Tongue Ulcer: Causes, Symptoms, Treatment

Tongue ulcers are often canker sores that appear on the tongue. These usually start as tiny papules or protrusions on the tongue. Some are mild and can be treated. Others are serious and may be a symptom of lichen planus, oral cancers, pulmonary tuberculosis, and other serious diseases that require urgent medical attention. Some cases cannot be usually cured, but do not pose a threat.

Tongue ulcers can be classified into three categories — acute, chronic, and recurrent. These can be further classified into sub-groups based on the severity and duration of the ulcer.

Symptoms of Tongue Ulcer

Below are the common symptoms of the medical condition:

• Sore tongue with the pain varying in severity
• Blisters
• Burning sensation in and around the affected site
• Fever, which might be a recurrent condition
• Difficulty in swallowing
• Inability to eat hot or warm food
• Painful round or oval swollen sores inside the mouth
• Can be seen on the inner cheeks, lips, or tongue
• It can be white, red, yellow in color
• Can be more than one

Causes

The common causes of a tongue ulcer are as follows:

• Microbial agents like bacteria, viral infections (such as herpes simplex gingivostomatitis in children), and fungal infections
• Trauma due to ill-fitting dentures, braces, sharp/chipped tooth or irregular tooth filling
• Accidental bites
• Tongue abrasion due to the sharp tips of the teeth
• Excess consumption of citrus foods
• Deficiencies of vitamin B12, iron, and folic acid
• Autoimmune disorders, wherein the immune system attacks the body, misinterpreting it as a foreign antibody
• Prolonged oral administration of corticosteroids
• Other drugs like antithyroid drugs, nicorandil, and cytotoxic agent
• During pregnancy due to hormonal changes
• Chronic autoimmune diseases like inflammatory bowel disease (IBD), coeliac disease, or Behçet’s disease
• Genetic condition
• Initial stages of smoking cessation
• Eating or drinking very hot or spicy food – which might damage the mucosa
• A harsh toothbrush or toothpaste – which might damage your gums
• Accidentally biting your tongue or inner cheek
• Stress and anxiety
• Allergy or intolerance to certain foods
• Certain medications like NSAIDs and beta-blockers

Diagnosing a Tongue Ulcer

The diagnostic process for a tongue ulcer depends on the number of ulcers, and severity and location of the condition. The process of diagnosis is a combination of physical examination and investigation of symptoms and medicine intake.

Take your medical record of doctors’ prescriptions as your doctor is likely to study them carefully. In case you are taking other over-the-counter (OTC) medications as well, discuss them with your doctor. 

After carefully analysing the symptoms, the doctor will decide whether medical tests are required. 

For ulcers that the doctor wants to investigate further, biopsies and other diagnostic tests can be recommended. Ulcers that have not subsided within 3 weeks are referred for a biopsy to eliminate the risk of chronic infections. If the doctor suspects that the tongue ulcer may be due to vitamin deficiencies, allergic reaction, or autoimmune disorder, other tests may be recommended.

Treatment

• Tongue ulcers due to trauma, which have developed over one week, can be effectively treated with anesthetic anti-inflammatory throat spray or mouthwash. These help in healing the ulcer and maintaining good oral hygiene.
• Sores that make eating and drinking difficult are usually treated with topical drugs if they last for more than two weeks and do not subside on their own.
• Non-prescription pain relievers like acetaminophen and ibuprofen may help in case the ulcers are of a mild, uncomplicated nature.

Lifestyle Changes and Home Remedies for Tongue Ulcer

Below are some lifestyle changes and home remedies that are advised if you have a tongue ulcer:

• Do not eat very spicy, salty, or acidic food.
• Keep away from acidic food like tomatoes and lemons.
• Avoid hard, crispy food like potato chips, nuts, pizza, etc. 
• Use the medicated toothpaste and mouthwash that has been prescribed by your doctor. If you have not received any advice, purchase one that does not contain SLS.
• Avoid using toothpaste that contains sodium lauryl sulphate.
• Strictly take care not to brush over your ulcers.
• Drink liquids like cold drinks through a straw.
• Use a soft-bristled toothbrush.
• Drink cool liquids through a straw.
• Eat softer foods.
• Get regular dental check-ups.
• Eat a healthy, balanced diet.
• Do not eat rough, crunchy food, such as toast or chips.
• Avoid very hot or acidic drinks, such as fruit juice.

If the tongue ulcer is recurrent, lasts longer than three weeks, becomes more painful, red, or even numb, it may be an early sign of oral cancer. Please consult your doctor to know more.

Learn more about Oral Health here.

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