A tongue ulcer is a sore or lesion on the surface of the tongue. These small, often painful disruptions are common. While most are generally harmless and resolve on their own, some can signal underlying health issues. This article explores the various factors that contribute to tongue ulcers and what they might indicate.
Understanding Common Causes
One frequent cause of tongue ulcers is aphthous ulcers, commonly known as canker sores. These small, round or oval sores have a white or yellowish center and a distinct red border. They are not contagious and often appear on the soft tissues of the mouth, including the tongue. Triggers include stress, minor injuries, acidic or spicy foods, and nutritional deficiencies in iron, vitamin B12, or folate.
Physical trauma to the tongue can also cause ulcers. This includes accidentally biting the tongue, friction from sharp teeth, or irritation from dental work or ill-fitting dentures. Eating hard or sharp-edged foods, or even brushing too vigorously with a hard-bristled brush, can create minor wounds. These traumatic ulcers usually heal within a few days once the source of irritation is removed.
Minor infections can also cause tongue ulcers. Oral thrush, a fungal infection caused by Candida albicans, leads to painful, creamy white lesions on the tongue and inner cheeks. These lesions may bleed if scraped and can cause a dry mouth. The herpes simplex virus (HSV) can also cause painful sores on the tongue, which may initially appear as red spots that develop into ulcers, sometimes with a thin white coating. Unlike canker sores, herpes ulcers are contagious and can spread through direct contact.
Signs That Indicate Concern
While many tongue ulcers are benign, certain characteristics and symptoms may indicate a more serious underlying issue requiring medical attention. A persistent ulcer that does not heal within two to three weeks is a significant concern, as common ulcers typically resolve within 10 to 14 days.
Ulcers causing severe pain, making it difficult to eat, swallow, or speak, also warrant evaluation. When tongue ulcers are accompanied by systemic symptoms, such as unexplained fever, swollen lymph nodes in the neck, or unintentional weight loss, it suggests a broader health problem.
Changes in the ulcer’s appearance, such as becoming unusually large, irregular in shape, hard to the touch, or raised, are red flags. Abnormal color changes, like red and white patches around the ulcer, are also concerning. Frequent, severe recurrences could signal an underlying condition like inflammatory bowel disease, celiac disease, or a weakened immune system. In rare instances, a non-healing tongue ulcer can be an early symptom of oral cancer, especially if it bleeds easily or is accompanied by numbness or a lump.
Professional Diagnosis and Care
When a tongue ulcer is concerning, a healthcare provider typically begins with a thorough medical history, asking about its duration, symptoms, and recurring patterns. This is followed by a visual examination of the mouth and tongue to assess the ulcer’s appearance, size, and location. The doctor may also check for swollen lymph nodes in the neck.
Depending on the initial assessment, several diagnostic tests may be performed. Blood tests can identify nutritional deficiencies, like iron or vitamin B12, or uncover signs of underlying systemic conditions. If an infection is suspected, a swab of the ulcer may be taken to test for fungal or viral pathogens. For possible oral cancer, a biopsy, involving a small tissue sample for laboratory analysis, is performed to confirm the diagnosis.
Treatment varies based on the identified cause. For common, benign ulcers, symptomatic relief is the primary focus, using over-the-counter pain relievers or topical gels and rinses. If an infection is present, specific antifungal or antiviral medications are prescribed. When ulcers link to an underlying systemic condition, managing that condition becomes the main treatment strategy. For severe or complex cases, a referral to a specialist, such as an oral medicine specialist or oncologist, may be necessary.
Managing and Preventing Ulcers
For immediate relief from existing tongue ulcers, self-care measures can be helpful. Choosing a soft, bland diet and avoiding spicy, acidic, or very hot foods can reduce irritation and pain. Maintaining good oral hygiene, including gentle brushing with a soft-bristled toothbrush, is important to prevent secondary infections. Over-the-counter pain relievers and topical numbing gels can also help manage discomfort.
Preventing future tongue ulcers involves addressing known triggers. Stress management techniques are beneficial, as stress is a common factor. A balanced diet rich in essential vitamins and minerals, particularly B vitamins, iron, and folate, can prevent deficiencies. Regular dental check-ups identify and address issues like sharp teeth or ill-fitting dental appliances that could cause trauma. Avoiding toothpastes containing sodium lauryl sulfate (SLS) may also reduce ulcer recurrence for some.