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What Causes White Coating On Tongue And Dry Mouth?

Posted on Mon, 24 Aug 2015

Question: For the past 4 or 5 months, I've noticed my tongue looks very white. I can scrape some of it off, but it never fully goes away and comes right back. The back of the tongue is where it is most white. Scraping does not cause any bleeding. My mouth feels a little bit dry, but it is tolerable. I first asked my physician who said he thought it was due to dry air, and as such suggested I get a humidifier. I did, and there were no changes. I then asked my dentist, who took the attached pictures of the middle of the tongue, and back of the tongue. He initially suspect it could be oral thrush. I went back to my physician who was convinced it wasn't oral thrush, said it was "one of those things that might just go away on its own," and prescribed me oral thrush medication anyway. The medication has not worked. The medication was Fluconazole.

With the attached images, what do you think could be the cause of this? I have no other symptoms which I am aware of?

Answered by Dr. Abubakar Siddiqh (10 hours later)

Brief Answer:
needs fungal culture.

Detailed Answer:

Hi,

I have gone through your question and understand your concerns that you are having tongue lesions. I would like to ask you few more details.

Are you using any mouth inhalers (bronchial asthma) ?

Kindly get back to me with the details.

As per your clinical details and picture, it appears to be geographical tongue (erythma migrans) or oral candidiasis.

Solutions for your tongue related issues.

1. Oral candidiasis is common in patients who are immuno-compromised (thallessemia) and on persons who are on prolonged usage of steroidal inhalers.

You need to give tongue scrapings for fungal culture and sensitivity, to confirm candidiasis.

2. Erythema Migrans- The condition typically waxes and wanes, most individuals are asymptomatic and do not require treatment for this benign condition. For symptomatic cases ( pain or burning sensation), you need to use topical steroids, zinc supplements, and topical anesthetic rinses.

3. Meantime, start simple salt water gargling and take multivitamins.

Kindly discuss with your physician or ent surgeon, for the above investigations and treatment.

Hope this answers your question, if you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.

Wishing you good health.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Abubakar Siddiqh (7 hours later)

Do not use mouth inhalers for asthma. I was unaware thalassemia means my immunity is compromised.

Answered by Dr. Abubakar Siddiqh (1 hour later)

Brief Answer:
Some type, do not require treatment.

Detailed Answer:

Hello again,

Thanks for considering my answer and for your follow up.

Thallesimia is an autosomal recessive disorder, where on can have defective hemoglobin, which may cause iron deficiency anemia or iron over load or spleen enlargement depending on the seviarity. This factors, may push you in immunocompromised status.

Do not worry, some types are asymptomatic and non lethal, and do not require any treatment.

Hope, I have answered your query.

All the best. Take care.

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj