The phrase “the thing under my tongue” generally refers to the delicate floor of the mouth, including the lingual frenulum and the openings of the major salivary glands. Pain in this sensitive area can be alarming, but the cause is often a common, temporary issue. Understanding the specific location and nature of the discomfort is the first step toward finding relief. This pain is frequently a localized symptom of minor irritation, though it can occasionally signal a problem with the underlying salivary glands or a broader health condition.
Minor Injuries and Common Ulcers
The most frequent source of pain under the tongue is damage to the soft lining, known as the oral mucosa. This delicate tissue is easily injured by accidental trauma, such as biting down while chewing or irritation from sharp foods like crusty bread or potato chips. Burns from consuming excessively hot beverages or food can also cause localized pain that lasts until the tissue regenerates. Poorly fitting dental appliances, like braces or retainers, can rub against the floor of the mouth, leading to persistent soreness and inflammation.
A common source of sharp, localized pain is an aphthous ulcer, often called a canker sore. These sores typically appear as a painful, round or oval lesion with a white or yellowish center surrounded by a red border. They can be triggered by stress, minor injury to the mouth lining, or certain acidic foods. Minor aphthous ulcers usually heal completely on their own within seven to fourteen days.
Salivary Gland Blockages and Infections
Intense pain under the tongue often relates directly to the sublingual and submandibular salivary glands, which release saliva into the floor of the mouth. The formation of a salivary stone, known as sialolithiasis, is a frequent cause of this pain. These stones are calcified mineral deposits that obstruct the flow of saliva inside the duct. The pain often intensifies during or immediately after eating, when the gland attempts to increase production. The blockage causes a sudden, uncomfortable swelling that may be felt as a hard lump under the tongue or jaw.
A separate issue is sialadenitis, which is a bacterial infection of the salivary gland itself. This infection may occur independently or as a complication of a blocked duct. Symptoms include generalized swelling, tenderness, redness of the overlying skin, and sometimes a fever or feeling of illness. Treating sialadenitis typically involves increasing fluid intake, massaging the gland to encourage drainage, and a course of antibiotics.
Systemic Conditions and Less Frequent Causes
Discomfort under the tongue sometimes serves as a localized sign of a broader health issue or deficiency. Nutritional deficiencies, particularly in B vitamins like B12 and folate, or a lack of iron, can cause inflammation of the tongue and oral tissues. This can result in atrophic glossitis, where the tongue appears smooth and is accompanied by soreness and a burning sensation.
Some medications can also contribute to oral pain by causing severe dry mouth, or xerostomia. Drugs such as diuretics, antihistamines, and some blood pressure medications reduce saliva flow, making the mouth more susceptible to irritation and injury. Reduced saliva means less protection for the sensitive tissues under the tongue. Less commonly, chronic autoimmune conditions, such as Sjögren’s Syndrome, directly affect the salivary glands, leading to persistent dryness and irritation.
When to Seek Professional Care
While most instances of pain under the tongue resolve naturally, certain signs warrant prompt evaluation by a dentist or medical doctor. Any sore or lesion that persists and does not show signs of healing after two to three weeks should be examined. Severe, rapidly progressing swelling under the tongue, particularly if it extends into the neck or jaw, requires immediate attention.
Accompanying symptoms like a high fever, chills, or difficulty with swallowing or breathing are signs of a potentially severe, spreading infection that requires urgent medical intervention. Recurrent pain and swelling that consistently occur during mealtimes are highly suggestive of a salivary gland stone or a chronic blockage. Professional diagnosis and treatment are necessary to prevent complications.