White spot under tongue

Tongue Problems

The specific symptoms you’re experiencing will help your doctor identify the cause of your tongue problem.

Causes of a burning sensation on the tongue

A burning sensation on the tongue may occur in women who are postmenopausal. It can also occur due to exposure to irritants, such as cigarette smoke.

Causes of a change in tongue color

A bright pink color on the tongue is most often due to a deficiency in iron, folic acid, or vitamin B-12. An allergic reaction to gluten can also cause this.

A white tongue is usually a result of smoking, drinking alcohol or poor oral hygiene. White lines or bumps may be an inflammation called oral lichen planus. People think this occurs due to an abnormal immune response that may occur from an underlying condition, such as hepatitis C or allergies.

Causes of a change in tongue texture

If your tongue appears to be furry or hairy, it’s most likely caused by a course of antibiotics. Radiation to the head or neck can also lead to this symptom. It can also develop if you consume too much of an irritating substance, such as coffee or mouthwash, or if you smoke.

Causes of tongue pain

Tongue pain usually occurs due to an injury or infection. If you bite your tongue, you may develop a sore that can last for days and be very painful. A minor infection on the tongue isn’t uncommon, and it can cause pain and irritation. Inflamed papillae, or taste buds, are small, painful bumps that appear after an injury from a bite or irritation from hot foods.

A canker sore is another common cause of pain on or under the tongue. This is a small, white or yellow sore that can occur for no apparent reason. Canker sores, unlike cold sores, don’t occur due to the herpes virus. Some possible causes are mouth injuries, abrasive ingredients in toothpastes or mouthwashes, food allergies or nutritional deficiencies. In many cases, the cause of a canker sore is unknown and referred to as an aphthous ulcer. These sores usually go away without any treatment.

Other, less common reasons for tongue pain include cancer, anemia, oral herpes, and irritating dentures or braces.

Neuralgia can also be a source of tongue pain. This is a very severe pain that occurs along a damaged nerve. Neuralgia occurs for no obvious reason, or it can occur due to:

  • aging
  • multiple sclerosis
  • diabetes
  • tumors
  • infections

Causes of tongue swelling

A swollen tongue may be a symptom of a disease or medical condition, such as:

  • Down syndrome
  • tongue cancer
  • Beckwith-Wiedemann syndrome
  • an overactive thyroid
  • leukemia
  • strep throat
  • anemia

When the tongue swells very suddenly, the likely reason is an allergic reaction. This can result in difficulty breathing. Difficulty breathing due to tongue swelling is a medical emergency. If this occurs, you should get medical help right away.

White Spot On The Tongue: Is It Serious?

You might notice a white spot on the tongue after experiencing discomfort or when checking inside your mouth after brushing your teeth. Most of these spots or patches go away by themselves, but it’s worth visiting a dentist to have them checked out if they linger. Oral thrush, canker sores and leukoplakia are the most common causes of white spots on the tongue. Here are a few conditions that can cause white spots on your tongue, and when it’s time to see your dentist.

Oral Thrush

Oral thrush, an overgrowth of a naturally occurring fungus, often appears when the immune system is depressed. Babies, denture wearers, patients with cancer, HIV and other immune-compromising conditions, anemia and diabetes patients, smokers and dry mouth sufferers are all at a higher than normal risk of developing oral thrush. A course of antibiotics can also trigger an attack.

It’s rarely serious, but a long-term infection may require treatment. Creamy white lesions on the tongue are one sign of thrush; other symptoms include:

  • White patches in other areas of the mouth.
  • Lesions that look like cottage cheese.
  • Red, cracked corners of the mouth and lips.
  • Loss of taste.
  • Cotton mouth or dry mouth.

Scraping oral thrush spots usually removes the white coating, but this can also cause slight bleeding.

Canker Sores

A white spot on the tongue surrounded by a red, inflamed halo is probably a canker sore. These common and recurring lesions can be small or large and appear on its own or in groups. Canker sores are often painful and scraping doesn’t remove them.

Viruses, bacteria and immune system issues are some suspected causes of canker sores. Trauma, allergies, stress, cigarette smoking, iron and vitamin deficiencies make you more susceptible.

Leukoplakia

White or grayish patches called leukoplakia usually appear on the gums, the bottom of the mouth or the insides of the cheeks, but sometimes they appear on the tongue as well. Wiping or scraping does not change their appearance or texture, which may be thick or hardened.

Chewing or smoking tobacco and drinking alcohol cause most cases of leukoplakia, and about 75 percent of smokeless tobacco users develop leukoplakia, according to the Oral Cancer Foundation. The condition also carries a small risk of developing into oral cancer.

