Dear Alice,

Are there other causes for white-coated tongues?? I believe I have thrush. Do I need a tongue culture to confirm it? Can my mate get it by kissing? Could it be the reason for my chronic sore throats lately?? The only difference I notice is I don't have any metallic or salty taste in my mouth. When I get it really bad, that is what I usually experience, as well as a raw tongue. Thanks for any help!!

— Lindee

Dear Lindee,

Sounds like you already know a bit about thrush (also referred to as an oral yeast infection). First, thrush isn't necessarily considered a transmittable infection (more on why later). But, before you kiss your partner, there could be other reasons for a white-coated tongue — thrush is just one of a few possible diagnoses. To know for sure what's causing your white tongue and to determine whether to stop the smooching or not, it’s best to see your health care provider and be treated if necessary.

To give you a bit more information on thrush: it's an infection caused by the fungus Candida, the same little beastie responsible for other types of yeast infections. Who can get thrush? People who take an antibiotic or steroid medication, folks with compromised immune systems, and smokers are also at risk for an oral yeast infection. Thrush is also common among babies, who may be exposed to the microorganism as they pass through the birth canal. In all of these cases, the infection occurs when the balance of bacteria in the mouth is disrupted, making it easier for Candida yeast to grow and spread. Also, sometimes thrush can be a sign of a more serious, underlying condition such as diabetes or human immunodeficiency vius (HIV). Symptoms of an oral yeast infection might include:

  • White patches on the tongue and insides of the cheeks
  • Creamy, cottage cheese-like sores, also on the tongue and in the mouth
  • Pain or burning in the mouth and throat
  • Lessened ability to taste food
  • Metallic or unpleasant taste in the mouth

You may be wondering, if it's not thrush, what could be causing a white tongue. Often, the white coating is a harmless buildup of debris, bacteria, and dead cells caught by inflamed cells on the surface of the tongue, also known as papillae. This can be caused by: 

  • Poor oral hygiene
  • Dry mouth
  • Dehydration
  • Smoking or other oral tobacco use
  • Alcohol use (excessive)
  • Mouth breathing
  • Low roughage diet (eating mostly soft or mashed foods) 
  • Mechanical irritation from sharp tooth edges or dental appliances
  • Fever

List from Mayo Clinic.

Your white tongue might be caused by another condition, including:

  • Scarlet fever — a condition during which the tongue has a white coating for the first two days
  • Lichen planus — a skin infection that causes lacy white patches on the tongue and inner cheeks if the mouth is infected
  • Leukoplakia — an irritation of the mouth, which can sometimes cause a white-coated tongue
  • Prolonged use of antibiotics
  • Geographic tongue — a condition in which the person does not have a tongue surface covered by papillae
  • Mouth or tongue cancer
  • Syphilis
  • Immunosuppression through diseases such as HIV

Since you mentioned you’ve also experienced a sore throat, it may be time to consult a health care provider. They may be able to diagnose you just by examining your mouth, or they might use smears, stains, or cultures of the mouth or throat to confirm if it's thrush or another condition.

So, do you need to cross kissing off your list for the time being? While thrush is considered a non-communicable disease, kissing can technically spread the yeast from your mouth to your mate's. This doesn't necessarily mean that your partner's infected because thrush is an opportunistic infection. This means that whether an infection occurs or not depends on the conditions of the environment in which the yeast reside. So, although someone with thrush may not directly transmit it through kissing, you're wise to consider placing a hold on smooches until you can confirm the cause of your white tongue, just in case your condition could, in fact, be spread through kissing.

Best wishes for a healthy tongue!

Alice!

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