Tongue Ulcer: What is It, Causes, Symptoms and Treatment

Tongue ulcers, also known as canker sores, are white, reddish, and inflamed spots in the mouth or on the tongue. However, they are painful but are non-contagious, which means that they cannot spread from one person to another via any mode of contact.

Tongue ulcers or canker sores can be of three types:

1. Minor Canker Sores: They are the most common, and the characteristics of minor sores are: 
   1. Small - only a few millimetres wide,
   2. Oval-shaped bumps with a red border,
   3. Burning sensation while eating or talking,
   4. Heal without scarring within two weeks.
2. Major Canker Sores: This type of sores is less common and may take up to four to six weeks to heal. Their characteristics are:  
   1. Larger and deeper than minor sores,
   2. Usually round but may have irregular borders when they grow,
   3. Extensive pain,
   4. May leave scarring after healing.
3. Herpetiform Canker Sores: These are extremely rare. Only 5% of people develop herpetiform canker sores. They may appear in a cluster that may take several weeks to heal, and there is also a risk of extensive scarring. Other characteristics are: 
   1. Pinpoint-sized bumps often merged to form a cluster. The cluster may include 10-100 canker sores. 
   2. Extremely painful that may be aggravated while chewing, talking, or drinking.

The main symptom of tongue ulcers is mouth pain. For some people, pain may remain steady throughout the day, or it can increase or decrease in intensity. Other symptoms of tongue ulcers may vary depending on their type. The common symptoms of tongue ulcers are:

1. Bleeding or bruising
2. Difficulty in speaking
3. Swollen tongue
4. Difficulty in eating, chewing, and swallowing
5. Sore throat
6. Ulcer spreading to other parts of the mouth

Other symptoms that may occur along tongue ulcers are:

1. Diarrhoea
2. Fever
3. Headache
4. Body ache
5. Rash
6. Swollen lymph nodes

Tongue ulcers can develop in any age group or gender. Below mentioned are some of the most common causes of tongue ulcers:

1. Accidentally biting the tongue or cheeks
2. Consuming acidic foods like seafood, cheese, or citrus fruits like oranges, strawberries, or tomatoes
3. Dental procedures like filling a tooth cavity can cause slight trauma to the gums and oral cavity
4. Ill-fitting dentures or braces
5. Rough or defective dental fillings
6. Iron or vitamin B12 deficiency
7. Use of harsh toothpaste
8. Hormonal changes during menstruation or pregnancy
9. A food intolerance
10. Lack of proper sleep
11. Bacterial, viral, or fungal infections
12. Anxiety or stress

Tongue ulcers can also develop because of the following diseases:

1. Hand, Foot, and Mouth Disease: It is a contagious disease most commonly found in children. However, it can also affect adults. 
2. Oral Lichen Planus: It is a rash that can affect an individual’s entire body, including the mouth. It can cause a white, lacy pattern inside the cheeks. 
3. Crohn’s disease or Coeliac disease attacks the digestive system.
4. HIV AIDS or lupus weakens the immune system of an individual. 
5. Cold Sores: It is a group of tiny but painful blisters inside the mouth, including the lips and tongue, due to the herpes simplex virus (HSV). A cold sore first appears as a blister, and when the blister pops, it becomes an inflamed sore. A person can also get cold sores on the nose and eyes. 
6. Swollen Taste Buds: Sometimes, eating extremely hot or hard food can damage the taste buds causing them to swell. Swollen taste buds can also result from a common condition known as Transient Lingual Papillitis (TLP), which occurs when one or more taste buds swell and become painful or tender. 

If someone has a family history of mouth or tongue ulcers, then his or her chances of developing one also increase. An individual may also be at a higher risk of developing tongue ulcers if he/she has:

1. Mouth injury
2. Weak immune system
3. Food allergy
4. Viral infection
5. Hormonal fluctuation
6. High-Stress levels
7. Smoking
8. Sharp teeth

There are multiple things that an individual can do to prevent tongue ulcers. Some of the measures to prevent tongue ulcers are listed below:

1. Using a soft toothbrush 
2. Eating a healthy and balanced diet
3. Avoiding hard, spicy, and acidic food
4. Avoiding chewing gum
5. Avoiding toothpaste that contains sodium lauryl sulphate

An individual or a dental specialist can diagnose tongue ulcers easily by their appearance. It is usually round or oval with a yellow centre. A significant redness around them is also noticeable. Sometimes the patient may notice a burning or tingling sensation two to three days before a visual confirmation. It is usually the case with cold sores. Cold sores differ from tongue ulcers as they can appear outside the mouth (more details about cold sores are mentioned later in the article). 

If the ulcers are severe and abnormally large, the dental specialist may require a blood test to determine if there is a risk of infection. Sometimes, the doctor may also do a biopsy, which requires a sample of the patient’s tissue to identify if the sore is cancerous. 