Hairy Leukoplakia

Fuzzy white patches that appear on the sides of the tongue as ridges or folds are symptoms of hairy leukoplakia. These patches result from infection with the Epstein-Barr virus (EBV), which lasts a lifetime but remains dormant in the body until a weakened immune system sparks an attack, according to the Mayo Clinic.

When to Visit Your Dentist

If a white spot on tongue doesn’t go away after a week to ten days, visit your doctor to have it checked. Some conditions, like thrush, may go away on their own, but it’s always wise to go see your dentist or doctor for a consultation to make sure it’s not something more.

To help keep your mouth fresh and healthy and reduce the risks of white spots and other problems, brush twice a day with a fluoride toothpaste, such as Colgate TotalSF Advanced Deep Clean Toothpaste. Most people experience white spots on the tongue at some point in their lives and for many they’re a common occurrence. Though the spots are unlikely to be harmful, they could be a sign of something more serious. If you’re concerned, a checkup at your dentist can put your mind at rest.

What causes a white tongue?

Share on PinterestMaintaining good oral hygeine is important for preventing problems from ocurring with the tongue.

The most common cause of a white tongue is poor oral hygiene. Small bumps on the tongue called papillae can start to swell up and become inflamed in a mouth that is not cared for well.

Plenty of germs, debris, food particles, and dead cells can get stuck in between these papillae. This causes the tongue to appear white as the particles build.

Oral and hygiene issues that can lead to a white tongue include:

  • dry mouth caused by mouth-breathing or sleeping with the mouth open
  • not brushing or flossing the teeth correctly
  • not cleaning the tongue
  • dehydration
  • irritation from sharp edges inside the mouth, such as teeth, braces, or dentures
  • regular alcohol consumption
  • smoking, chewing, or dipping tobacco

Basic oral hygiene is essential for everyone, but there are some conditions that cause a white tongue even in people who take great care of their mouths. These include:

Oral lichen planus

Oral lichen planus is an inflammatory condition that can affect the mouth and cause thick, white patches of skin to appear in the mouth and tongue.

These white patches may appear alongside other symptoms, including ulcers or painful cheeks and gums.

Leukoplakia causes thick white patches to form on the tongue and mouth. Leukoplakia is usually caused by irritants such as tobacco and alcohol, but may also result from inflammatory conditions and irritation from dentures.

The patches that leukoplakia causes are harmless by themselves. Rare cases can have serious complications, so a doctor should always diagnose leukoplakia.

Share on PinterestWhite tongue can be caused by various fungal infections.
Image credit: Grook da oger, (2012, April 6)

Oral thrush is one condition that may cause the tongue to appear white. Oral thrush is a fungal infection caused by the Candida yeast.

Oral thrush causes patches to develop in the mouth and on the tongue. These patches usually have a white or off-white color and may have an unpleasant taste.

Oral thrush can also be painful, especially when eating or drinking.

People who have a weakened immune system may be more likely to develop oral thrush. This includes people who have recently taken antibiotics or undergone chemotherapy. Poor oral hygiene or wearing poorly fitting dentures are other risk factors.

Oral thrush can be caused by the use of inhaled corticosteroids for asthma. Certain conditions also increase the risk of infection, including diabetes.

Syphilis

Syphilis is a commonly-known sexually transmitted infection (STI) that can cause symptoms in the mouth.

Untreated syphilis can cause white patches to appear on the tongue and sores in the mouth. Syphilis requires medical treatment.

Other conditions

Rarer but sometimes serious conditions can lead to white patches on the tongue.

Mouth or tongue cancer may cause a white tongue, and other mouth conditions may also make the symptoms worse.

Underlying chronic inflammatory disorders may influence a white tongue as well.

Mouth and oropharyngeal cancer

Tongue cancer is a type of head and neck cancer. Symptoms can include a patch, spot or lump on your tongue that doesn’t go away. The main risk factors are smoking, drinking a lot of alcohol and infection with the HPV virus.

The tongue

There are two parts to your tongue:

  • the oral tongue
  • the base of the tongue

Cancer can develop in either part.

The oral tongue is the part you see when you poke your tongue out at someone. This is the front two thirds of your tongue. Cancers that develop in this part of the tongue come under a group of cancers called mouth (oral) cancer.

The base of the tongue is the back third of the tongue. This part is very near your throat (pharynx). Cancers that develop in this part are called oropharyngeal cancers (pronounced oar-o-farin-gee-al).

Types of tongue cancer

The most common type of tongue cancer is squamous cell carcinoma (SCC). Squamous cells are the flat, skin like cells that cover the lining of the mouth, nose, larynx, thyroid and throat. Squamous cell carcinoma is the name for a cancer that starts in these cells.

