Tongue problems

Answer 1

Definition

Tongue problems include pain, swelling, or a change in how the tongue looks.

Alternative Names

Dark tongue; Burning tongue syndrome

Considerations

The tongue is mainly composed of muscles. It is covered with a mucous membrane. Small bumps (papillae) cover the upper surface of the tongue. Between the papillae are the taste buds, which allow you to taste. The tongue moves food to help you chew and swallow.

The tongue also helps you form words.

There are many different reasons for changes in the tongue's function and appearance.

DIFFICULTY MOVING THE TONGUE

Tongue movement problems are most often caused by nerve damage. However, problems moving the tongue may also be caused by ankyloglossia, a disorder where the band of tissue that attaches the tongue to the floor of the mouth is too short. Tongue movement disorders may result in speech difficulties or difficulty moving food during chewing and swallowing.

TASTE ABNORMALITIES

Taste problems can be caused by damage to the taste buds, nerve problems, side effects of medications, an infection, or other condition. The tongue normally senses sweet, salty, sour, and bitter tastes. Other "tastes" are actually a function of the sense of smell.

ENLARGEMENT OF THE TONGUE

Tongue swelling occurs with Down syndrome, acromegaly, myxedema, amyloidosis, rhabdomyoma, and other disorders. The tongue may get wider in persons who have no teeth and do not wear dentures.

COLOR CHANGES

Color changes may occur with inflammation of the tongue (glossitis). Papillae are lost, causing the tongue to appear smooth. Geographic tongue is a patchy form of glossitis where the location of inflammation and the appearance of the tongue change from day to day.

HAIRY TONGUE

Hairy tongue is a harmless condition in which the tongue looks hairy or furry. Its appearance can be worrisome. The disorder usually goes away with antibiotics.

BLACK TONGUE

Sometimes the upper surface of the tongue turns black or brown in color. This is an unsightly condition but is not harmful.

PAIN IN THE TONGUE

This may occur with glossitis and geographic tongue. Tongue pain may also occur in with diabetic neuropathy, oral cancer, mouth ulcers, and leukoplakia.

After menopause, some women have a sudden feeling that their tongue has been burned. This is called burning tongue syndrome or idiopathic glossopyrosis. There is no specific treatment for burning tongue syndrome.

Common Causes

Minor infections or irritations are the most common cause of tongue soreness. Injury, such as biting the tongue, can cause painful sores. Heavy smoking will irritate the tongue and make it painful.

A viral ulcer, also called a canker sore, commonly appears on the tongue (or anywhere in the mouth) for no apparent reason. Some doctors believe that these ulcers are linked to emotional stress or fatigue, although this has not been proved.

Possible causes of tongue pain include:

• Anemia
• Cancer
• Dentures that irritate the tongue
• Oral herpes (ulcers)
• Neuralgia
• Referred pain from teeth and gums
• Referred pain from the heart

Possible causes of tongue tremor:

• Neurological disorder
• Overactive thyroid

Possible causes of white tongue:

• Local irritation
• Smoking and alcohol use

Possible causes of smooth tongue:

• Anemia
• Vitamin B-12deficiency

Possible causes of red (ranging from pink to magenta) tongue:

• Folic acid and vitamin B-12 deficiency
• Pellagra
• Pernicious anemia
• Plummer-Vinson syndrome
• Sprue

Possible causes of tongue swelling:

• Acromegaly
• Allergic reaction to food or medicine
• Amyloidosis
• Angioedema
• Beckwith syndrome
• Cancer of the tongue
• Congenital micrognathia
• Down syndrome
• Hypothyroidism
• Infection
• Leukemia
• Lymphangioma
• Neurofibromatosis
• Pellagra
• Pernicious anemia
• Strep infection
• Tumor of the pituitary gland

Possible causes of a hairy tongue:

• AIDS
• Antibiotic therapy
• Drinking coffee
• Dyes in drugs and food
• Chronic medical conditions
• Overuse of mouthwashes containing oxidizing or astringent agents.
• Radiation of the head and neck
• Tobacco use

Possible cause of grooves in the tongue:

• Birth defect -- normally occurs in 10% of population

Home Care

Practice good oral hygiene for hairy tongue and black tongue. Be sure to eat a well-balanced diet.

Canker sores are caused by viruses and can't be cured by treatment. They must heal on their own.

See your dentist if you have a tongue problem caused by dentures.

Antihistamines can help relieve a swollen tongue caused by Allergies. You should avoid the food or drug that causes the tongue swelling.

