White tongue coating, also known as white fur, refers to the appearance of white fur on the tongue surface. It is usually divided into thick and thin. If the tongue body can be seen through the tongue coating, it is a thin white tongue, and vice versa, it is a thick white tongue. Clinically, white fur can be a normal tongue coating for healthy people, and can also be seen in superficial syndrome, cold syndrome, dampness syndrome, and in a few cases, heat syndrome. Western medicine believes that it is often related to oral diseases, digestive system diseases, diabetes and other diseases.
Epidemiology
Epidemiology
White tongue coating is common in clinical practice, but there is no exact incidence data.
Infectious
Not contagious.
Incidence
It is relatively common in clinical practice, but there is no exact incidence data.
Prone population
There is no specific susceptible population.
symptom
Classification
White fur can be divided into thin white fur and thick white fur according to the thickness of the tongue fur. According to the different textures of the tongue fur, thin white fur can be further divided into thin white fur and moist, thin white fur and smooth, thin white fur and dry (dry), while thick white fur can be divided into thick white fur and greasy, thick white fur and dry, powdery fur, etc.
Typical manifestations
1. Thin white coating
There is a thin layer of white coating on the surface of the tongue, through which the tongue body can be seen, which is called thin white coating.
(1) The tongue coating is thin, white and moist: The tongue coating is thin, white, moist and has a moderate degree of dryness and wetness, and is neither slippery nor dry.
(2) The tongue coating is thin, white and slippery: The tongue coating is thin, white, and the surface of the tongue is moist. When the tongue is extended, it seems to be dripping, and it feels wet and slippery.
(3) Thin, white and dry tongue coating: The tongue coating is thin, white and dry. It feels dry and dry. In severe cases, the tongue coating may be dry and cracked.
2. Thick white moss
The tongue coating is milky white or pinkish white, slightly thinner at the tip of the tongue, and becomes thicker at the middle and root. The tongue body is covered by the tongue coating and not exposed, which is called thick white coating.
(1) Thick, white and greasy coating: The tongue coating is thick, white, dense, with small particles that fuse into pieces, as if coated with grease. It is thick in the middle and thin around the edges, clinging to the surface of the tongue and cannot be wiped off or scraped off.
(2) Thick, white and dry tongue coating: The tongue coating is thick, white and dry, with no saliva when touched. In severe cases, the tongue coating is dry and cracked, and it is difficult to touch.
(3) Powdery white fur: The tongue is covered with white fur, like an accumulation of white powder, which is not dry when touched. It is also called “powdery white fur”.
3. Others
Depending on the cause and condition of the disease, the tongue may shrink, become enlarged, have teeth marks on the edges, or change in color from pale white to light red or crimson. The distribution of the white coating on the tongue also plays a role in determining the location of the lesion.
Associated symptoms
1. Traditional Chinese Medicine Diseases
(1) Exterior symptoms: Patients may experience aversion to cold or wind, fever, sweating or no sweating, headache, body aches, nasal congestion and clear runny nose, cough, and clear and thin sputum.
(2) Cold syndrome: fear of coldness all over the body, cold limbs, or local cold pain, difficulty in flexion and extension, or abdominal pain, diarrhea, vomiting, tasteless mouth without thirst, clear and thin sputum, mucus, saliva, etc., clear and long urine, and loose stools.
(3) Dampness syndrome: Headache or heaviness in the head, chest tightness and nausea, abdominal distension, no thirst, laziness in the limbs, heaviness and discomfort in the body, or sore and heavy joints, difficulty in flexing and extending the joints, poor appetite, loose stools, etc.
2. Western medicine diseases
(1) Oral diseases: symptoms such as red, swollen, painful, bleeding gums, and loose teeth.
(2) Digestive system diseases: symptoms such as stomach pain, abdominal distension, nausea, vomiting, constipation or diarrhea.
(3) Diabetes: Symptoms include thirst, increased drinking, increased urination, weight loss, dry skin with itching, and susceptibility to infection.
complication
There are generally no obvious complications.
reason
Overview
In traditional Chinese medicine theory, white tongue coating can be caused by superficial symptoms, cold symptoms, dampness symptoms, and heat symptoms. In modern clinical practice, white tongue coating may be caused by food staining, poor oral health or oral diseases, as well as digestive system diseases, diabetes, etc. In addition, white tongue coating can also be seen in normal people.
Cause of symptoms
1. Normal people
The normal tongue is pale red with a thin white coating. Therefore, if the tongue coating is white and evenly distributed on the tongue surface, and the tongue surface can be faintly seen through the tongue coating, it may be a normal phenomenon.
2. Causes of disease in traditional Chinese medicine
(1) Exterior syndrome: Since the exogenous pathogenic qi is relatively mild and has not yet entered the body, the tongue coating often does not change significantly and remains the normal thin white coating. For those who are affected by wind-cold pathogenic qi, the tongue coating may be thin, white and moist; for those who are affected by wind-heat pathogenic qi, the tongue coating may be thin, white and dry; for those who are affected by wind-rheumatic pathogenic qi, the tongue coating may be thin, white and slippery.
(2) Cold syndrome: In traditional Chinese medicine theory, white represents cold, so a white tongue coating may be caused by invasion of cold pathogens or internal cold syndrome. Usually, the coldness causes contraction, which leads to poor circulation of qi and blood and dysfunction of internal organs, which in turn causes qi and blood to be unable to nourish the tongue.
(3) Dampness syndrome: Factors such as exposure to dampness, internal accumulation of dampness, and food stagnation can lead to abnormal water metabolism in the body, which can be reflected in the tongue as a white greasy or white slippery coating.
(4) Heat syndrome: It is often caused by other pathogenic factors. For example, if a patient is suffering from wind-heat or a febrile disease, the tongue coating may be thin, white and slightly dry. If the patient is suffering from excessive dampness and heat, a thick, white and greasy coating may appear. If the patient is suffering from foul external factors or excessive toxicity, the tongue may be covered with white coating, like a pile of white powder. If the febrile disease progresses rapidly and the body fluids are damaged, the tongue coating may be white, dry and cracked like sand and stone, and rough to the touch.
3. Western medicine factors
(1) Food staining: Eating white foods such as milk, cream, cake, or brushing your teeth may stain your tongue white. This can usually be alleviated by rinsing your mouth or drinking water.
(2) Poor oral hygiene: Western medicine believes that the tongue coating is composed of desquamated keratinized epithelium, saliva, bacteria, food debris and exuded white blood cells. Therefore, if oral hygiene is not taken seriously, food debris may remain and bacteria may multiply, leading to white tongue coating, which may be accompanied by changes such as thickening, roughness and granularity of the tongue coating.
(3) Oral diseases: If you suffer from oral diseases such as gingivitis, pulpitis, and periodontitis, it will not only cause bacteria to multiply on the surface of the teeth, but also increase the number of bacteria in the mouth and tongue, resulting in a white tongue coating, accompanied by bad breath and halitosis. Diseases such as oral candidiasis, oral lichen planus, and oral leukoplakia may cause irregular white spots to appear on the tongue coating.
(4) Others: Peptic ulcers, acute and chronic gastritis, diabetes, infections and other diseases can also cause white tongue coating.
Common diseases
Gingivitis, pulpitis, periodontitis, oral candidiasis, oral lichen planus, oral leukoplakia, peptic ulcer, acute and chronic gastritis, diabetes
Medical treatment
Home treatment
For those who have no discomfort, no special treatment is generally needed. For those who have white tongue coating due to poor oral hygiene, it can usually be improved at home by brushing teeth on time, rinsing mouth after meals and other general treatments.
Outpatient Indications
1. White tongue coating that cannot be relieved by general treatment;
2. Patients with oral disease symptoms such as oral ulcers, toothache, bad breath, taste changes, etc.
3. Patients with symptoms of external symptoms such as fever, fear of cold, headache, and general headache;
4. Those with symptoms of cold syndrome such as fear of coldness, cold limbs, cold and painful joints, abdominal pain and diarrhea;
5. Patients with symptoms of dampness such as heaviness in the head, chest and abdominal distension, heaviness in the limbs, and a sticky feeling in the mouth.
6. Accompanied by other persistent or recurring discomfort symptoms.
Anyone experiencing the above symptoms should seek medical attention at a regular hospital promptly.
Department
1. Tooth-marked tongue falls within the scope of diagnosis and treatment of Traditional Chinese Medicine, and patients can go to the Department of Traditional Chinese Medicine for treatment.
2. If you suspect you have an oral disease, you can go to the dental department for treatment.
3. If you suspect a digestive system disease, you can go to the gastroenterology department for treatment.
4. If you suspect you have diabetes, you can go to the endocrinology department for treatment.
5. If you suspect an infectious disease, you can go to the infectious department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. If you have had medical treatment recently, please bring relevant medical records, examination reports, test results, etc.
3. If you have taken some medicine to relieve symptoms recently, you can carry the medicine box.
4. Blood tests may be performed, and it is best to have the visit in the morning on an empty stomach.
5. Family members can accompany you to see the doctor and prepare a list of questions you want to ask in advance.
Questions your doctor may ask you
1. What symptoms do you have? How long have they lasted?
2. Do you have other accompanying symptoms, such as toothache, bad breath, heaviness in limbs, fever, etc.?
3. Are there any factors that may make your uncomfortable symptoms worse?
4. Have you visited other hospitals for treatment of your symptoms? Is there a clear diagnosis? How was the treatment? What was the effect?
5. Do any of your family members have similar symptoms as you?
6. Do you have any other diseases? Is it serious? How is the treatment?
Questions patients can ask their doctors
1. Is my condition serious?
2. What is causing my symptoms?
3. What tests do I need to do now?
4. What treatment do I need? How long will it take to recover?
5. How much does the treatment cost? Can it be reimbursed by medical insurance?
6. I have other diseases. Will this affect my treatment?
7. What should we pay attention to in daily life?
8. Do I need follow-up examinations? How often?
examine
Estimated inspection
Doctors usually perform four traditional Chinese medical examinations on patients, namely, inspection, auscultation, questioning, and palpation, to determine the disease and syndrome. At the same time, they will also perform relevant Western medical examinations, such as physical examination, blood routine, blood biochemistry, X-ray, CT, ultrasound, etc., according to the actual situation of the patient. If necessary, pathological biopsy can be performed to determine the diagnosis and pathological conditions.
Physical examination
1. Four Diagnoses of Traditional Chinese Medicine
(1) Observation: The doctor will observe the white area of the tongue coating, the texture of the tongue coating, etc. He will also observe the patient’s tongue quality, tongue movement, and the patient’s overall appearance, such as complexion, body shape, and expression, to make a preliminary judgment on the condition.
(2) Olfaction: mainly includes smelling odors and listening to sounds. The doctor carefully identifies whether there is any peculiar smell in the patient’s mouth and body, listens to the pitch and strength of the patient’s voice, and whether there are any abnormal sounds such as coughing, wheezing, groaning, etc., so as to judge the nature and severity of the disease.
(3) Interview: This includes asking the patient about the symptoms associated with the white tongue coating, as well as his diet, taste, sleep, whether he is afraid of cold or heat, whether he is thirsty, etc., as well as his past medical history and family history, so as to determine the condition and cause.
(4) Palpation: This includes pulse diagnosis and palpation. Doctors will feel the pulse and touch the patient’s body to help determine the type of disease.
2. Western medicine physical examination
In addition to a full-body physical examination, a detailed examination of the oral cavity, tongue, and tongue coating is required. During the examination, a tongue depressor, mouth mirror, and mouth mirror can be used.
Laboratory tests
1. Blood routine test
An elevated white blood cell count may indicate an infection.
2. Blood biochemistry
Liver and kidney function tests can help determine whether there is liver or kidney damage.
3. Biomarkers
Such as cytokines, antigens and antibodies, tumor markers, etc.
Imaging tests
1. X-ray and CT examination
Oral X-rays can evaluate dental lesions. Chest X-rays or CT scans can determine whether there is chest inflammation. Joint X-rays and CT scans can determine whether there are structural changes in the bone joints.
2. Ultrasound
Liver and kidney ultrasound is helpful in evaluating the liver and kidney structures.
Pathological examination
For localized or abnormally shaped white tongue coating, a pathological examination may be required to determine its origin and nature.
diagnosis
Diagnostic principles
Usually, a specialist doctor will make a clear diagnosis based on the thickness, texture, distribution of the patient’s white tongue coating, and whether the patient has symptoms such as fever, fear of cold, cold or heavy limbs, sticky mouth, abdominal distension and diarrhea, and the results of Western medicine auxiliary examinations to obtain information on the patient’s condition.
Differential Diagnosis
1. Normal tongue appearance
In normal tongue appearance, the tongue coating may be white, but it is usually thin and uniform. The tongue body can be faintly seen through the tongue coating. At the same time, the tongue coating is slightly thicker in the middle and root of the tongue body, with moderate dryness and wetness, and is neither slippery nor dry. This type of people usually have no discomfort symptoms.
2. Food interference
The tongue coating may be stained by eating foods that are white in color, such as milk, ice cream, cream, coconut, etc. At the same time, food residues in the mouth may cause bacteria to grow, which in turn causes a thick white tongue coating. However, the white coating caused by food can usually be corrected by brushing and rinsing the mouth.
3. Gray moss
It may develop from white tongue coating, which is grayer than white tongue coating, or accompanied by white tongue coating. It usually indicates that the condition is serious, and is more common in patients with syndrome of excessive internal cold or intense internal heat.
treat
Expected treatment
Since the causes of white tongue coating vary, doctors will implement individualized intervention measures based on the patient’s specific cause. After excluding food interference and oral hygiene, Chinese medicine usually provides treatments such as relieving symptoms, removing cold, and removing dampness according to different syndromes; in Western medicine, the treatment plan needs to be determined according to the specific disease.
Treatment of the cause
1. For those with white tongue coating, first restore oral hygiene by brushing teeth carefully, using dental floss, rinsing mouth after meals, etc. to restore the tongue coating to normal.
2. For those whose diseases are caused by TCM etiology and pathogenesis, specialist doctors should perform syndrome differentiation and treatment.
3. For those who are suffering from diseases caused by Western medicine, treatment should be carried out according to the specific disease. For example, oral diseases can be treated by cleaning the mouth, removing dental plaque and tartar, and surgical treatment should be considered if necessary; digestive system diseases can be regulated by good eating habits, and anti-Helicobacter pylori treatment should be carried out in time for those infected with Helicobacter pylori; diabetes patients should actively carry out hypoglycemic treatment and life management.
Drug treatment
1. TCM Syndrome Differentiation and Treatment
(1) Exterior symptoms: The main treatment method is to dispel wind and relieve the exterior symptoms. Follow the doctor’s advice and use Jingfang Dabiao Decoction, Jingfang Baidu Powder, Mahuang Decoction, Guizhi Decoction, or Yinqiao Powder, Sangju Yin and other prescriptions according to the condition of the disease.
(2) Cold syndrome: The main treatment method is to warm the middle and dispel the cold. Follow the doctor’s advice and use Lizhong Pills, Fuzi Lizhong Pills, Xiaojianzhong Decoction, Dajianzhong Decoction, Wuzhuyu Decoction, Danggui Sini Decoction, etc. according to the condition of the disease.
(3) Dampness syndrome: The main treatment method is to dry dampness and resolve phlegm. Follow the doctor’s advice and use prescriptions such as Pingwei Powder, Huoxiang Zhengqi Powder, Wuling Powder, Weiling Decoction, Linggui Shugan Decoction, Shipi Powder, Qianghuo Shengshi Decoction, Erchen Decoction, Banxia Baizhu Tianma Decoction, Baohe Pills, and Zhishi Daozhi Powder according to the patient’s condition.
2. Western medicine disease treatment
(1) Oral diseases: If there is infection, sensitive antibiotics can be used. Depending on the type of pathogen, sensitive antibiotics such as metronidazole, amoxicillin, doxycycline, azithromycin, and cephalosporin can be used for treatment. If the pain is severe, analgesics can be used.
(2) Digestive system diseases: according to the condition, you can use gastric acid inhibitors, gastric mucosal protective agents, gastric prokinetic agents, etc. If there is Helicobacter pylori infection, you can follow the doctor’s advice to use “quadruple therapy” (including a proton pump inhibitor, a bismuth agent, and two antibacterial drugs) for treatment, so as to completely eliminate it. Commonly used drugs include omeprazole, pantoprazole, potassium bismuth citrate, bismuth pectin, domperidone, cisapride, clarithromycin, amoxicillin, metronidazole, quinolones, furazolidone, tetracycline, etc.
(3) Diabetes: Oral hypoglycemic drugs and insulin can be used according to the doctor’s advice based on the condition of the disease.
Related drugs
Jingfang Datang Decoction, Jingfang Baidu Powder, Mahuang Decoction, Guizhi Decoction, Yinqiao Powder, Sangjuyin, Lizhong Pills, Fuzi Lizhong Pills, Xiaojianzhong Decoction, Dajianzhong Decoction, Wuzhuyu Decoction, Danggui Sini Decoction, Pingwei Powder, Huoxiang Zhengqi Powder, Wuling Powder, Weiling Decoction, Linggui Shugan Decoction, Shipi Powder, Qianghuo Shengshi Decoction, Erchen Decoction, Banxia Baizhu Tianma Decoction, Baohe Pills, Zhishi Daozhi Powder, Metronidazole, Amoxicillin, Doxycycline, Azithromycin, Omeprazole, Pantoprazole, Bismuth Potassium Citrate, Bismuth Pectin, Domperidone, Cisapride, Clarithromycin, Furazolidone, Tetracycline
Surgery
For severe oral diseases, such as recurrent periodontitis, surgical treatment may be considered. Commonly used methods include flap surgery, bone grafting, dental implants, etc.
Other treatments
Traditional Chinese medicine acupuncture, physical therapy, massage, and other methods also have certain therapeutic effects. They must be performed under the guidance of professional doctors or masseurs.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, timing of treatment, age and physical condition, and may vary from individual to individual.
Estimated cost of treatment
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General Prognosis
The prognosis of white tongue coating is usually good. Most patients can recover completely after active treatment and life management. However, for those whose causes are difficult to remove, they may not be completely cured. If the treatment is not timely or improper, it may also lead to worsening of the disease. In addition to severe systemic symptoms, the tongue coating may change from white to gray or black.
Hazards
1. Some people with white tongue coating will have bad breath or halitosis, which will have an adverse effect on the patient’s daily life and social life to a certain extent.
2. Whether it is a traditional Chinese medicine disease or a Western medicine disease, patients usually have obvious systemic symptoms. If not treated in time, the disease will gradually worsen, which will damage human health and reduce the quality of life. For example, for patients with oral diseases, if not treated in time, it will often affect the chewing function and thus affect food digestion. Some patients will also have missing teeth, which will not only affect the chewing function but also the patient’s appearance.
Self-healing
For those with food staining and poor oral hygiene, the disease can heal itself by cleaning the mouth.
Curative
Patients with exogenous pathogenic qi, internal cold and dampness, oral diseases, infections, and digestive system diseases can generally recover completely through active specialist treatment and lifestyle management. However, patients with weak constitution, strong pathogenic qi in the body, long-term illness, or chronic diseases may not be able to recover completely, but active treatment is conducive to improving symptoms and thus improving the quality of life of patients.
Recurrent
If you do not pay attention to oral hygiene or lifestyle management, or are affected by external pathogens, the white tongue coating may recur.
daily
Nursing principles
Scientific and effective nursing care is conducive to helping patients recover as soon as possible and stabilizing their condition. The nursing principles for white tongue coating mainly include adjusting diet and living habits, taking medicine according to doctor’s orders, etc.
Psychological care
White tongue coating may cause bad breath, taste changes, or general discomfort. Long-term non-healing or repeated attacks may cause trouble in daily life and work, and thus have a negative impact on the patient’s mental health, including inferiority, social barriers, anxiety, depression, etc. Family members should promptly understand the patient’s psychological changes, pay more attention to and enlighten the patient, enhance the patient’s sense of security, and enable the patient to accept treatment with the best attitude. The patient himself should face the disease, maintain a positive and optimistic attitude, and build confidence.
Medication care
1. Patients should take medications regularly and in fixed amounts according to the doctor’s instructions and should not change the dosage or stop taking the medication at will.
2. Pay close attention to the reaction after taking the medicine. If you experience any discomfort or the treatment effect is not obvious during the medication, you should consult a doctor in time.
Life Management
1. Patients should develop good oral hygiene habits, including brushing their teeth carefully and regularly, using dental floss correctly, and rinsing their mouths promptly after meals. If there is dental plaque or tartar, they should go to a professional institution for cleaning regularly.
2. Developing good living habits, regular work and rest, reasonable diet, proper exercise, and regulating emotions will help to strengthen the physical fitness and thus improve the body’s resistance to disease.
3. When the seasons change, you should add or remove clothes according to the climate. Avoid getting cold, getting wet in the rain, or wading in water.
Disease monitoring
During treatment, patients should monitor changes in their tongue coating and whether other systemic discomfort symptoms have improved.
Follow-up consultation instructions
Patients should follow their doctor’s orders for regular follow-up visits. If their condition worsens or new symptoms occur, it should be determined whether the treatment plan needs to be adjusted.
diet
Diet
A scientific and reasonable diet can ensure the normal functioning of the body, and play a role in assisting in controlling the disease, maintaining the treatment effect, and promoting recovery from the disease.
Dietary advice
1. Patients are advised to eat more nutritious and easily digestible foods.
2. Ensuring the intake of protein, lipids, carbohydrates, vitamins and dietary fiber will help promote recovery from the disease.
3. You can eat some therapeutic food under the guidance of a doctor. For example, if you are affected by wind-cold, you can eat onions and ginger. If you are affected by wind-heat, you can drink mint, chrysanthemum, and honeysuckle instead of tea. If you are affected by cold evil or cold in the middle jiao, you can eat more beef, mutton, yam, astragalus, walnuts, etc. If you are affected by damp evil, you can eat coix seed, red bean, mung bean, tangerine peel, hawthorn, etc.
Dietary taboos
1. Avoid eating greasy foods, such as fried foods, fat, fat, cream, crab roe, dairy products, etc., so as not to affect the spleen and stomach.
2. Avoid eating raw and cold foods, such as ice cream, cold drinks, fresh food, etc.
3. Avoid smoking, drinking, strong tea, strong coffee and other foods.
prevention
Precautions
1. Pay attention to oral hygiene, brush your teeth on time, and remember to rinse your mouth after meals.
2. Quit smoking and limit alcohol intake to reduce the irritation of cigarettes and alcohol to the tongue.
3. Maintain a regular schedule, exercise properly, eat a healthy diet, maintain a happy mood, avoid catching cold or getting caught in the rain, etc., so as to reduce the invasion of pathogens.
4. Have regular physical examinations. If you experience any abnormal changes in your oral cavity or systemic discomfort, seek medical attention immediately.