionally, leukoplakia may look ‘hairy’ in appearance. This is usually caused by a specific virus (EBV – the glandular fever virus) in individuals that may have a problem with their immune system, so this would need investigating further too.6
Apthous mouth ulcers
These are painful sores that occur inside the mouth. They are sore, but are usually harmless and disappear on their own, and it is likely you have had one of these before. If your ulcer has lasted more than two to three weeks, or it is becoming much more painful or inflamed, please see your doctor. It is also important to go and see your doctor if you are continually getting new mouth ulcers.
These also usually occur on the cheeks, lips, or tongue, and can be white, red, or even grey in appearance. Often we are unsure why people get mouth ulcers, but they may be caused by trauma in the mouth, such as biting your tongue, poor fitting dentures, or a rough edge on a tooth. Other things such as stress, hormones, and certain foods such as chocolate and coffee are possibly thought to contribute too.7
Usually, mouth ulcers do not need treatment but there are some things you can do to help it feel more comfortable, or to speed up healing. These include avoiding salty, acidic, or spicy foods, using a protective paste or gel from your pharmacist, and using a soft toothbrush. Your pharmacist may also advise you to try an antimicrobial mouthwash, gel, or lozenges, to help with pain relief and healing.
What should I do if I have a white patch in my mouth or my tongue looks coated?
If a white or discoloured patch in your mouth does not fully clear up by itself within 14 days, it is important to go and see your doctor or dentist, as most white patches would be expected to settle in this time.
If your doctor or dentist feels it necessary, they may refer you to have the lesion biopsied. This is where a small amount of the lesion is removed and examined under a microscope. Usually this is not needed however, and simple management like good oral hygiene or mouth washes can be used to good effect.
Last updated June 2019
Next update due 2021
- A. Akpan and R. Morgan, ‘Oral candidiasis’, Postgraduate Medical Journal, Vol. 78, No. 922, 2002, pp. 455-459.
- Alanazi, H., et al., Cigarette smoke-exposed Candida albicans increased chitin production and modulated human fibroblast cell responses, BioMed Research International, 2014, [website]: https://www.hindawi.com/journals/bmri/2014/963156/ (accessed 24 June 2019)
- F. S. Younai, ‘Oral Candidiasis’, BMJ Best Practice, 2017, [website], http://bestpractice.bmj.com/topics/en-gb/106, (accessed 24 June 2019).
- P.B. Sugerman and N.W. Savage, ‘Oral lichen planus: Causes, diagnosis, and management’, Australian Dental Journal, 2002, vol 47, issue 4, pp 290-297
- C. Scully, Oral and Maxillofacial Medicine: The basis of diagnosis and treatment, Edition 3, England, Churchill Livingsone, 2013, pp 186-191. Accessed online: https://www.sciencedirect.com/topics/medicine-and-dentistry/leukoplakia (accessed 24 June 2019)
- NICE, Aphthous ulcer, scenario management guidelines, NICE guidelines, Revised April 2017, accessed online: https://cks.nice.org.uk/aphthous-ulcer#!scenario