Swollen Tongue - A Painful and Possibly Dangerous Health Disorder

A swollen tongue is often a painful condition. It may also be dangerous, because 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, but the swelling is most commonly caused by inflammation.

Inflammation of the tongue is called glossitis. Glossitis generally causes the tongue to become red as well as swollen, and also causes it to develop a smooth or glossy appearance as the papillae - the small bumps on the upper surface of the tongue - disappear.

Glossitis may affect the whole tongue or only certain areas. An alternate name for the disorder is “burning tongue syndrome”. This name is very appropriate, because although glossitis is sometimes painless it often produces a continuous burning sensation. The tongue may also be sore and tender when touched.

Ten days is often quoted as the longest time that should be waited before someone gets a diagnosis and treatment for an enlarged tongue. Someone with a swollen tongue that lasts longer than ten days, that occurs repeatedly or is accompanied by other symptoms should seek medical attention to determine the cause of the swelling. If the swelling is rapid or severe - no matter what the cause - the condition requires emergency treatment to prevent the airway from being blocked. Any tongue swelling that is bad enough to cause difficulty in breathing, swallowing, chewing or talking, or that produces drooling, also requires prompt medical attention.

Glossitis 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 anaphylactic shock (or anaphylaxis), 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. There is also a rapid heartbeat and low blood pressure, and the person may wheeze, develop hives and feel dizzy, weak and faint. The skin may turn blue. Allergies to food, medications and insect bites and stings are the leading causes of anaphylactic shock. Rapid treatment with epinephrine is essential. People who have been diagnosed with a serious allergy usually carry an epinephrine self-injector around with them.

There are other possible causes for a swollen tongue besides allergies. 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 or irritation caused by drinking alcohol or smoking.

A swollen tongue can also be a symptom of diseases such as hypothyroidism, Down syndrome, pituitary gland problems and some types of cancer. Hypothyroidism is a disorder in which the thyroid gland doesn't produce enough thyroid hormone.

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.

Geographic tongue is also known as benign migratory glossitis. About 2% of the population suffers from geographic tongue. In this condition the tongue has smooth red patches that lack papillae. The red patches have an irregular shape that resembles the appearance of countries on a map of the world. The patches may be flat or swollen.

Keratin is a fibrous protein made in the surface layer of the tongue. In a geographic tongue, patches of the surface produce too much keratin and appear as white, wavy areas around the red patches.

The positions of the red areas on the tongue change daily (or even hourly) as they disappear in one area and then appear in another, "migrating" around the tongue. Geographic tongue is said to be a benign condition because it's harmless. The symptoms sometimes last for months before they disappear, and then may reappear at a later time.

The cause of geographic tongue isn't known, but the disorder sometimes runs in families and is more common in people with a fissured tongue (one which has cracks) and 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 may not cause any 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. An epinephrine injection is usually 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 identify the allergen. Without an allergy test, the best that someone can do to identify the culprit is to review what entered the mouth shortly before the tongue began to swell.

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 NSAID's (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 in the tongue.

To avoid further damage, hot and irritant foods and drinks should be avoided and toothpaste should be gentle and contain as few additives as possible. Maintaining good oral hygiene is important.

Here are some strategies that people use to reduce swelling after a tongue piercing. 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.
• 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.

A swollen tongue should always be treated with care and attention. The problem may be mild and painless and may disappear without treatment or with only minor help. On the other hand, it may be painful or very dangerous, depending on how much swelling is present and how quickly the swelling develops.