A “bubble” under the tongue can be a surprising discovery. While often benign, these oral formations usually result from common, non-serious conditions. Understanding their causes, characteristics, and when to seek medical attention can help alleviate anxiety.
Understanding Common Causes
The most common causes of a bubble under the tongue are mucoceles and ranulas, both related to the salivary glands. Mucoceles are fluid-filled cysts that arise from minor salivary glands. They form when a salivary gland duct becomes blocked or damaged, causing saliva to accumulate in surrounding tissues instead of draining. Trauma, such as biting the lip, can cause mucoceles, but under the tongue, they often result from a blocked duct.
Mucoceles usually present as soft, dome-shaped lesions that can appear clear, bluish, or pinkish. They are generally painless unless irritated and range in size from a few millimeters to several centimeters. Many mucoceles may rupture and resolve on their own, but they can recur. A ranula is a specific type of mucocele on the floor of the mouth, directly under the tongue. These are associated with the major sublingual salivary glands and are typically larger than other mucoceles.
Ranulas can appear as clear or bluish swellings and may interfere with speaking, eating, or swallowing due to their size. They form when a salivary gland duct is blocked or damaged, causing saliva to leak into adjacent tissues. While often painless, a ranula can cause discomfort or a feeling of fullness.
Other Potential Reasons and When to Seek Help
Less common causes can also manifest as a bubble-like lesion under the tongue. Salivary gland stones (sialolithiasis) can block a salivary duct. This blockage leads to saliva backing up, causing swelling and pain, particularly during meals. The pain can be dull and intermittent, or intense if the blockage is complete.
Other benign cysts or growths can form under the tongue, such as soft, yellowish, and typically painless lymphoepithelial cysts. Infection or inflammation in the oral cavity, such as Ludwig’s angina, can cause rapid and significant swelling. These infections can affect breathing and warrant immediate medical attention.
Seek medical attention if a bubble under the tongue is painful, grows rapidly, or interferes with eating, speaking, or swallowing. A doctor’s visit is also advisable if the bubble persists for several weeks, frequently recurs, or shows signs of infection like fever, redness, or pus. Additionally, if the lesion feels firm or fixed, has an unusual color or texture, or is associated with numbness or tingling, a medical evaluation is recommended.
Medical Diagnosis and Treatment
Diagnosis of a bubble under the tongue typically begins with a visual examination by a doctor or dentist. They assess the lesion’s size, color, texture, and location to determine its nature. In some cases, appearance and location alone may be sufficient for diagnosis.
For larger or complex cases, or to confirm diagnosis, imaging tests may be used. An ultrasound can visualize salivary gland stones or cysts. A CT scan or MRI may define the extent of swelling, especially for ranulas extending into the neck, or rule out other issues. A biopsy, a small tissue sample for analysis, may be performed to confirm diagnosis or exclude malignancy, particularly if the lesion has an unusual appearance.
Treatment approaches vary depending on the underlying cause and severity. Small, asymptomatic mucoceles often resolve spontaneously without intervention; watchful waiting may be recommended. For larger or symptomatic mucoceles and ranulas, minor surgical procedures like marsupialization (creating an opening for drainage) may be performed.
Surgical excision, removing the cyst and sometimes the associated salivary gland, is an option for recurrent or persistent cases. If a salivary gland stone is identified, massage or surgical removal may be necessary. Antibiotics are prescribed for infections.