What causes a swollen tongue?

There are many potential causes of a swollen tongue. They may be obvious, such as trauma or allergies, or something less immediately identified, such as an underlying medical condition or medication side effect. Some causes can have relatively mild effects, while others can be life-threatening.

Knowing more about each cause of tongue swelling can help you respond appropriately and know when to seek immediate medical attention.

This article explores the many causes of tongue swelling and explains how doctors diagnose and treat them. It also provides some self-help tips to help with recovery.

swollen tongue symptoms

Depending on the cause of the swelling, one or both sides of the tongue may become larger. In some cases, the swelling can interfere with eating or speaking.

If your taste buds are affected, it can cause an unusual taste in your mouth, and it may even be itchy or sore.

Serious effects of a swollen tongue include:

  • Worsening swelling can block your airways, so it’s important to seek medical attention if you find yourself gasping for air or gulping for air. In some cases, you may need a breathing tube placed right away.
  • Rapid, severe swelling can be a sign of a potentially fatal systemic allergy called allergic reaction. Swelling of the tongue may be accompanied by swelling of the face or lips, hives, difficulty breathing, Cyanosis (blue lips), nausea and vomiting.

If your tongue is swollen and you have trouble breathing, drooling, or swallowing, call 911 or go to the emergency room right away.

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Tongue swelling may affect one or both sides of the tongue and be accompanied by itching, pain, drooling, and changes in taste. Rapid, severe swelling of the tongue can be a potentially life-threatening allergic reaction called anaphylaxis.

reason

Many different conditions and situations can cause your tongue to swell.

allergic reaction

Food or chemical allergies are the main cause of tongue swelling. You may only have a mild allergic reaction. However, if the swelling is the result of an allergic reaction, the reaction can be fatal.

Symptoms of an allergic reaction usually begin within minutes or hours of exposure to an allergen, such as peanuts, tree nuts, milk, eggs, sesame seeds, fish, and shellfish.

More and more dentists are seeing patient reactions to flavors, dyes, and chemical additives in toothpaste, mouthwash, denture cleansers, and other oral care products.

It is important to note that it is possible to be exposed to a particular allergen multiple times in the past without problems, only to have an allergic reaction later in life.

drug

Angioedema Swelling under the skin, most commonly due to allergies. Following a food allergy, drug reactions are the most common cause of angioedema of the face, lips, or tongue in the emergency room.

The reaction may be the result of the body releasing too much bradykinin, which are immune system chemicals that are normally needed to open blood vessels. A variety of prescription and over-the-counter medications can cause this type of nonallergic tongue swelling.

Tongue swelling is an uncommon side effect of medications, but some medications carry risks.

Angiotensin-converting enzyme (ACE) inhibitors, commonly used to lower blood pressure, are most likely to cause lingual angioedema. 20% to 40% of emergency room visits related to drug-related angioedema are the result of ACE inhibitors.

In rare cases, other medications can cause the tongue to swell, including antidepressants, pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs), or medications used to treat high cholesterol.

skin condition

Conditions that affect the skin can cause irritation of the tongue, which may cause mild swelling. For example, these diseases can cause mouth ulcers and tooth erosion, causing the tissue around the tongue to swell:

  • pemphigus: A group of potentially fatal autoimmune diseases in which the immune system attacks the skin and mucous membranes, causing skin blisters and mouth sores
  • Oral lichen planus: A little-known condition that causes a rash on the skin or mouth
  • Oral psoriasis: An autoimmune disease that causes fur (the hair-like protrusions on the surface of the tongue are stripped) and cleft tongue (deep grooves on the surface of the tongue)

trauma

Eating hot food or drink, biting your tongue, or piercing your tongue may cause temporary swelling that goes away in about five days. If not, consult your healthcare provider.

A serious injury or perforation of the mouth can cause a bacterial infection called Ludwig’s angina, a swelling of the area under the tongue. In this case, your airway may become completely blocked if you don’t get treatment.

Infect

The oral cavity is susceptible to many infections, including sexually transmitted diseases (STDs) that can be transmitted during oral sex.

Syphilis, gonorrhea, and human papillomavirus (HPV) can cause inflammation, ulcers, warts, or swelling of the tongue and nearby tissues.

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) can cause chronic irritation in the back of the throat. In some cases, this can cause the tongue to expand at its base.

