Swollen Tongue: A Painful and Possibly Dangerous Health Problem
The Problem With Tongue Swelling
A swollen tongue is often a painful or an uncomfortable condition. The swelling may be a minor problem. On the other hand, it may be dangerous. A very enlarged tongue can block the airway at the back of the throat and stop air from reaching the lungs.
There are several reasons why a tongue may swell, including an allergic reaction, trauma to the tongue, nutritional deficiencies, and the presence of certain infections and diseases. In some people, the tongue periodically swells due to a hereditary problem.
Ten days is often quoted as the longest time that should be waited before someone gets a diagnosis and treatment for an enlarged tongue. This is only true if the swelling is mild, however. More serious swelling requires earlier treatment. Someone with a swollen tongue that lasts longer than ten days, that occurs repeatedly, or that is accompanied by other symptoms should seek medical attention. If the swelling is rapid or severe, the condition requires emergency treatment to prevent the airway from being blocked.
Any tongue swelling that produces drooling or that causes difficulty in breathing, swallowing, chewing, or talking requires prompt medical attention.
An Allergic Reaction
A swollen tongue is often part of an allergic reaction to foods, drinks, medications, toothpastes, mouthwashes, breath fresheners, or even material in dentures or retainers. The throat and lips may also become swollen during the allergic reaction. Medications such as aspirin, ibuprofen, or ACE inhibitors (which are taken to lower high blood pressure) are known to cause an allergic response and an enlarged tongue in some people.
Sometimes a swollen tongue may indicate a problem that extends beyond the mouth. It may be the first sign of anaphylaxis. This is a severe and very dangerous allergic reaction which affects the whole body, takes only seconds or minutes to develop, and is life threatening. In this condition both the tongue and lips may swell and the person usually has trouble breathing due to swelling in the throat. The person may also have a rapid heartbeat and low blood pressure. In addition, the person may wheeze, develop hives, and feel dizzy, weak, and faint. The skin may turn blue due to lack of oxygen.
Allergies to food, medications, and insect bites and stings are the leading causes of anaphylaxis. Rapid treatment with epinephrine is essential. People who have been diagnosed with a serious allergy usually carry an epinephrine auto-injector around with them.
Other Causes of a Swollen Tongue
Other conditions besides allergies may cause a swollen tongue. These include nutritional deficiencies, such as a lack of sufficient iron, vitamin B12, or vitamin B3, infections, damage to the tongue by trauma, such as from a burn or tongue piercing, irritation by hot and spicy foods and drinks, irritation caused by drinking alcohol or smoking, and an infection in the mouth.
A swollen tongue can also be a symptom of disorders such as hypothyroidism, pituitary gland problems, Down syndrome, and some types of cancer. Hypothyroidism is a disorder in which the thyroid gland doesn't produce enough thyroid hormone. One of the functions of the pituitary gland is to control the thyroid gland, so problems with this gland can also cause a swollen tongue.
Some people have an inherited tendency for the tongue to swell, which it may do periodically and with no obvious cause. This condition is known as hereditary angioedema. "Angioedema" means swelling below the skin surface in the tongue, mouth, throat, and other areas of the body due to fluid accumulation.
Rarely, a tongue may swell due to the collection of abnormal proteins in the tongue in a disease called primary amyloidosis or due to the presence of a tumour in the tongue.
How the Pituitary Gland Controls the Thyroid Gland
A swollen tongue is sometimes a symptom of a disorder called glossitis. "Glossitis" means inflammation of the tongue. Inflammation involves increased blood flow, heat, pain, and redness.
In glossitis, the tongue is red as well as swollen. It may have a smooth or glossy appearance because the papillae—the small bumps on the upper surface of the tongue—disappear. Glossitis may affect the whole tongue or only certain areas.
Glossitis may develop due to allergies, infections, injuries, irritants, or hormonal changes. It may also appear as a symptom of Sjogren syndrome. In this autoimmune condition, salivary glands are destroyed, creating a dry mouth. The dry mouth is technically known as xerostomia.
