Swollen Tongue: A Painful and Possibly Dangerous Health Problem
Linda Crampton is a writer and teacher with a first class honors degree in biology. She often writes about the scientific basis of disease.
The Problem of Tongue Swelling
A swollen tongue is often a painful or an uncomfortable condition. The swelling may be a minor problem. On the other hand, it may be dangerous. A very enlarged tongue can block the airway at the back of the throat and stop air from reaching the lungs.
There are multiple reasons why a tongue may swell, including an allergic reaction, nutritional deficiencies, trauma to the tongue, and the presence of certain diseases and infections. In some people, the tongue periodically swells due to a hereditary problem.
Ten days is often quoted as the longest time that should be waited before someone gets a diagnosis and treatment for an enlarged tongue. This is only true if the swelling is mild, however. More serious swelling requires earlier treatment. Someone with a swollen tongue that lasts longer than ten days, that occurs repeatedly, or that is accompanied by other symptoms should seek medical attention. If the swelling is rapid or severe, the condition requires emergency treatment to prevent the airway from being blocked.
Tongue swelling that produces drooling or that causes difficulty in breathing, swallowing, chewing, or talking requires prompt medical attention. A doctor should also be consulted if a tongue problem lasts for a long time, if the problem disappears and then returns, or if the swelling is accompanied by other symptoms.
An Allergic Reaction
A swollen tongue is often part of an allergic reaction to foods, drinks, medications, toothpastes, mouthwashes, breath fresheners, or even material in dentures or retainers. The throat and lips may also become swollen during the reaction. Medications such as aspirin, ibuprofen, or ACE inhibitors (which are taken to lower high blood pressure) are known to cause an allergic response and an enlarged tongue in some people.
Sometimes a swollen tongue may indicate a problem that extends beyond the mouth. It may be the first sign of anaphylaxis. This is a severe and very dangerous allergic reaction which affects the whole body, takes only seconds or minutes to develop, and is life threatening. In this condition both the tongue and lips may swell and the person usually has trouble breathing due to swelling in the throat. The person may also have a rapid heartbeat and low blood pressure. In addition, the person may wheeze, develop hives, and feel dizzy, weak, and faint. The skin may turn blue due to lack of oxygen.
Allergies to food, medications, and insect bites and stings are the leading causes of anaphylaxis. Rapid treatment with epinephrine is essential. People who have been diagnosed with a serious allergy usually carry an epinephrine auto-injector around with them.
Nutritional Deficiencies and Trauma
Other conditions besides allergies may cause a swollen tongue. These include nutritional deficiencies, such as a lack of sufficient vitamin B12, vitamin B3 (niacin), or iron. Another potential cause is damage to the tongue by trauma, such as from a burn or tongue piercing, irritation by hot and spicy foods and drinks, and irritation caused by drinking alcohol. Biting the tongue can also cause swelling.
A smooth, thick, and red tongue that is often described as "beefy" may be a sign of pernicious anemia. In people with this disorder, an inadequate number of red blood cells are made due to the insufficient absorption of vitamin B12 in the intestine. The condition is caused by the lack of a chemical called intrinsic factor. The chemical is made by the stomach and is necessary for the absorption of the vitamin in the small intestine.
Doctors can treat nutritional deficiencies. It's important that someone doesn't self-diagnose an iron deficiency and start taking iron supplements. While excessive B vitamins are excreted in the urine, excessive iron collects in the body and is dangerous.
It's possible to have swelling on only one side of the tongue. That may be the side that experienced trauma, for example, or an infection may be located in only one half of the tongue.
The Thyroid Gland and Hypothyroidism
A swollen tongue can be a symptom of disorders such as hypothyroidism and pituitary gland problems. Hypothyroidism is a disorder in which the thyroid gland in the neck doesn't produce enough thyroid hormones. The most common cause of hypothyroidism in the United States is Hashimoto's disease, which is also known as Hashimoto's thyroiditis. The disorder is an autoimmune condition. The patient's immune system attacks the thyroid gland (or the thyroid). The cause of this attack is unknown. Other causes of hypothyroidism exist besides Hashimoto's disease.
One of the functions of the pituitary gland is to control the thyroid, so problems with this gland can also cause a swollen tongue. The pituitary gland is located at the base of the brain. It releases hormones that travel to other parts of the body—including the thyroid—and stimulates their activity.
Disease and Inheritance
Rarely, a tongue may swell due to the collection of an abnormal protein in a disease called primary amyloidosis. The disorder is also known as AL (amyloid light-chain) amyloidosis. Amyloid is made in the bone marrow and travels to other areas of the body, where it may be deposited in organs and structures, including the tongue.
An infection in the tissue of the tongue can cause the structure to swell. The presence of a tumour in the tongue or on the floor of the mouth can do the same thing.
Some people have an inherited tendency for the tongue to swell, which it may do periodically and with no obvious cause. This condition is known as hereditary angioedema. "Angioedema" means swelling below the skin surface in the tongue, mouth, throat, face, and other areas of the body due to fluid accumulation. The disease is rare but potentially dangerous.
A swollen tongue is sometimes a symptom of a disorder called glossitis. "Glossitis" means inflammation of the tongue. Inflammation involves increased blood flow, which produces symptoms such as heat, pain, redness, and swelling.
In glossitis, the tongue is often swollen as well as red. It may have a smooth or glossy appearance because the papillae—the small bumps on the upper surface of the tongue—disappear. Glossitis may affect the whole tongue or only certain areas.
The disorder may develop due to allergies, infections, injuries, irritants, or hormonal changes. It may also appear as a symptom of Sjogren (or Sjogren's) syndrome. In this autoimmune condition, salivary glands are destroyed, creating a dry mouth. The dry mouth is technically known as xerostomia.
The term "glossitis" comes from the Greek word glossa, which means tongue, and the suffix -itis, which means inflammation.
About 2% to 3% of the population suffers from geographic tongue, which is often considered to be a special case of glossitis. In this condition the tongue has smooth red patches that lack papillae. The red areas have an irregular shape that resembles the appearance of countries on a map of the world. They are usually bordered by white, wavy lines or patches that are sometimes raised above the red areas. The white lines frequently look like the outlines of continents, which gives the disorder its name.
Raised white areas on a geographic tongue may look swollen. The colour and appearance are created by excess keratin, however. Keratin is a protective protein made by cells on the surface of the tongue. The excess protein sometimes appears in people who don't have geographic tongue as well.
The positions of the red areas on a geographic tongue change frequently—sometimes daily—as they disappear in one area and then appear in another. The patches are said to migrate around the tongue. For this reason the condition is also known as benign migratory glossitis. The condition is said to be benign because it's harmless. The symptoms sometimes last for months before they disappear and then may reappear at a later time.
Cause of a Geographic Tongue
The cause of geographic tongue is unknown. The disorder sometimes runs in families and is more common in people with a fissured tongue (one which has furrows or cracks) and perhaps in people that have psoriasis. There have been suggestions that geographic tongue is triggered by factors such as nutritional deficiencies, medications, oral irritants, allergies, stress, and hormonal changes such as those that occur during a woman's monthly cycle. The condition often causes no discomfort, but it sometimes produces a burning sensation that is made worse by eating irritating foods. If the disorder is causing discomfort, a doctor or dentist can prescribe helpful treatments.
Geographic tongue that causes no symptoms may not need to be treated. A person should make sure that they actually have the condition instead of another disorder before they ignore it, however. For example,Candida albicansis a yeast that is normally present in the mouth but can sometimes multiply excessively. It can produce white deposits on the tongue and on the inside of the mouth. The disorder is called oral candidiasis or oral thrush.
The treatment for a swollen tongue depends on its cause. If you have tongue swelling that concerns you, make sure that you see a doctor for a diagnosis and treatment recommendations. The treatments described below are given for general interest only.