Symptoms of tongue cancer

The symptoms of tongue cancer might include:

  • a red or white patch on the tongue that won’t go away
  • a sore throat that doesn’t go away
  • a sore spot (ulcer) or lump on the tongue that doesn’t go away
  • pain when swallowing
  • numbness in the mouth that won’t go away
  • unexplained bleeding from the tongue (that’s not caused by biting your tongue or other injury)
  • pain in the ear (rare)

It’s important to remember that these symptoms might be due to a less serious medical condition. But it’s best to check symptoms with your GP just to make sure.

The photos below give you an idea of what tongue cancers can look like, but remember that they might appear differently from this. Contact your GP or dentist if you notice anything abnormal.

This picture shows cancer on the side of the tongue.

And below is a picture of a red patch underneath the tongue.

Risks and causes of tongue cancer

We don’t know the exact causes of most head and neck cancers, but several risk factors have been identified.

Smoking tobacco (cigarettes, cigars and pipes) and drinking a lot of alcohol are the main risk factors for cancers of the head and neck in the western world. The HPV virus transmitted through sexual contact is another risk factor.

Having a risk factors means that your risk is increased. But it does not mean that you will definitely develop cancer.

Stages

The stage of your cancer tells you how big it is and whether it has spread. It helps your doctor decide what treatment you need.

The stage of your cancer depends on:

  • how far your cancer has grown into local tissues
  • whether it has spread to nearby lymph glands
  • whether it has spread to any other part of the body

Doctors use different staging systems. The staging system they use for you depends on where your cancer starts:

Tongue cancer that starts in the front two thirds of your tongue (oral tongue) is staged as a mouth cancer.

Tongue cancer that starts in the back third of your tongue ( base of your tongue) is staged as oropharyngeal cancer.

Treatment

The treatment for tongue cancer depends on:

  • the stage of your cancer
  • where the cancer is on your tongue
  • your general health

Thrush (Candidiasis)

What Is It?

Thrush is the common name for a mouth infection caused by an overgrowth of the Candida fungus, which normally lives in many people’s mouths. It is a surface infection that can affect the corners of the mouth, the insides of the cheeks, the tongue, palate and throat. Thrush is a common infection in babies. A newborn may acquire the Candida fungus during delivery, if its mother had an active vaginal yeast infection. Symptoms of thrush usually follow within 7 to 10 days after birth.

In older children or adults, episodes of thrush are triggered most frequently by diseases or drugs that affect the immune system, cancer chemotherapy, steroid therapy, or by treatment with antibiotics. Antibiotics trigger thrush by killing the mouth’s normal population of bacteria. Once these normal bacteria are gone, Candida fungi are free to multiply and grow without competition. People with dry mouth have less saliva and are prone to developing thrush. Several medicines cause dry mouth as a side effect.

Certain people are more likely to get thrush. Examples include people with diabetes, and the elderly and debilitated. People who are malnourished or have illnesses that weaken immune defenses, such as cancer or HIV infection, are also at risk.

Symptoms

The first symptoms may be a bad taste in the mouth and decreased taste. Thrush causes curdlike white patches inside the mouth, especially on the tongue, palate (roof of the mouth and/or back of the throat) and corners of the mouth. If you try to scrape off the whitish surface of a patch, you will usually find a red, inflamed area that may bleed slightly. There may also be cracked, red, moist areas of skin at the corners of the mouth.

Sometimes thrush patches are painful, but often they are not. Infants who do have painful patches may be fussy, irritable and feed poorly.

Diagnosis

Your dentist or physician usually diagnoses thrush by examining your mouth to look for white patches that scrape off with a tongue blade or gauze pad. If the diagnosis is in question, your doctor or dentist also may send a sample of these scrapings to a laboratory for testing. In certain cases, a biopsy is necessary. In this procedure, a small piece of skin is removed with a scalpel and examined in a laboratory.

In most patients, this is all that needs to be done for diagnosis. However, if you have frequent or persistent infections, your doctor or dentist may want to see if you have an undiagnosed medical illness, such as diabetes, cancer or HIV infection. In this case, blood tests or other types of diagnostic procedures may be necessary. Your doctor or dentist will ask about your history of these illnesses and about recent drug therapy.

Your doctor or dentist also will ask about your recent use of antibiotics or medications that suppress the immune system, such as steroids or cancer chemotherapy drugs. Your doctor or dentist also can determine if you are taking certain medicines that are associated with significant dry mouth.

Expected Duration

With proper medical treatment, most simple thrush infections can be cured in about 7 to 14 days.

Prevention

You can help to prevent thrush by using antibiotics only as prescribed by your doctor and by seeing your dentist promptly for any mouth irritation or soreness around dentures. To prevent thrush in newborns, a pregnant woman should be checked by her doctor whenever she develops any white, cheesy vaginal discharge.

In patients with HIV or others who are taking drugs that suppress the immune system, doctors may prescribe antifungal drugs, such as clotrimazole (Mycelex), as a long-term measure to prevent thrush. However, because there is some evidence that Candida fungi eventually become resistant to these drugs, this preventive use is still controversial.

Doctors treat thrush with antifungal medications such as nystatin (Mycostatin, Nilstat), clotrimazole (Mycelex), ketoconazole (Nizoral), or fluconazole (Diflucan). For mild cases, a suspension of nystatin can be swished in the mouth and swallowed, or a clotrimazole lozenge can be dissolved in the mouth. For more severe cases, ketoconazole or fluconazole may be taken once a day for seven to 10 days. The corners of the mouth can be treated effectively with a nystatin ointment.

After successful treatment of thrush, your doctor may switch you from medicines that are suspected of causing significant dry mouth to medicines that are less drying. Only your doctor should change prescribed medicines that you are taking. Sometimes, medicines cannot be substituted for medical reasons. In this case, you should drink more water, and use mouth moisturizers and saliva replacements often.

When To Call A Professional

Call your doctor whenever curdlike white patches appear inside your mouth or in the mouth of your infant. Call your doctor immediately whenever any mouth irritation prevents your baby from feeding normally. Rarely, the fungus may affect tissue in the esophagus and cause difficulty swallowing. If this happens, you should phone your dentist or doctor. All patients with suppressed immune systems should be checked periodically for oral problems such as thrush.

Prognosis

In most otherwise healthy patients, a thrush infection that is treated properly goes away without permanently damaging the skin. The infection may not return as long as the patient remains healthy and well nourished. However, people with long-term illnesses or weakened immune systems may have frequent episodes of thrush. In some debilitated patients, the Candida fungus may even spread to the throat, causing Candida esophagitis, or to other parts of the body.

Additional Info

What can cause spots on the tongue?

Tongue spots that are unusual in color, size, or appearance or are accompanied by other symptoms could signal a health problem.

Causes of unusual tongue spots include:

Lie bumps

Transient lingual papillitis is a condition more commonly referred to as lie bumps. A key symptom is small red or white bumps on the tongue. These bumps are enlarged or inflamed papillae.

Lie bumps can affect one or several papillae. Other symptoms can include:

  • pain
  • a burning or itching sensation
  • greater sensitivity to heat

Lie bumps commonly result from injury to the tongue, for example, when a person accidentally bites their tongue.

Viruses, psychological stress, and poor nutrition can also cause the condition.

Lie bumps usually heal without treatment within a week. If treatment is necessary, a person can try a medicated mouthwash or antihistamines to help them reduce the swelling.

A person with lie bumps can quicken the healing of the tongue by:

  • avoiding spicy foods
  • avoiding hot liquids or food
  • not sucking sweets
  • brushing teeth with care

Tongue burn

If a person burns their tongue on hot food or liquid, it can cause blisters. These can appear as small, fluid-filled spots on the tongue.

Blisters will heal more quickly if they remain unbroken. A person can promote healing and prevent blisters from breaking by taking care when brushing the teeth and eating and drinking.

A burn on the tongue does not usually require treatment. Keeping the mouth clean by using mouthwash can help to prevent an infection.

Canker sores

Canker sores are very common. These small ulcers look white or yellow and can appear on the tongue, inside of the mouth, and on the lips. The cause of canker sores is not clear.

Canker sores usually go away without treatment. Directly applying an over-the-counter (OTC) medication, such as benzocaine, to the ulcer can relieve discomfort and promote healing.

In some cases, canker sores can be a sign of an underlying health condition. If a person has other symptoms, they may wish to seek medical advice. These symptoms include fever, stomach pain, and a rash elsewhere on the body.

Share on PinterestGeographic tongue may appear as a blotch or spot of redness with a white border.
Image credit: Dimitrios Malamos, 2015

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

Share on PinterestSymptoms of scarlet fever can include “strawberry tongue.”
Image credit: SyntGrisha, 2015

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.

White Tongue

What is white tongue?

White tongue is a condition in which the tongue is coated by a noticeable white film. The coating may cover the entire surface of the tongue, the back part of the tongue only, or may appear in patches.

In most cases, white tongue is not a serious or long-lasting condition.

What causes white tongue?

