Suffering from tongue pain? This is what it could be trying to tell you

Tongue pain my point at wider health issues—here's what to know...

Are you experiencing tongue pain? If so, it might be trying to tell you something that's going on with your health. While how your tongue feels might not be something you often consider, it can be a very important indicator of what's going on in the rest of your body. As such, if you feel any discomfort in your mouth it should most certainly not be ignored. In fact, tongue pain can point to everything from stress and nutrient deficiency to diabetes and even oral cancer.

That said, remember that there are many common reasons that could be behind it, says Dr Martina Hodgson, dentist at The Dental Architect. "It could be that you've accidentally bitten on your tongue or burned it, causing a painful ulcer, which you may not even remember doing at the time," she points out. Find out what your tongue pain—and other symptoms, like burning and white lumps—could mean, as well as how to treat it.

tongue pain

Tongue pain can point to everything from stress and nutrient deficiency to diabetes and even oral cancer

Pharetra Himenaeos

1. A Cracked Tongue

It could mean: You need to step up your brushing

A fissured tongue, or a cracked tongue, is rarely a cause for concern and is considered very normal. The condition is thought to be genetic (over 80% of Down's Syndrome children have fissured tongues) and just as wrinkles deepen with age, so can the cracks on the tongue.

Problems only tend to arise with a fissured tongue if poor dental hygiene causes debris to collect in the cracks, which can lead to infection. Symptoms can include a sore or burning tongue.

How to treat it: If you have any concerns about your fissured tongue, it's a good idea to get your tongue checked out by a dentist, who can clean out the fissures and recommend the best oral hygiene practices—including a tongue scraper and the best toothpaste for your needs.


2. CANKER SORES ON TONGUE

It could mean: You're feeling stressed.

Canker sores on tongues are punched-out, painful areas that occur on the tongue or cheeks. They are most uncomfortable for the first four to five days, then subside and eventually disappear within two weeks.

Canker sores on tongues are thought to be caused by a virus and typically occur when people are run down or stressed. Other causes can include excessive consumption of acidic or spicy foods, vitamin deficiencies, hormones, stress, or autoimmune disorders.

How to treat it: If you experience canker sores on your tongue accompanied by a fever, you have difficulty swallowing or the sores last for more than three weeks, visit your doctor for medical advice. Also, learn how to relax your mind and keep stress to a minimum.


3. WHITE LUMPS ON TONGUE

It could mean: You have thrush.

Tongue pain caused by white lumps on tongues that are not your toothpaste could mean you're suffering from oral thrush. This is a yeast infection caused by an overproduction of candida which manifests as white lumps on tongues. The condition is often linked to antibiotics as these can kill off good bacteria and allow the yeast to take over.

Thrush, which can be painful and cause food to taste a bit strange, typically occurs in young children but can also affect people with autoimmune diseases, diabetes that isn't well-controlled, chemotherapy patients, and the elderly.

How to treat it: If you suspect you might have thrush, see your doctor. Unlike other yeast infections, thrush can't be treated with over-the-counter products.


4. BURNING TONGUE

It could mean: You're drinking too much, overusing mouthwash, or are menopausal.

A burning tongue sensation can also be caused by irritation or a vitamin deficiency. Drinking too many irritating fizzy or alcoholic beverages, overbrushing your tongue or overusing your mouthwash can irritate the mouth tissues and cause a burning tongue. If you experience a burning sensation in your mouth, try to drink fewer or less acidic drinks.

Deficiencies in B vitamins and minerals including iron and zinc can also contribute to burning tongue syndrome by affecting the health of your oral tissues. Make sure you are eating a healthy, balanced diet with fresh fruits and vegetables, whole grains, dairy, nuts, seeds and lean proteins.

It could also, less commonly, be a sign of Lichen planus. "This is a chronic inflammatory condition that affects the skin, nails, hair and mucous membranes, and which is characterized by purplish, itchy, flat bumps," explains Dr Jeff Foster, a GP at H3 Health.

A burning tongue is also one of the lesser-known symptoms of the perimenopause too. In fact, it affects around four in ten women who are menopausal—proving it's not just about hot flushes.

How to treat it: Make sure you're drinking plenty of water, cut down on acidic drinks and visit your doctor for a blood test to find out if you should be taking additional vitamin supplements.


5. WHITE PATCHES ON TONGUE

It could mean: You are at risk of oral cancer.

It could be a condition called leukoplakia, which is accompanied by thick white patches on the tongue you cannot rub off," explains Dr Foster. While it is not a form of cancer, it does increase your risk of developing oral cancer.

Smoking is the most common cause of Leukoplakia, but other irritants can trigger it too, such as rough, uneven teeth, injury to the side of the cheek from biting, chewing tobacco, and inflammatory conditions of the body.

Leukoplakia often goes away on its own, but in 5-17% of cases it can develop into oral cancer, so it's always best to get it checked out by your dentist or doctor if you have concerns.

How to treat it: Small white patches on tongues can be removed by your doctor or dentist using a scalpel or laser. Larger leukoplakia patches will require oral surgery.


6. RED TONGUE

It could mean: You have a vitamin B12 or iron deficiency.

