You glance in the mirror, stick out your tongue, and there it is. A spot. Or maybe a few. Your mind might jump to all sorts of worries, and that’s completely natural. I see folks in my clinic fairly often who’ve noticed something new on their tongue and want to understand what’s going on. The good news? Many times, these spots on tongue are perfectly normal or just a temporary blip.
But before we dive into what might be new, let’s talk about what’s usually there.
What Your Healthy Tongue Looks Like
First off, let’s remember that a healthy tongue isn’t perfectly smooth. It’s covered in tiny bumps called papillae. Think of them as the tongue’s texture. Your tongue is covered with these papillae—those tiny bumps and projections. There are actually a few different kinds:
- Filiform papillae: These are threadlike and found mostly at the front and center. They don’t have taste buds but help with sensation.
- Fungiform papillae: These are more mushroom-shaped and scattered across the tongue, especially at the tip and edges. Each one has a few taste buds.
- Foliate papillae: You’ll find these on the sides at the back of your tongue; they look like small, rough folds and contain many taste buds.
- Circumvallate papillae: These are the big guys, found in a V-shape at the very back of your tongue, also packed with taste buds.
All these papillae work together to help with speaking, chewing, and, of course, tasting our food. So, these are the ‘spots’ that are meant to be there.
Common Reasons for New Spots on Your Tongue
But then there are other kinds of spots – ones that might be new, look different, or maybe even feel a bit uncomfortable. Most of these are harmless, truly. But sometimes, a new spot can be a little signal from your body that something else needs attention, like a food allergy, an autoimmune response, or, much less often, something more serious like tongue cancer.
Let’s walk through some of the common things we see.
Canker Sores (Aphthous Ulcers)
Ever had one of those? Canker sores, or aphthous ulcers as we call them, are little sores that pop up inside your mouth. They can be on your tongue, lips, or the inside of your cheeks. They often look like small, roundish white or yellowish spots with a red ring around them. Annoying, yes, but usually not a big worry.
Cold Sores (Fever Blisters)
Cold sores, sometimes called fever blisters, are a bit different. These are tiny, fluid-filled blisters, often in clusters. While they love to appear on the lips, they can show up on your tongue too. These are caused by a virus, the herpes simplex virus (HSV-1), which is super common and spreads easily through saliva. There are over-the-counter treatments that can help, and we can certainly chat about what might work best for you.
Geographic Tongue
This one sounds a bit odd, doesn’t it? Geographic tongue actually looks like a map on your tongue. You’ll see smooth, reddish patches, often with a white or light-colored border. It can change patterns over time, just like a map might be redrawn. The interesting thing? It’s completely harmless and not contagious. Usually, no treatment is needed.
Transient Lingual Papillitis (Lie Bumps)
Ah, the infamous ‘lie bumps‘! Medically, we call it transient lingual papillitis. It’s just when those normal papillae on your tongue get a bit inflamed or enlarged. They look like small red or white bumps. Super common, and they usually disappear on their own in a few days. And no, despite the name, they don’t actually mean you’ve been fibbing! Weird, right?
Thrush (Oral Candidiasis)
Oral thrush is a fungal infection. Think of it like a yeast infection, but in the mouth. It can happen to anyone, but we see it more often in little ones, like toddlers, and also in adults whose immune systems might be a bit down. It shows up as raised, white, cottage-cheese-like spots on the tongue and inner cheeks. If you try to scrape them off, they might bleed. If you suspect thrush, a quick visit can get you an antifungal medication to clear it right up.
Lichen Planus
Lichen planus is a bit of a mystery. It’s a condition where your immune system, for reasons we don’t fully understand, decides to attack cells in your body, including in your mouth. Oral lichen planus can look like lacy white patches, or sometimes it can cause sore spots or swollen areas. If it’s bothersome, we have medications to help manage the symptoms.
Leukoplakia
Now, leukoplakia is one we pay closer attention to. These are white patches or spots that can show up on your inner cheeks, or on or under your tongue. A key thing is that you can’t scrape them off. While most leukoplakia patches don’t turn into oral cancer, there is an increased risk. So, if we see this, we usually recommend getting it checked thoroughly, which might involve a biopsy (taking a tiny sample for the lab), and often removing them, just to be safe.
Erythroplakia
Similar to leukoplakia, but red. Erythroplakia shows up as abnormal red spots inside your mouth, maybe on your tongue or the floor of your mouth. And like leukoplakia, these patches don’t come off when scraped. These also carry a higher risk of developing into oral cancer, so we take them seriously. Again, a biopsy is usually needed. Treatment might involve radiation, surgery, or working on any risk factors.
Tongue Cancer
It’s important to mention, though it’s rare, that sometimes spots on tongue can be a sign of tongue cancer. These might look like red or white patches, or even ulcers or sores that just don’t heal. This is why getting new or persistent spots checked out is so important. Early detection makes a huge difference.
When Should You See a Doctor About Spots on Tongue?
So, with all these possibilities, when should you pick up the phone and call your doctor? My general advice is this: if you notice any new sore, spot, or ulcer on your tongue or anywhere in your mouth, especially if it’s sticking around for more than a couple of weeks, or if it’s painful, or if it’s changing, it’s always best to get it looked at.
When you come in, we’ll have a good look, ask some questions about your health and habits, and try to figure out what’s going on. Sometimes, just looking is enough. Other times, we might need to do a little more. For instance, if a spot looks like it could be leukoplakia or erythroplakia, or if there’s any concern about something more serious, we’d likely suggest a biopsy. That just means taking a tiny sample of the tissue for a specialist, called a pathologist, to examine under a microscope.
Treatment, of course, depends entirely on the cause.
- For many things, like those lie bumps or geographic tongue, no treatment is needed!
- For infections like thrush, an antifungal medicine will do the trick.
- For canker sores or cold sores, we can suggest ways to ease discomfort and sometimes speed healing.
- If it’s something like leukoplakia or erythroplakia, we’ll talk about the best way to manage it, which often involves removing the lesion.
And if, in the rare case, it’s something more serious, we’ll be right there with you to discuss all the options and next steps. We’ll make sure you understand everything.
Key Takeaways for Spots on Tongue
Here’s a quick rundown of what to keep in mind:
- Your tongue naturally has bumps (papillae); these are normal ‘spots’.
- Many new spots on tongue are harmless (like lie bumps or geographic tongue) and resolve on their own.
- Some spots, such as canker sores or cold sores, can be uncomfortable but are usually manageable with home care or simple treatments.
- Infections like thrush need straightforward medical treatment, usually an antifungal.
- Persistent white or red patches (leukoplakia, erythroplakia) or sores that don’t heal for a few weeks absolutely need a doctor’s evaluation, as they can sometimes be precancerous or, rarely, cancerous.
- Don’t panic, but do get any new, changing, or persistent spots on tongue checked out by your doctor or dentist.
It’s easy to worry when you see something new or different in your mouth, but remember, we’re here to help you figure it out. You’re not alone in this.