White tongue is commonly caused by a buildup of bacteria and/or fungi, along with dead cells trapped between the papillae (small bumps that contain the taste buds) on the surface of the tongue.

Since papillae are raised up, they create a large surface area on which debris and micro-organisms inside the mouth can easily collect. This buildup almost certainly contributes to bad breath and may also be a factor in poor gum health.

In rarer cases, white tongue may be caused by an infection or by the following conditions:

  • Leukoplakia: Leukoplakia is a common condition caused by overproduction of cells in the lining of the mouth. These cells combine with deposits of the protein keratin to form white patches. In many cases, irritation to the mouth and tongue comes from drinking alcohol or using tobacco products. Sometimes no cause can be found. The condition is usually not serious; however, in some cases, it can turn cancerous years or even decades after first appearing.
  • Oral lichen planus: Oral lichen planus, a chronic (long-term) inflammatory mouth condition, is caused by a disorder of the immune system (the body’s defense mechanism against microbes) and other outside invaders. It cannot be passed on to others.
  • Geographic tongue: Geographic tongue occurs while the skin on the tongue is renewing. Parts of the upper layer of skin on the tongue shed too quickly, leaving tender red areas that are prone to infection, while other parts of the skin remain in place too long and take on a white appearance. This condition cannot be passed on to others.
  • Oral thrush: Oral thrush is an infection in the mouth caused by the Candida yeast. Although Candida is normally found inside the mouth, it becomes a problem when it multiplies too much. The following situations can encourage overgrowth of Candida:
    • Diabetes
    • Being very young or very old
    • Use of antibiotics
    • A shortage of iron or vitamin B12 in the diet
    • Weak immune system
    • Wearing dentures
    • Poor oral hygiene
    • Dry mouth caused by a medical condition or the use of medications
    • Smoking
    • Cancer treatments
    • Hypothyroidism (underactive thyroid)
  • Syphilis: Syphilis is a bacterial infection that is passed through sexual contact.

What are the symptoms of white tongue?

  • Leukoplakia: Leukoplakia produces one or more white patches in the mouth or on the tongue that cannot be removed by scraping. The patch is usually painless and somewhat raised. Patches may also appear on the top or bottom of the mouth, the insides of the cheeks, the lower lip, or the gums.
  • Oral lichen planus: Oral lichen planus produces white patches on the gums, tongue, or insides of the cheeks. A mild case is usually not painful; in more serious cases, the patient may have a burning sensation, painful red gums, and sore patches on the insides of the cheeks, especially when eating or drinking.
  • Geographic tongue: Geographic tongue appears on the top and sides of the tongue, and sometimes on the bottom, as wavy white lines surrounding red areas. This makes the condition look like the outlines of a map (where the condition gets its name). After some weeks or months, the lines and patches may change their position or shape.
  • Oral thrush: Oral thrush is marked by the following:
    • White patches in the mouth that can be wiped away, leaving behind red or even bloody skin
    • Burning sensation of the tongue and mouth
    • Loss of taste, or unpleasant taste in the mouth
    • Red areas inside the mouth and throat
    • Cracked corners on the mouth

Symptoms will continue unless the condition is treated. In severe cases that are not treated, serious infection could spread to other areas of the body.

  • Syphilis: A small painless sore on the tongue may appear from 10 days to three months after exposure to infection during oral sex. If it is not treated, a condition called syphilitic leukoplakia will produce white plaques on the tongue. Other symptoms may include headache, joint pain, fever, and swollen glands.

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Oral Cancer

The oral cavity includes:

  • The lips, teeth, and gums

  • The front two-thirds of the tongue

  • The lining inside the lips and cheeks (buccal mucosa)

  • The floor of the mouth (under the tongue)

  • The top of the mouth (hard palate)

  • The small area behind the wisdom teeth

The oropharynx includes:

  • The back one-third of the tongue

  • The soft palate

  • The tonsils

  • The back of the throat

What causes oral and oropharyngeal cancers?

The main causes of are:

  • Tobacco use

  • Alcohol use

Other causes may include the following:

  • A diet low in fruits and vegetables

  • Human papillomavirus (HPV) infection

  • Excessive sun exposure, which, like elsewhere on the body, can cause cancer on the lip

What are the symptoms of oral and oropharyngeal cancers?

The following are the most common symptoms. However, each individual may experience symptoms differently. Symptoms may include:

  • A lip or mouth sore that does not heal

  • A white or red patch on the gums, tongue, or lining of mouth

  • A lump on the lip or in the mouth or throat

  • Unusual bleeding, pain, or numbness in the mouth area

  • Swelling of the jaw or neck

  • Pain in the ear

  • Change in voice

  • A chronic sore throat

  • Feeling as if something is caught in the throat

  • Pain or difficulty in swallowing or chewing

  • Cough

The symptoms of oral and oropharyngeal cancers may resemble other disorders or medical problems. Always consult your health care provider for a diagnosis.

