Tongue Problems

What is the tongue?

The tongue is a muscular organ positioned against the floor of the mouth and extending into the pharynx. It is anchored to the jaw, hyoid bone in the neck, and skull and extends beyond what is visible inside the mouth. Humans and many animals use the tongue to chew and swallow food, as well as for speech, by moving it against the palate and teeth. The tongue’s outer layer is covered with a moist mucosa. The top surface contains small papillae, which give the tongue its rough texture and house taste buds responsible for tasting food.

Many tongue issues are typically not severe, but sometimes, symptoms may indicate an underlying medical condition requiring treatment. Good oral hygiene practices can prevent many tongue problems. For those already experiencing tongue issues, simple home remedies may help alleviate symptoms.

What are the symptoms of tongue problems?

Possible symptoms related to the tongue that a person may experience include:

• Partial or complete loss of taste or changes in the ability to taste sour, salty, bitter, or sweet flavours
• Difficulty moving the tongue
• Tongue swelling
• Changes in the normal colour of the tongue, such as white, bright pink, black, or brown patches
• Pain throughout the tongue or in specific areas
• Swelling of the tongue
• Burning sensation throughout the tongue or in specific areas
• Furry or hairy appearance of the tongue

What are the causes of tongue problems?

Your specific symptoms will help your doctor identify the cause of your tongue problem. Potential causes include:

• Burning Mouth Syndrome (BMS): Also known as glossodynia or stomatopyrosis, BMS is a chronic condition that can cause a burning sensation in the tongue or mouth, often accompanied by dryness and changes in taste perception, such as a bitter or metallic taste. It is more common in postmenopausal women and can be triggered by irritants like cigarette smoke. See a doctor for proper diagnosis and treatment if you experience tongue burning.
• Macroglossia: This refers to an abnormally large tongue, which can be present from birth (congenital) or develop later in life due to underlying conditions such as Beckwith-Wiedemann syndrome, Down syndrome, or metabolic disorders like Pompe disease.
• Tongue Swelling: A swollen tongue can indicate various medical conditions, including:
  1. Acromegaly (excess growth hormone)
  2. Amyloidosis (abnormal protein accumulation)
  3. Myxedema (severe hypothyroidism)
  4. Rhabdomyoma (rare tumours in muscle tissue) Sudden tongue swelling can also be a sign of an allergic reaction (angioedema), which requires immediate medical attention due to potential breathing difficulties.

• Atrophic Glossitis: This condition involves the loss of tongue papillae, resulting in a smooth tongue surface. It can lead to difficulties in tasting food and pain, burning, and numbness in the tongue. Causes include nutrient deficiencies (e.g., vitamin B12, iron), candidiasis, and infections like Helicobacter pylori.
• Herpes Stomatitis: Caused by the herpes simplex virus (HSV-1), oral herpes (cold sores) can affect the tongue, lips, and other mouth parts. Symptoms include painful sores, fever, swollen lymph nodes, and general discomfort. Herpes stomatitis is common in children but can also occur in adults.

Other Causes of Tongue Pain:

• Injury
• Infection
• Inflamed papillae (from bites or hot food irritation)
• Canker sores
• Tongue cancer (may or may not cause pain)
• Anemia
• Irritation from dentures or braces
• Neuralgia (severe nerve pain)
• Geographic tongue (benign condition causing mild discomfort)

Seek medical evaluation if you experience persistent or severe tongue symptoms to determine the underlying cause and appropriate treatment.

What are the causes of changes in tongue colour?

A bright pink tongue colour is often associated with deficiencies in iron, folic acid, or vitamin B-12. Allergic reactions to gluten can also cause this discolouration. A white tongue is commonly caused by smoking, alcohol consumption, poor oral hygiene, or a candida infection. White lines or bumps may indicate oral lichen planus, an inflammation possibly triggered by abnormal immune responses linked to conditions such as hepatitis C or allergies.

Leukoplakia and erythroplakia can manifest as white or red patches on the tongue, potentially indicating precancerous changes. A doctor typically recommends a biopsy of the tongue to rule out cancer in such cases.

What are the causes of hairy tongue?

A black hairy tongue can develop due to several factors:

• Antibiotics: Prolonged use of antibiotics can contribute to a black hairy tongue.
• Radiation: Treatment of the head or neck with radiation therapy can lead to this condition.
• Substance Exposure: Excessive exposure to substances like coffee, mouthwash, or smoking can also cause it.
• Benign Condition (Black Hairy Tongue—BHT): The abnormal growth of papillae on the tongue can make it appear black, brown, yellow, green, or blue or return to its normal colour.
• Hairy Leukoplakia: Caused by the Epstein-Barr virus (EBV) may result in hairy leukoplakia (HL). This condition often occurs in people living with HIV but can affect others as well.

How are tongue problems diagnosed?

If you experience severe, unexplained, or persistent tongue problems that do not improve over several days, it’s essential to seek medical attention from your doctor or dentist. Additionally, you should consult them if you notice any of the following:

• Larger sores than previously experienced
• Recurring or frequent sores
• Recurring or frequent pain
• A persistent problem lasting longer than two weeks
• Tongue pain that does not respond to over-the-counter pain medications or self-care measures
• Tongue problems accompanied by a high fever
• Extreme difficulty eating or drinking

During your appointment, your doctor will thoroughly examine your tongue, assessing its overall appearance, function, and surface condition.

Diagnostic Tests: If a diagnosis cannot be made based on the examination and your medical history, your doctor may recommend further tests. These may include:

• Full Blood Count (FBC): To assess overall health and rule out underlying disorders.
• Biopsy: If serious conditions like tongue cancer are suspected, a biopsy of the tongue may be ordered.
• Indirect Pharyngoscopy and Laryngoscopy: Using specialised instruments to examine the base of the tongue. Alternatively, a flexible fiberoptic endoscope may be used.

Once a diagnosis is established, your doctor will recommend appropriate treatments.

Home Care Tips for Tongue Problems: You can prevent or alleviate some tongue problems by practising good oral hygiene:

• Brush and floss regularly and attend routine dental checkups.
• Avoid risky behaviours like smoking, chewing tobacco, chewing betel nuts, or excessive alcohol consumption, which can increase the risk of oral cancers.

Managing Canker Sores or Mouth Injuries: If you have a canker sore or mouth injury, consider the following self-care measures:

• Avoid hot and spicy foods.
• Consume only cold beverages and eat bland, soft foods until the sore heals.
• Use over-the-counter oral pain treatments as directed.
• Rinse your mouth with warm saltwater or a mixture of warm water and baking soda.
• Apply ice to the sore to reduce discomfort.