In some cases, you may have a sore tongue due to certain vitamin deficiencies or anemia," says Hussain Abdeh, clinical director and superintendent pharmacist at Medicine Direct.

Another sign your body is lacking iron or vitamin B12 is a glossy, bright red tongue. Both of these nutrients are needed to mature papillae on the tongue and if your body is deficient in them, you can lose the papillae, which can make your tongue appear very smooth. In severe cases, this 'balding' red tongue can cause pain when eating hot liquids or spicy foods.

"Some people who have sore tongues may be suffering from it due to iron deficiency anemia," explains Abdeh. "It is unusual for iron deficiency to be caused purely by a lack of iron in your diet. Nonetheless, not eating enough foods like leafy green vegetables, fortified cereals, eggs and nuts can make the problem more likely. What's more, Iron deficiency anemia may also occur due to stomach or bowel cancer, or a stomach ulcer."

Tongue pain can also be caused by a lack of vitamin B12. "This issue can result in an inflamed or swollen tongue," continues Abdeh. "Vitamin B12 is not produced by your body, so you need to get it from external sources, namely, supplements or animal-based foods. These include eggs, fish, meat, poultry, and dairy products. If you are not getting enough of these types of food, it is possible you are suffering from vitamin B12 deficiency, which could account for your tongue pain." Vegetarians and vegans are especially prone to low levels of B12, which are found in animal products.

How to treat it: If your tongue is a strawberry red color, ask your doctor for advice on supplements.


7. RED PATCHES ON TONGUE (OR 'GEOGRAPHIC TONGUE')

It could mean: Nothing at all—you've simply inherited it from your family.

"Along with thrush, geographic tongue is the second most common cause of tongue pain," says Dr Foster. "It is an inflammatory, but non-cancerous, condition of the tongue that causes patches on the surface of the tongue where the normal tongue taste buds—or papillae—appear as smooth, red 'islands', often with slightly raised borders. They can then go white and these flattened inflammatory areas can become sore and painful."

How to treat it: In most cases, there is no need for treatment of this condition. Occasionally, geographic tongue may cause a burning or smarting sensation. In this case, topical anesthetics can be used for surface numbing. Anti-inflammatory drugs (cortisone-like drugs) can also be prescribed to help control discomfort. There have not been any reports of geographic tongue causing cancer. In most cases, biopsies are not necessary to establish a diagnosis.


8. TONGUE ULCERS THAT CAUSE TONGUE PAIN

It could mean: Nothing at all—tongue ulcers are very common and rarely a sign of anything serious, although they can cause tongue pain.

"Tongue ulcers can be caused by a variety of things including stress, trauma—like dentures and biting—having an existing viral illness, immune suppression, and even certain gut inflammatory conditions such as Crohn's disease," notes Dr Foster. "However, the most common cause remains just being run down. "

How to treat it: In most cases, there is no need for treatment of this condition unless they last longer than three weeks and keep coming back— in which case see your doctor for advice. If you have several mouth ulcers at once this can be a symptom of hand, foot, and mouth (which also causes a rash on the hands and feet) or oral lichen planus, a rash that affects inside your mouth, as well as other parts of your body.

TONGUE CANCER SYMPTOMS—HOW TO TELL IF YOUR TONGUE PAIN COULD BE SOMETHING SERIOUS

Tongue pain my point at wider health issues—here's what to know...

In some cases, your symptoms could be symptomatic of something much more worrying going on—like oral cancer. "This can cause lumps and ulcers on the tongue," notes Dr Hodgson. "If you have an ulcer or lump, or any pain that doesn’t improve after two weeks, seek immediate advice from your dentist or doctor."

There's also the possibility it could be tongue cancer. "Although this condition is rare and often unheard of by the public, cancer of the tongue could be a possibility," warns Abdeh. "If you have had an ulcer, sore, or lump on the tongue that has not gone away after three weeks, it is important that you get it checked out by your doctor. You may also experience pain when swallowing food and drinks, numbness in your mouth, and a burning sensation on the tongue.”

We've already covered above that white patches on the tongue can be a sign of Leukoplakia, which increases your risk of tongue cancer. But the symptoms of tongue cancer might include:

  • A red or white patch on the tongue that won't go away and isn't geographic tongue
  • A sore throat that doesn't go away
  • A sore spot (ulcer) or lump on the tongue that doesn't go away
  • Pain when swallowing
  • Numbness in the mouth that won't go away
  • Unexplained bleeding from the tongue (that's not caused by biting your tongue or another injury)
  • Pain in the ear (this is a very rare symptom)

These symptoms can be signs of other conditions and might be due to something less serious. But if you have any concerns, always ask for medical advice.

"Any persistent tongue pain lasting more than three weeks should be reviewed by a dentist," advises Dr Foster. "This does not mean that it is cancerous, but clearly there is problem with the mouth that is not resolving with your own immune system."


W&H thanks Dr Martina Hodgson, dentist at The Dental Architect, Dr Jeff Foster, a GP at H3 Health, and Hussain Abdeh, clinical director and superintendent pharmacist at Medicine Direct for their time and expertise.