What are the different types of oral and oropharyngeal cancers?

Tumors can develop anywhere in the oral cavity and oropharynx (or the back of the mouth where it connects with the throat). Some tumors are benign (noncancerous), some may be precancerous (a condition that may become cancerous), while others may be cancerous. Different types of cancer may develop in different areas of the mouth and throat.

What are benign tumors?

Many forms of benign (noncancerous) tumors can appear in the oral cavity or oropharynx (in addition to other sites in/on the body), including:

Condyloma acuminatum (also known as genital warts)

A small, moist, pink or red growth that grows alone or in cauliflower-like clusters

Eosinophilic granuloma

A benign tumor which most often affects children and adolescents and is usually found in a bone or the lungs

Fibroma

A benign tumor consisting of fibrous connective tissues

Keratoacanthoma

A flesh-colored, fast-growing bump on the skin with a keratin plug in the center (keratin, the main component of the external layer of skin, hair, and nails, is a tough substance)

Leiomyoma

A tumor of the smooth muscle, often found in the esophagus, small intestine, uterus, or stomach

Lipoma

A tumor made up of mature fat cells

Neurofibroma

A fibrous tumor consisting of nerve tissue

Odontogenic tumors

Tumors in the jaw that start in the tooth-forming tissues

Osteochondroma

A tumor made up of bone and cartilage

Papilloma

A tumor that resembles a wart, growing on the epithelium (the cells that form the skin and mucous membranes)

Pyogenic granuloma

A small, round bump that often has an ulcerated surface

Rhabdomyoma

A striated-muscle tumor that may appear on the tongue, pharynx, uterus, vagina, or heart

Schwannoma

A single tumor that grows in the neurilemma (Schwann’s sheath) of nerves

Verruciform xanthoma

Wart-shaped tumors

Some benign tumors disappear on their own. Others may have to be removed surgically. Most benign tumors do not recur (come back). Always consult your health care provider for a diagnosis.

What oral conditions may be precancerous?

Two conditions in the mouth — leukoplakia and erythroplakia — actually can be precursors to cancer. Often caused by smoking or chewing tobacco, these (initially) benign conditions can occur anywhere in the mouth. Only a biopsy can determine whether precancerous cells (dysplasia) or cancer cells are present in a leukoplakia or erythroplakia.

  • Leukoplakia. A condition characterized by a whitish patch that develops inside the mouth or throat.

  • Erythroplakia. A condition characterized by a red, raised patch that develops inside the mouth.

Treatment for leukoplakias or erythroplakias may include use of retinoids — medications that are related to vitamin A — to eliminate, reduce, and/or prevent dysplasia from forming.

What are malignant tumors?

Although there are several types of malignant oral and oropharyngeal cancers, more than 90% of all diagnosed oral and oropharyngeal cancers are squamous cell carcinoma.

Squamous cell carcinoma

Also known as squamous cell cancer, this type of cancer originates in the squamous cell layer in the lining of the oral cavity and oropharynx. In the early stages, this cancer is present only in the lining layer of cells (called carcinoma in situ). When the cancer spreads beyond the lining, it is called invasive squamous cell cancer.

Verrucous carcinoma

Although also considered a type of squamous cell carcinoma, this low-grade cancer rarely metastasizes (spreads to distant sites). Comprising less than 5% of all diagnosed oral cancers, verrucous carcinoma can spread deeply into surrounding tissue, requiring surgical removal with a wide margin of surrounding tissue.

Minor salivary gland cancers

The lining of the oral cavity and oropharynx contains numerous salivary glands. Sometimes cancer will originate in a salivary gland. Treatment depends on the type and location of the salivary gland cancer, as well as the extent of spreading. According to the ACS, salivary gland cancers are rare.

What is a risk factor?

A risk factor is anything that may increase a person’s chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person’s risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.

But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

What are the risk factors for oral and oropharyngeal cancers?

Although heredity also plays a factor, certain lifestyle habits and health conditions can increase a person’s risk for developing oral and oropharyngeal cancers. These include, but are not limited to:

Tobacco use

The majority of patients with oral and oropharyngeal cancers use tobacco in one form or another. Tobacco can damage cells in the lining of the oral cavity and oropharynx, causing abnormal cells to grow more rapidly to repair the damage. Researchers believe that the DNA-damaging chemicals in tobacco are linked to the increased risk of oral and oropharyngeal cancers, according to the ACS.

