A swollen tongue, medically known as glossitis, occurs when the tongue becomes inflamed and enlarges. This condition can range from a minor irritation to a medical emergency, impacting speech, eating, and even breathing. It often indicates an underlying health concern.
Common Causes of Tongue Swelling
Allergic reactions are frequent causes of a swollen tongue, often appearing rapidly after allergen exposure. These can stem from foods (e.g., peanuts, shellfish), insect stings, or medications. Severe reactions can progress to anaphylaxis, a life-threatening condition where the tongue and throat swell, potentially blocking the airway.
Infections also lead to tongue swelling, with various microorganisms capable of causing inflammation. Bacterial infections can arise from injuries or piercings, while fungal infections like oral thrush can result in a swollen and often discolored tongue. Viral infections, such as those caused by the herpes simplex virus, can also manifest as sores or blisters on the tongue. Generalized inflammation of the tongue, known as glossitis, can occur from different irritants.
Physical trauma and irritation are common causes. Biting the tongue, burns from hot food or liquids, or irritation from ill-fitting dental appliances can cause temporary swelling. Harsh oral hygiene products, alcohol, tobacco, or very spicy foods can also irritate the tongue’s delicate tissues, leading to inflammation and swelling.
Underlying health conditions can contribute to tongue swelling. Angioedema, characterized by swelling under the skin, can be hereditary or acquired, affecting the tongue and other areas. Conditions like hypothyroidism (underactive thyroid) or autoimmune diseases such as Sjögren’s syndrome (causing dry mouth) can also result in a swollen tongue. Rarely, it may signal serious conditions like certain cancers or amyloidosis, where abnormal proteins build up in organs.
Some medications can induce tongue swelling. Angiotensin-converting enzyme (ACE) inhibitors, prescribed for high blood pressure, are known to cause angioedema in a small percentage of users, leading to swelling of the face, lips, or tongue. This rare reaction can be severe and may occur weeks or months after starting the medication.
Nutritional deficiencies can also cause a swollen tongue. Severe deficiencies, particularly of vitamin B12 or iron, can lead to a smooth, swollen tongue. Other B vitamins (B1, B2, B6, B9) and vitamin E are also associated with tongue inflammation when deficient.
Accompanying Signs to Watch For
When the tongue swells, other signs often appear. Difficulty breathing or swallowing is a serious symptom, sometimes accompanied by wheezing or throat tightness. Changes in voice, such as hoarseness, can also occur if swelling affects the throat.
Skin reactions like hives or a rash, along with generalized itching, frequently accompany allergic reactions. The tongue itself might show changes including redness, discoloration, or a smooth, glossy appearance. Pain or a burning sensation on the tongue are common, especially if due to injury or an allergic response.
Other systemic signs might be present, such as fever or chills, which could indicate an underlying infection. Enlarged lymph nodes in the neck can also signal an infectious process. A persistent dry mouth might contribute to irritation and swelling, particularly in conditions affecting salivary glands.
When to Seek Urgent Medical Attention
Seek immediate medical attention if a swollen tongue is accompanied by difficulty breathing, wheezing, or throat tightness. Inability to swallow, excessive drooling, or rapid, severe swelling also require emergency care. These symptoms can indicate a compromised airway, which is life-threatening.
Also seek prompt medical attention for any tongue swelling that is worsening, persistent, or does not improve within a few days. Swelling accompanied by fever, severe pain, unexplained bruising, or widespread hives should also be evaluated. If swelling interferes with speaking or eating, or if there is any concern about the cause, consult a healthcare provider without delay.
Diagnosis and Treatment Options
Diagnosing the cause of a swollen tongue typically begins with a physical examination and detailed medical history. The provider will ask about recent exposures to foods, medications, or insect bites, and any other symptoms. This assessment helps determine the extent of swelling and immediate breathing risks.
Further diagnostic tests may be necessary depending on the suspected cause. Blood tests check for nutritional deficiencies (e.g., low vitamin B12 or iron) or signs of infection. Allergy tests may be conducted if an allergic reaction is suspected, while imaging (X-rays, MRI) can rule out structural issues or tumors. A biopsy may be taken if specific diseases are considered.
Treatment for a swollen tongue depends on the underlying cause. In emergencies like severe allergic reactions, immediate administration of epinephrine, antihistamines, and corticosteroids reduces swelling and manages the immune response. For infections, antibiotics or antifungals are prescribed. If a medication side effect is the cause, discontinuing or adjusting the medication is often necessary.
When nutritional deficiencies are identified, treatment involves dietary changes or supplements, such as vitamin B12 or iron. For mild discomfort or swelling due to trauma, symptomatic relief can include sucking on ice chips, applying cold compresses, or using over-the-counter pain relievers. Maintaining good oral hygiene, including regular brushing and flossing, also supports recovery and helps prevent further irritation or infection.