White Coating on Tongue

My five-year-old son has had a chalky white coating on the rear two thirds of his tongue for years. Dentists and doctors tell me not to worry about it. I think it has affected his breath for years. No one else in the family has this condition. What is causing this condition? Will it will ever go away?

Question:

One possibility is that your son simply has an overgrowth of keratin in this area. Skin, hair, and fingernails also have keratin as a protective coating. An overgrowth would appear white in color and would not be a worrisome condition.

Another possibility is "white hairy tongue." Usually no specific cause for this condition can be determined, but medications such as broad spectrum antibiotics, corticosteroids, mouthrinses that contain hydrogen peroxide, sodium perborate, and carbamide peroxide, have been implicated as initiating factors. This condition has also been observed in heavy smokers and patients who have received radiation therapy to the head and neck region. Hairy tongue appears to be the result of a change in the bacteria normally present in the oral cavity. An abundance of fungi and chromogenic (colored) bacteria may cause the appearance you describe. This is basically an overgrowth of the filiform papillae (one of several types of papillae covering the tongue) and a retardation of natural tissue sloughing. This thick matted surface entraps bacteria, fungi, cellular debris, and foreign material. The color varies from white, tan, brown, or black. The color depends on the bacteria present, patient diet, and oral hygiene. Generally, no treatment is needed because this condition can resolve on its own.

Other possible conditions may include geographic tongue, lichen planus, and some type of chronic candidal (fungal) infection. Geographic tongue is generally characterized by both red and white lesions, and changes position on the tongue. Lichen planus is typically a disease of middle age and is rarely seen in children. Lichen planus can have several appearances, including the plaque form which is white. This form generally appears to have several different focal areas. It primarily appears on the tongue and inner cheek. There is no specific treatment for lichen planus; however, in some cases, corticosteriods have been successful.

Some type of chronic candidiasis, such as mucocutaneous candidiasis, may also be possible. This can begin early in life as a white area in the mouth, with the tongue as a possible affected region. It generally progresses to involve nails and skin as well. A biopsy can aid in the differential diagnosis, although I am not sure it would be necessary at this time. Discuss the possibilities with your current dentist and pediatrician.

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