Alcohol use

The majority of patients with oral and oropharyngeal cancers use alcohol frequently. Paired with tobacco use, patients who drink and smoke increase their risk of developing oral and oropharyngeal cancers even more. Researchers have found that alcohol increases the penetration of DNA-damaging chemicals in the lining of the oral cavity and oropharynx, according to the ACS.

Sunlight

Prolonged exposure to ultraviolet radiation from the sun can cause skin cancer. People who are outdoors for an extended period of time increase their risk of lip cancer, as well.

Chronic irritation

Chronic irritation to the lining of the mouth, due to poorly fitting dentures or other reasons, may increase a person’s risk for oral cancer.

Lack of fruits and vegetables in diet

Research has suggested that fruits and vegetables, which contain antioxidants that can “trap” harmful molecules, can decrease the risk for oral and oropharyngeal cancers (and other cancers). Thus, it is speculated that persons with a low intake of these types of foods are at an increased risk for (oral and oropharyngeal) cancer.

Human papillomavirus (HPV) infection

HPV usually causes warts and has been linked to cervical, vaginal, and penile cancers. HPV also increases the risk for cancers of the oral cavity and oropharynx.

Males

Oral and oropharyngeal cancers are twice as common in men then in women, partly because men are more likely to use tobacco and alcohol.

Can oral and oropharyngeal cancers be prevented?

It is important to detect cancers of the oral cavity and oropharynx as early as possible because treatment works best before the disease has spread. The National Cancer Institute (NCI) and ACS encourage people to take an active role in the early detection of these cancers by performing monthly self-examinations. The Oral Health Education Foundation recommends the following steps (below) when examining your mouth. Take special note of any red or white patches, lumps or thickening of skin, tissue, or gums, a sore that either does not heal properly (after a 1- to 2-week period), or a sore that tends to bleed easily or excessively. In addition, be sure to take note of a persistent sore throat, hoarseness, or difficulty maneuvering the jaw during chewing or swallowing. Be sure to consult your doctor right away if any of these symptoms are present:

  • Remove any dental products in the mouth.

  • Visually look and touch your mouth, including the lips and gums.

  • Check the roof of your mouth.

  • Check the inside of the cheeks and the back gums.

  • Check the tongue, including the sides and underneath.

  • Check for enlarged lymph nodes in the neck and under the jaw.

Regular dental checkups that include an examination of the entire mouth are also important in the early detection of oral and oropharyngeal cancers or precancerous conditions. Your doctor should also check your mouth as part of a routine physical exam.

How are oral and oropharyngeal cancers diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for oral cancers of the oral cavity and oropharynx may include one or more of the following:

  • Biopsy. A procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope to determine if cancer or other abnormal cells are present.

  • Computed tomography (CT or CAT scan). A noninvasive procedure that takes horizontal, or axial, images of the brain or other internal organs to detect any abnormalities that may not show up on an ordinary X-ray.

  • Ultrasonography. A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs.

  • Magnetic resonance imaging (MRI). A noninvasive procedure that produces 2-dimensional view of an internal organ or structure, especially the brain and spinal cord. If additional imaging is needed, your doctor may order a PET scan, which can determine where your cancer started.

  • Barium swallow. Because cancer of the esophagus may occur with oral cancer, your doctor may order this test, often called an upper GI series, to look for cancer of the esophagus. You will drink a chalky solution while X-rays are taken.

  • Endoscopy. A small fiberoptic scope can be used to to examine the oropharynx and oral cavity. The scope can also be used to obtain biopsies.

Once a diagnosis is made, the cancer will be staged (to determine the extent of the disease) before a treatment plan is established.

What is the treatment for oral and oropharyngeal cancers?

Specific treatment for cancers of the oral cavity and oropharynx will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include:

  • Surgery. Different surgery techniques are used to remove specific types of tumors, including:

    • Primary tumor resection. Removal of the entire tumor and surrounding area of tissue

    • Maxillectomy. Removal of the tumor, including part or all of the hard palate (roof of the mouth), if bone is involved

    • Glossectomy. Removal of the tongue

    • Mohs’ micrographic surgery. Removal of the tumor in “slices” to minimize amount of normal tissue removed (may be considered when the cancer involves the lip)

    • Laryngectomy. Removal of a large tumor of the tongue or oropharynx, which may involve removing the larynx (voice box).

    • Neck dissection. If cancer has spread to the lymph nodes in the neck, these lymph nodes may need to be removed as well.