Call your health care provider if

Make an appointment with your doctor if your tongue problem persists.

What to expect at your health care provider's office

The doctor will perform a physical examination, look closely at the tongue, and ask question such as:

• When did you first notice the problem?
• Have you had similar symptoms before?
• Do you have pain, swelling, breathing problems, or difficulty swallowing?
• Do you have a tongue tremor?
• What makes the problem worse? (Eating, drinking, swallowing, talking)
• Do you wear dentures?
• What have you tried that helps?
• Are there problems with the teeth, gums, lips, or throat?
• Does the tongue bleed?
• Do you have a rash or fever?
• Do you have allergies?
• Are there problems with speaking or moving the tongue?
• Have you noticed changes in taste?
• What medications do you take?
• Do you smoke cigarettes, cigars, or a pipe?
• Do you use alcohol excessively?

Blood tests may be done to confirm specific disorders, particularly systemic causes of tongue disorders. Biopsyof tongue lesions may be needed in some cases.

Treatment depends on the cause of the tongue problem.

• If nerve damage has causes a tongue movement problem, the underlying condition must be treated. Therapy may be needed to improve speech and swallowing ability.
• Ankyloglossia may not require treatment unless you have speech or swallowing difficulties. Surgery to release the tongue can relieve the problem.
• Medicine may be prescribed for mouth ulcers, leukoplakia, oral cancer, and other mouth sores.
• Anti-inflammatory medicines may be prescribed for glossititis and geographic tongue.

This list is not all inclusive. For more details, see the specific disorder.

References

Rakel P, ed. Conn's Current Therapy 2006. 58th ed. Philadelphia, Pa: WB Saunders; 2005:1038.

McKenna JK. Dermatologic drug reactions. Immunol Allergy Clin North Am. Aug 2004; 24(3): 399-423, vi.

Answer 2

Some common tongue problems include canker sores, oral thrush, and geographic tongue. Canker sores are small ulcers that can be painful and heal on their own. Oral thrush is a fungal infection that can cause white patches on the tongue. Geographic tongue is a condition where the tongue has irregular patches that change in location over time. If you are experiencing persistent or severe tongue problems, it is important to consult with a healthcare provider for proper diagnosis and treatment.

Answer 3

Definition

Tongue problems include pain, swelling, or a change in how the tongue looks.

Alternative Names

Dark tongue; Burning tongue syndrome

Considerations

The tongue is mainly made up of muscles. It is covered with a mucus membrane. Small bumps (papillae) cover the upper surface of the tongue.

• Between the papillae are the taste buds, which allow you to taste.
• The tongue moves food to help you chew and swallow.
• The tongue also helps you form words.

There are many different reasons for changes in the tongue's function and appearance.

PROBLEMS MOVING THE TONGUE

Tongue movement problems are most often caused by nerve damage. Rarely, problems moving the tongue may also be caused by a disorder where the band of tissue that attaches the tongue to the floor of the mouth is too short. This is called ankyloglossia.

Tongue movement disorders may result in:

• Breastfeeding problems in newborns
• Difficulty moving food during chewing and swallowing
• Speech difficulties

TASTE PROBLEMS

Taste problems can be caused by damage to the taste buds, nerve problems, side effects of medications, an infection, or other condition. The tongue normally senses sweet, salty, sour, and bitter tastes. Other "tastes" are actually a function of the sense of smell.

INCREASED SIZE OF THE TONGUE

Tongue swelling occurs with:

• Acromegaly
• Amyloidosis
• Down syndrome
• Myxedema
• Rhabdomyoma

The tongue may get wider in persons who have no teeth and do not wear dentures.

Sudden swelling of the tongue can happen due to an allergic reaction or a side effect of medications.

COLOR CHANGES

Color changes may occur when the tongue becomes inflamed (glossitis). Papillae (bumps on the tongue) are lost, causing the tongue to appear smooth. Geographic tongue is a patchy form of glossitis where the location of inflammation and the appearance of the tongue change from day to day.

HAIRY TONGUE

Hairy tongue is a harmless condition in which the tongue looks hairy or furry. The disorder usually goes away with antibiotics.

BLACK TONGUE

Sometimes the upper surface of the tongue turns black or brown in color. This is an unsightly condition but it is not harmful.