Possible Treatments for a Swollen Tongue
An epinephrine injection is often given to treat a severally swollen tongue that is caused by an allergic reaction. For milder allergic reactions, taking antihistamines may be recommended. If the swelling is caused by an allergy, the allergen must be avoided in the future to prevent the tongue from swelling again. Allergy tests can help to identify the allergen. Without an allergy test, reviewing what entered the mouth shortly before the tongue began to swell may be helpful.
Supplements or other treatments may be prescribed to correct nutritional deficiencies and infections are often treated with antibiotics or antifungal medicines. Corticosteroids may be prescribed to reduce swelling and NSAIDs (non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen) may be taken to reduce inflammation and pain—provided the person isn't allergic to them. Treating other health disorders causing the swollen tongue, such as hypothyroidism, may also relieve the swelling. Hypothyroidism may be treated by the administration of synthetic thyroid hormones. Pituitary gland hormones may be prescribed if other treatments don't solve a problem with the gland.
To avoid further damage to the tongue, hot and irritant foods and drinks should be avoided. Toothpaste should be gentle and contain as few additives as possible. Maintaining good oral hygiene is important.
Treating Tongue Swelling After Piercing
The tongue often swells temporarily after a piercing. Here are some strategies that people use to reduce the swelling. Some of them may help with swelling from other causes while someone is waiting for treatments such as antibiotics to work.
- Place ice shavings in the mouth. Allow them to melt instead of actively sucking them. Don't put whole ice cubes in the mouth, which may be hard to manipulate with a swollen tongue.
- Gently swill ice water in your mouth.
- Rinse with a gentle antibacterial mouthwash that doesn’t contain alcohol. Dilute the mouthwash if necessary.
- Salt water rinses are controversial, with some people advocating the use of a dilute salt solution and others saying that it makes the situation worse.
Have you ever had a swollen tongue?
A Minor or a Dangerous Disorder
A swollen tongue should always be treated with care and attention. The condition may be mild and only slightly uncomfortable and it may disappear without treatment or with only minor help. On the other hand, a swollen tongue may be a painful or even dangerous condition that makes breathing difficult, depending on how much swelling is present and on how quickly it develops.
The tongue is important in food manipulation, taste, and speech. It normally does its jobs well and without problems. Since it has the ability to block the passage of air—as it does every time we swallow—it's important that it doesn't enlarge significantly. It's always a good idea to find the cause of a swollen tongue if possible in order to avoid the problem in the future.
Questions & Answers
How can I get relief from a painfully swollen tongue?
If your tongue is very painful, or if the discomfort lasts for a long time, you must see a doctor as soon as possible. I've described some techniques in the article that may reduce discomfort while you are waiting for the doctor's treatment to work, but they are not a substitute for a physician's advice.
I have been biting my tongue for some time. This happens mostly at night while I'm using a CPAP machine. The sores do heal eventually. l wear a mouth guard on the lower teeth, which helps. Might this cause cancer of the tongue?
Biting the tongue repeatedly can cause inflammation of the tongue and damage tissue in the area of the bite. I’ve never heard of this action leading to cancer of the tongue, but only a doctor or dentist can give you an accurate answer to your question. You should mention your concern to one or both of these health professionals when you next visit them.
The doctor or dentist may be able to give you further suggestions to help you stop biting your tongue in addition to answering your question.
What does oral lichen planus mean when on the tongue?
Oral lichen planus is a condition in which white and lacy or red and inflamed lesions (injured areas) appear in the mouth. Sometimes open sores form. The cheek, tongue, gums, inside of the lips, or palate may be affected.
The condition might be an autoimmune disease. An autoimmune condition is caused when the immune system attacks the body’s tissues, which isn’t usual behavior. The system’s normal job is to attack pathogens or other invaders that enter the body. Some researchers think that there is insufficient evidence to classify oral lichen planus as an autoimmune condition, however.
Several other causes of the disorder have been suggested, including an allergic response to something in the mouth, a reaction to medications, an infection, or an injury. Once again, though, these are only possible causes and aren’t proven. If you have the condition, your doctor can probably offer you helpful information.