Geographic Tongue: A Special Case of Glossitis
About 2% to 3% of the population suffers from geographic tongue, which is a special case of glossitis. In this condition the tongue has smooth red patches that lack papillae. The patches are often slightly swollen. The red areas have an irregular shape that resembles the appearance of countries on a map of the world. They are usually bordered by white, wavy lines or other shapes that are slightly raised above the red areas. The white lines often look like the outines of continents.
The white color in a geographic tongue comes from excess keratin, a protective protein made by cells on the surface of the tongue. The excess keratin sometimes appears in people who don't have geographic tongue as well.
The positions of the red areas on a geographic tongue change frequently—sometimes daily—as they disappear in one area and then appear in another. The patches are said to migrate around the tongue. For this reason geographic tongue is also known as benign migratory glossitis. The condition is said to be benign because it's harmless. The symptoms sometimes last for months before they disappear and then may reappear at a later time.
Cause of a Geographic Tongue
The cause of geographic tongue is unknown. The disorder sometimes runs in families and is more common in people with a fissured tongue (one which has furrows or cracks) and perhaps in people that have psoriasis. There have been suggestions that geographic tongue is triggered by factors such as nutritional deficiencies, medications, oral irritants, allergies, stress, and hormonal changes such as those that occur during a woman's monthly cycle. The condition often causes no discomfort, but it sometimes produces a burning sensation that is made worse by eating irritating foods.
The treatment for a swollen tongue depends on its cause. If you have tongue swelling that concerns you, make sure that you see a doctor for a diagnosis and treatment recommendations. The treatments described below are given for general interest only.
Possible Treatments for a Swollen Tongue
An epinephrine injection is often given to treat a severally swollen tongue that is caused by an allergic reaction. For milder allergic reactions, taking antihistamines may solve the problem. If the swelling is caused by an allergy, the allergen must be avoided in the future to prevent the tongue from swelling again. Allergy tests can help to identify the allergen. Without an allergy test, reviewing what entered the mouth shortly before the tongue began to swell may be helpful.
Supplements may be prescribed to correct nutritional deficiencies and infections are often treated with antibiotics or antifungal medicines. Corticosteroids may be prescribed to reduce swelling and NSAIDs (non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen) may be taken to reduce inflammation and pain—provided the person isn't allergic to them. Treating other health disorders causing the swollen tongue, such as hypothyroidism, will also relieve the swelling.
To avoid further damage, hot and irritant foods and drinks should be avoided. Toothpaste should be gentle and contain as few additives as possible. Maintaining good oral hygiene is important.
Tongue Swelling After Piercing
The tongue often swells temporarily after a piercing. Here are some strategies that people use to reduce the swelling. Some of them may help with swelling from other causes while someone is waiting for treatments such as antibiotics to work.
- Place ice shavings in the mouth. Allow them to melt instead of actively sucking them. Don't put whole ice cubes in the mouth, which may be hard to manipulate with a swollen tongue.
- Gently swill ice water in your mouth.
- Rinse with a gentle antibacterial mouthwash that doesn’t contain alcohol. Dilute the mouthwash if necessary.
- Salt water rinses are controversial, with some people advocating the use of a dilute salt solution and others saying that it makes the situation worse.
Have you ever had a swollen tongue?
A Minor or a Dangerous Disorder
A swollen tongue should always be treated with care and attention. The condition may be mild and only slightly uncomfortable and it may disappear without treatment or with only minor help. On the other hand, a swollen tongue may be a painful or even dangerous condition that makes breathing difficult, depending on how much swelling is present and on how quickly it develops.
The tongue is important in food manipulation, taste, and speech. It normally does its jobs well and without problems. Since it has the ability to block the passage of air—as it does every time we swallow—it's important that it doesn't enlarge significantly. It's always a good idea to find the cause of a swollen tongue if possible in order to avoid the problem in the future.
© 2012 Linda Crampton