Sjögren’s syndrome

Sjögren’s syndrome is an autoimmune disease associated with dry eyes and mouth. It can cause many problems, including enlargement of the salivary glands, which produce saliva, and the tear glands, which produce tears.

The tongue may also be swollen or feel swollen.

Melkersson-Rosenthal syndrome

Melkersson-Rosenthal syndrome is a rare disorder of the central nervous system (brain and spinal cord) that primarily affects the muscles of the face.

Although facial paralysis is the more common symptom, edema, including tongue swelling, may occur.​​

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Some of the more common causes of tongue swelling include trauma, allergies, gastroesophageal reflux disease, infections, oral lichen planus, and medications. Less common causes include autoimmune diseases such as psoriasis and Sjögren’s syndrome.

diagnosis

If your tongue is only slightly swollen, you can see your regular healthcare provider for treatment. If the swelling gets worse quickly or is accompanied by signs of an allergic reaction, you should go straight to the emergency room.

To determine the cause of your tongue swelling, your healthcare provider will examine your tongue and the tissues around it. They will take extra care to make sure your airway is clear.

They will also consider the following:

  • Is there an immediate risk to your breathing?
  • Do you have an underlying medical condition such as an autoimmune disease?
  • Do you have other symptoms, such as hives?
  • What is your medical history, current medication, diet and lifestyle?

Additional tests may be required if your healthcare provider suspects allergies, drug reactions, or underlying medical problems.

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Tongue swelling is diagnosed based on a physical examination of the tongue and a review of your medical history and symptoms. Based on initial findings, doctors may order additional tests to narrow down the cause.

treat

Treatment initially focuses on reducing swelling to relieve any breathing problems or discomfort. Your healthcare provider will also work with you to prevent future accidents.

drug

Up to 15% of patients with angioedema develop airway obstruction quickly. This is usually a sign of an allergic reaction requiring life-saving injections epinephrine. In less severe allergic reactions, oral antihistamines may be used instead.

When tongue swelling is not related to allergies, your healthcare provider may use one of the following treatments:

  • For reactions associated with too much bradykinin, you may be prescribed antihistamines, epinephrine, oral corticosteroids, or preventive medications such as Berinert (C1-esterase inhibitor concentrate) to stop its production.
  • For mouth ulcers and inflammation, you may use topical corticosteroids or retinoids to relieve the lesions.

For swollen tongue related to infection or pre-existing conditions, your healthcare provider will also prescribe treatments to manage your underlying problem. For example, this might include a course of antibiotics if you have a bacterial STD, or immunosuppressants if the underlying cause is autoimmunity.

There are also a variety of products on the market to help relieve dry mouth. You can ask your healthcare provider about prescription oral medications that increase saliva production, such as Salagen (pilocarpine) or Evoxac (cevimeline).

There are also over-the-counter mouthwashes and sprays that act as artificial saliva to hydrate the mouth.

home remedies

For a mildly swollen tongue that doesn’t get worse, there are some simple things you can try at home to reduce swelling:

  • Eat or drink something cool or suck on ice to soothe your mouth and try to reduce swelling.
  • Practice good oral hygiene, such as brushing and flossing, but avoid harsh mouthwashes, such as alcohol-based mouthwashes.
  • Gargle with warm salt water.
  • Avoid very acidic or salty foods.

If dry mouth is causing tongue discomfort, chew sugar-free gum or suck on sugar-free hard candy. Drink more water.

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Treatment of swollen tongue varies depending on the underlying cause, but may include antihistamines, antibiotics, salivary stimulants, topical or oral corticosteroids, oral or injectable immunosuppressants, or injectable epinephrine. Good oral hygiene and salt water mouthwashes may also help.

generalize

A swollen tongue can have many causes and may include allergies, infections, trauma, gastroesophageal reflux disease, oral lichen planus, drug reactions, autoimmune diseases, or rare diseases such as Melkerson-Rosenthal syndrome.

Treatment depends on the underlying cause. Good oral hygiene may be sufficient in some cases, but medications such as antibiotics, antihistamines, corticosteroids, and other medications may also be necessary.

The most important thing to remember is that severe and rapid swelling of the tongue can be a potentially life-threatening allergic reaction called anaphylaxis. This is an emergency, so don’t delay getting medical attention right away.