  • Radiation therapy. Treatment that uses high-energy rays that damage cancer cells and halts the spread of cancer. Radiation therapy is very localized, aimed at only the area where the cancer is present. Radiation therapy may be administered externally with a machine, or internally with radioactive materials.

  • Chemotherapy. Medications that go throughout the entire body to kill cancer cells. Chemotherapy has the ability to interfere with the cancer cell’s replication. Chemotherapy may be used in combination with surgery and radiation therapy.

  • Targeted therapy. Drugs that target specific cancer cells are also an option and often cause less side effects than chemotherapy that kills both cancerous and noncancerous cells. One such example is cetuximab (Erbitux) that targets epidermal growth factor receptors.

For clues about problems in your mouth, stick out your tongue and look in the mirror. A healthy tongue should be pink and covered with small nodules (papillae). Any deviation from your tongue’s normal appearance, or any pain, may be cause for concern.

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Family physician Daniel Allan, MD, discusses why you should watch for changes that might need to be evaluated by a doctor or dentist.

If your tongue has a white coating or white spots

A white tongue, or white spots on your tongue, could be an indication of:

Oral thrush – a yeast infection that develops inside the mouth. It appears as white patches that are often the consistency of cottage cheese. “Oral thrush is most commonly seen in infants and the elderly, especially denture wearers, or in people with weakened immune systems,” says Dr. Allan. “People with diabetes and those who are taking inhaled steroids for asthma or lung disease can also get it. And oral steroids can trigger trush too. Oral thrush is also more likely to occur after you’ve taken antibiotics.”

Leukoplakia – a condition in which the cells in the mouth grow excessively, which leads to white patches on the tongue and inside the mouth. “Leukoplakia can develop when the tongue has been irritated,” Dr. Allan says. “It’s often seen in people who use tobacco products. Leukoplakia can be a precursor to cancer, but isn’t inherently dangerous by itself. If you see what you think could be leukoplakia, contact your dentist for an evaluation.”

Oral lichen planus – a network of raised white lines on your tongue that look similar to lace. “We don’t always know what causes this condition, but it usually resolves on its own,” says Dr. Allan.

If your tongue is red

A red tongue could be a sign of:

Vitamin deficiency – “Folic acid and vitamin B-12 deficiencies may cause your tongue to take on a reddish appearance,” Dr. Allan says. A simple blood test is available to determine these levels.

Geographic tongue – This condition causes a map-like pattern of reddish spots to develop on the surface of your tongue. “These patches can have a white border around them, and their location on your tongue may shift over time,” says Dr. Allan. “Geographic tongue is usually harmless.”

Scarlet fever – an infection that causes the tongue to have a strawberry-like (red and bumpy) appearance. “If you have a high fever and a red tongue, you need to see your family doctor,” Dr. Allan says. “Antibiotics are necessary to treat scarlet fever.”

Kawasaki disease – a condition that can also cause the tongue to have a strawberry-like appearance. It is seen in children under the age of 5 and is accompanied by a high fever. “Kawasaki disease is a serious condition that demands immediate medical evaluation,” says Dr. Allan.

If your tongue is black and hairy

Much like hair, the papillae on your tongue grow throughout your lifetime. In some people, they become excessively long, which makes them more likely to harbor bacteria.

“When these bacteria grow, they may look dark or black, and the overgrown papillae can appear hair-like,” Dr. Allan says. “Fortunately, this condition is not common and is typically not serious. It’s most likely to occur in people who don’t practice good dental hygiene.”

He says people with diabetes, taking antibiotics or receiving chemotherapy may also develop a black hairy tongue.

If your tongue is sore or bumpy

Painful bumps on your tongue can be due to:

Trauma – “Accidentally biting your tongue or scalding it on something straight out of the oven can result in a sore tongue until the damage heals,” says Dr. Allan. “Grinding or clenching your teeth can also irritate the sides of your tongue and cause it to become painful.”

Smoking – Smoking irritates your tongue, which can cause soreness.

Canker sores – mouth ulcers. “Many people develop canker sores on the tongue at one time or another,” Dr. Allan says. “The cause is unknown, but stress is believed to be a factor.” Canker sores normally heal without treatment within a week or two.

Oral cancer – “A lump or sore on your tongue that doesn’t go away within two weeks could be an indication of oral cancer,” says Dr. Allan “Keep in mind that many oral cancers don’t hurt in the early stages, so don’t assume a lack of pain means nothing is wrong.”

Watch your tongue!

Dr. Allan says everyone should check their tongue on a daily basis when they brush their teeth and tongue. “Any discoloration, lumps, sores or pain should be monitored and evaluated by a medical professional if they don’t go away within two weeks,” he says.

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