The appearance of small, dark, or red spots beneath the tongue can cause concern. The sublingual area is rich with blood vessels and covered by a very thin layer of tissue, making any vascular changes highly visible. While the sight of what seems to be a broken vessel might be alarming, these findings are often benign and related to common physical factors. Causes range from simple dilated veins to tiny ruptures called petechiae.
Identifying Common, Benign Causes
The most frequent cause of prominent, dark blue or purple vessels under the tongue is sublingual varicosities, or phlebectasia linguae. These are not truly “broken” vessels but rather veins that have become dilated and tortuous, much like varicose veins on the legs. Sublingual varicosities are extremely common, especially in older adults, affecting up to 10% of the population over the age of 40.
The primary factor contributing to this dilation is the natural aging process, which causes the degeneration and weakening of the elastic fibers within the vein walls. This loss of structural integrity allows the veins to widen and become more visible against the thin oral mucosa. Since these are veins, they typically blanch, or temporarily disappear, when light pressure is applied.
True broken vessels, manifesting as pinpoint red spots, are called petechiae and typically result from minor trauma or increased pressure. Actions that momentarily spike pressure within the head and neck can cause fragile capillaries to rupture. Examples include aggressive coughing, severe vomiting, or straining during heavy lifting or bowel movements. Minor physical injuries, such as scrapes from sharp foods or dental work, can also cause these small capillary bleeds.
Systemic Factors and Medication Side Effects
When the small spots are not directly attributable to trauma or aging, they may point toward underlying systemic issues that affect vascular health or clotting ability. One group of causes involves conditions that weaken the structure of the blood vessel walls. For instance, a severe deficiency of Vitamin C, historically associated with scurvy, can impair the body’s ability to produce collagen. Collagen is essential for maintaining strong, intact vessel walls.
Other systemic conditions, such as certain autoimmune disorders or chronic liver disease, can lead to widespread vascular fragility or affect the production of clotting factors. Specific hematological disorders like thrombocytopenia, which involves a low platelet count, compromise the blood’s ability to plug tiny leaks in the vessels. This leads to easy bruising and petechiae formation. Generalized disorders that affect connective tissue, such as Ehlers-Danlos Syndrome, can also predispose an individual to fragile blood vessels.
Medications represent a significant category of internal factors that can contribute to sublingual bleeding. Many people take blood-thinning medications, including antiplatelet drugs like aspirin or anticoagulants, which reduce the blood’s clotting capability. These drugs increase the likelihood of petechiae appearing, even from minimal trauma. Certain classes of antibiotics, antidepressants, and long-term use of systemic steroids have also been implicated in affecting vascular integrity, making small vessels more prone to rupture.
When to Consult a Medical Professional
While most prominent vessels under the tongue are harmless sublingual varicosities, certain signs warrant a medical evaluation to rule out a more serious underlying issue. A consultation is advised if the spots are new, rapidly spreading, or accompanied by localized pain or swelling. This is especially true if the spots do not blanch when pressed, as non-blanching lesions indicate bleeding into the tissue.
Medical attention should be sought immediately if the spots are accompanied by other signs of abnormal bleeding elsewhere in the body. This includes easy or excessive bruising, frequent nosebleeds, or bleeding from the gums without obvious cause. Systemic symptoms, such as an unexplained fever, fatigue, night sweats, or unintended weight loss, also serve as red flags. These combined symptoms may indicate an infection, blood disorder, or other systemic condition that requires prompt diagnosis and treatment.