The appearance of small red, purple, or dark spots underneath the tongue can be a surprising discovery. These spots represent blood vessels that have ruptured or become prominently visible, known medically as petechiae (pinpoint dots) or sublingual varicosities (enlarged veins). While this occurrence is relatively common and often harmless, it has a variety of causes ranging from minor physical stress to underlying systemic health issues. The delicate anatomy of the mouth’s floor helps explain why this area is particularly susceptible to these visible changes.
Understanding Sublingual Blood Vessels
The area beneath the tongue, known as the floor of the mouth, has a unique anatomical structure that makes its blood vessels highly visible. The mucous membrane covering this region, especially on the underside of the tongue, is exceptionally thin and translucent. This thinness allows the underlying vasculature, including the ranine veins, to be easily seen. When these small capillaries or veins sustain damage, blood leaks into the surrounding tissue, presenting as petechiae (tiny, flat, non-blanching red dots). Sublingual varicosities are dilated, tortuous veins that appear purplish or black, often referred to as “caviar tongue.”
Immediate Causes Related to Physical Stress
Many instances of broken blood vessels under the tongue are a direct result of mechanical damage or sudden pressure changes. Local trauma is a frequent cause, such as accidental biting of the tongue’s underside or irritation from sharp food edges. Ill-fitting dental appliances, like dentures, can also cause continuous friction and rubbing, leading to localized vessel damage.
Sudden, intense pressure within the chest and head can cause the small capillaries to rupture, a process related to the Valsalva maneuver. Activities that require forceful straining, such as severe coughing spells, violent vomiting, heavy weightlifting, or intense bowel movements, temporarily spike capillary pressure. This rapid pressure increase can overwhelm the fragile walls of the sublingual capillaries, resulting in petechiae. Furthermore, direct thermal or chemical irritation can damage the superficial lining of the mouth, such as from consuming excessively hot foods or liquids.
Systemic Health Conditions and Medications
Factors originating from inside the body, such as certain medications and underlying health conditions, can significantly increase the risk of sublingual bleeding. Blood-thinning medications, including anticoagulants like warfarin and antiplatelet drugs, are a common culprit because they interfere with the body’s clotting mechanism. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can also inhibit platelet function and make blood vessels more fragile.
The integrity of blood vessel walls and the ability of blood to clot are dependent on specific nutrients. Deficiencies in Vitamin C weaken capillary walls because Vitamin C is necessary for collagen production. Similarly, low levels of Vitamin K impair the liver’s ability to produce necessary clotting factors, making minor vessel injury more likely to result in noticeable bleeding.
Age-related changes are a significant factor in the development of sublingual varicosities. As individuals age, the connective tissue and elastic fibers within the vein walls naturally weaken, causing the veins to become dilated and tortuous. This weakening makes the veins more prominent and susceptible to rupture from minor stress, though the condition is typically harmless. Less commonly, underlying disorders that affect platelet count or function, such as thrombocytopenia, can manifest as petechiae in the mouth. These conditions usually cause widespread bruising and bleeding elsewhere in the body, indicating a generalized issue with blood clotting.
Indicators for Medical Consultation
While many broken blood vessels under the tongue are temporary and benign, professional medical evaluation is necessary if certain signs appear. Consult a doctor or dentist if the spots persist for more than two weeks without healing, are large, spreading quickly, or are accompanied by pain and swelling. Immediate attention is required if sublingual petechiae occur alongside systemic symptoms, such as unexplained bruising, high fever, extreme fatigue, or widespread bleeding from the gums or nose. These combined symptoms may signal an underlying condition affecting the blood or blood vessels.