How to prepare for the doctor's consultation?

1. The patient must:
   1. Note all the symptoms, when they first occurred, and how intense they have become over time. 
   2. Prepare a list of all non-prescribed medicines, vitamins, and other supplements that he or she takes.
   3. Mention any medical conditions for which he or she is undergoing treatment. 
   4. Inform the doctor about any recent life changes that are causing stress. 
   5. Prepare a list of all the questions that need to be asked. 
2. Ask questions to the specialist. Some of the questions are as follows:
   1. What could be the causes of a tongue ulcer? 
   2. Are there any tests required?
   3. What is the best treatment approach? 
   4. Are there any home remedies or self-care tips that can help relieve pain? 
   5. How long does it take for the symptoms to go away? 
   6. Can the tongue ulcers reoccur? If yes, then how to prevent them?

Tongue ulcers are rarely life-threatening, but their prolonged presence can certainly affect the daily life of an individual. Here are some treatment options to get pain relief from tongue ulcers:

Tongue Ulcers treatment without surgery

1. Home Remedies
   1. Coconut Oil: Coconut oil forms a protective shield around the ulcer and speeds up the healing of the damaged tissue. It also fights against the bacteria that may be responsible for the ulcer. Coconut oil can be directly applied to the ulcers individually to see improvements. 
   2. Honey: Honey is non-irritant and is known to possess wound healing benefits. It can speed up healing and can be used as an effective treatment method for ulcers. Honey can be used in two ways:
      1. Apply it gently to the ulcers at least 2-3 times a day
      2. Honey can also be consumed by adding it to the tea
   3. Saltwater: Rinsing the mouth with salt water also aids in healing tongue ulcers. A pinch of salt added to hot water is a simple way of getting rid of ulcers. 
   4. Milk of magnesia: It contains magnesium hydroxide which is an acid neutralizer and a laxative. When it is used orally, this will change the pH of the mouth and coat the sores to help prevent further growth, irritation and pain.
   5. Yoghurt: Eating yoghurt that contains live probiotic cultures may help prevent the development of canker sores.
   6. Apply damp tea bags: Tea is alkaline and also contains astringent contents that will neutralize the acid and also help in relieving the pain caused due to the ulcers.
   7. Applying ice cubes: The ice will give a soothing and numbing effect on burning ulcers
2. Medications: Severe ulcers that did not improve with topical treatment require oral medications. These medications are also used to treat the underlying medical conditions responsible for tongue ulcers.
   1. Mouth Rinses: In case of multiple ulcers, the doctor may prescribe a mouthwash to cleanse the mouth and relieve pain. It can contain either the steroid dexamethasone or lidocaine to reduce pain and inflammation.  
   2. Topical Products: These products can include gels, ointments, paste, or cream that is to be applied to the ulcers. The use of topical products can speed healing and provide relief from pain. These products may or may not have active ingredients. Some examples of the active ingredients include:-
      1. Benzocaine
      2. Fluocinonide
      3. Hydrogen Peroxide 
   3. Vitamin B Complex Supplement: Canker sores can develop if the diet of an individual is low in vitamin B12. A vitamin B complex supplement contains all eight essential B vitamins, including B12. 

Tongue Ulcers treatment with surgery

1. Oral lesion excision: It is a surgical procedure to remove a sore, ulcer, or patch (lesion) from inside your mouth. This includes the inner lip or cheek lining, gums, tongue, and floor and roof of the mouth.

If the tongue ulcers do not improve in a few weeks, the patient may experience prolonged pain and other serious complications, such as:

1. Sores spreading outside the mouth
2. Pain and discomfort while eating and brushing
3. Fatigue
4. Fever
5. Cellulitis: inflammation and tenderness in the affected skin due to a bacterial infection

A bacterial infection can spread rapidly and can create life-threatening risks. So, if the ulcers don’t improve within a few weeks, the patient must visit a doctor to find the underlying cause of the ulcers.

When to see a doctor?

Usually, canker sores are not dangerous. But if the patient notices any of the following conditions, he or she must consult a doctor:

1. Ulcers persisting for more than three weeks
2. New ulcers appear before the old ones heal
3. Intense pain that is not relieved by medication
4. Unusually large ulcers
5. Painless ulcers
6. Fever
7. Diarrohea

Generally, eating is painful with an ulcer. Therefore a patient should see what he/she is comfortable with and eat accordingly. Below mentioned are some of the dietary habits that one can take during tongue ulcers.

1. Milk-based dishes like kheer, porridge, and curd are easy to ingest.
2. Bland soft food including bakes, moong dal, khichri, idli, upma, bread, paneer, and soft-boiled eggs is easy to swallow.
3. Soft vegetables and fruits like pumpkin, potato, papaya, and banana are soothing to eat.

The temperature of the food should not be very hot or very chilled as both may cause discomfort and pain.