PAIN IN THE TONGUE

Pain may occur with glossitis and geographic tongue. Tongue pain may also occur with:

• Diabetic neuropathy
• Leukoplakia
• Mouth ulcers
• Oral cancer

After menopause, some women have a sudden feeling that their tongue has been burned. This is called burning tongue syndrome or idiopathic glossopyrosis. There is no specific treatment for burning tongue syndrome, but capsaicin (the ingredient that makes peppers spicy) can offer relief to some patients.

Common Causes

Minor infections or irritations are the most common cause of tongue soreness. Injury, such as biting the tongue, can cause painful sores. Heavy smoking can irritate the tongue and make it painful.

A viral ulcer, also called a canker sore, commonly appears on the tongue (or anywhere in the mouth) for no obvious reason. Some doctors believe that these ulcers are linked to emotional stress or fatigue, although this has not been proved.

Possible causes of tongue pain include:

• Anemia
• Cancer
• Dentures that irritate the tongue
• Oral herpes (ulcers)
• Neuralgia
• Pain from teeth and gums
• Pain from the heart

Possible causes of tongue tremor:

• Neurological disorder
• Overactive thyroid

Possible causes of white tongue:

• Local irritation
• Smoking and alcohol use

Possible causes of smooth tongue:

• Anemia
• Vitamin B12deficiency

Possible causes of red (ranging from pink to magenta) tongue:

• Folic acid and vitamin B12 deficiency
• Pellagra
• Pernicious anemia
• Plummer-Vinson syndrome
• Sprue

Possible causes of tongue swelling:

• Acromegaly
• Allergic reaction to food or medicine
• Amyloidosis
• Angioedema
• Beckwith syndrome
• Cancer of the tongue
• Congenital micrognathia
• Down syndrome
• Hypothyroidism
• Infection
• Leukemia
• Lymphangioma
• Neurofibromatosis
• Pellagra
• Pernicious anemia
• Strep infection
• Tumor of the pituitary gland

Possible causes of a hairy tongue:

• AIDS
• Antibiotic therapy
• Drinking coffee
• Dyes in drugs and food
• Chronic medical conditions
• Overuse of mouthwashes containing oxidizing or astringent ingredients
• Radiation of the head and neck
• Tobacco use

Possible cause of grooves in the tongue:

• Birth defect -- normally occurs in 10% of population

Home Care

Practice good oral hygiene for hairy tongue and black tongue. Be sure to eat a well-balanced diet.

Canker soreswill heal on their own.

See your dentist if you have a tongue problem caused by dentures.

Antihistamines can help relieve a swollen tongue caused by allergies. You should avoid the food or drug that causes the tongue swelling. Seek medical attention right away if swelling is starting to make breathing difficult.

Call your health care provider if

Make an appointment with your doctor if your tongue problem persists.

What to expect at your health care provider's office

The doctor will perform a physical examination, look closely at the tongue, and ask questions such as:

• When did you first notice the problem?
• Have you had similar symptoms before?
• Do you have pain, swelling, breathing problems, or difficulty swallowing?
• Do you have a tongue tremor?
• What makes the problem worse (eating, drinking, swallowing, talking)?
• Do you wear dentures?
• What have you tried that helps?
• Are there problems with the teeth, gums, lips, or throat?
• Does the tongue bleed?
• Do you have a rash or fever?
• Do you have allergies?
• Are there problems with speaking or moving the tongue?
• Have you noticed changes in taste?
• What medications do you take?
• Do you smoke cigarettes, cigars, or a pipe?
• Do you use alcohol excessively?

Blood tests may be done to check for conditions, including systemic causes of tongue disorders. A tongue biopsy may be needed in some cases.

Treatment depends on the cause of the tongue problem.

• If nerve damage has caused a tongue movement problem, the condition must be treated. Therapy may be needed to improve speech and swallowing.
• Ankyloglossia may not need to be treated, unless you have speech or swallowing problems. Surgery to release the tongue can relieve the problem.
• Medicine may be prescribed for mouth ulcers, leukoplakia, oral cancer, and other mouth sores.
• Anti-inflammatory medicines may be prescribed for glossititis and geographic tongue.

This list does not include every treatment.

References

Reamy BV, Derby R, Bunt CW. Common tongue conditions in primary care. Am Fam Physician. 2010;81(5):627-634.

Mirowski GW, Mark LA. Oral disease and oral-cutaneous manifestations of gastrointestinal and liver disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 22.

Pfeiffer RF. Neurogenic dysphagia. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann; 2008:chap 13.

Finelli PF, Mair RG. Disturbances of smell and taste. In: Bradley WG, Daroff Rb, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann; 2008:chap 19.

Reviewed By

Review Date: 03/05/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.