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

Are you experiencing tongue pain? If so, it may be your body trying to tell you something about your health as it can be an important messenger for what's going on elsewhere - and, as such, any discomfort in your mouth should most certainly not be ignored.

But, first, let us gently remind you that there are many common reasons that could be behind tongue pain. Indeed, it may be that you've accidentally bitten or burned it, causing a painful ulcer - which you may not even remember doing at the time. We've all been there after tucking into a hot meal too enthusiastically.

However, if your tongue pain persists - or is accompanied by other symptoms, like white lumps or canker sores - then it could be down to something else. Indeed, discomfort in this area can point to everything from nutrient deficiency to diabetes and even oral cancer. Here's what could be going on in your mouth, how to treat it yourself, and when to seek professional help according to the experts. 

Reasons for tongue pain

1. Tongue pain with 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. "People typically have no symptoms, other than the tongue's characteristic appearance," says Anna Middleton, an award-winning dental hygienist, and therapist. Although, it can cause a sore or burning tongue in rare cases.

The condition is thought to be genetic 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. "It is crucial to remove any debris, such as food, that can get stuck in the tongue's grooves," warns Middleton, who is also the founder of the London Hygienist. "Doing so can prevent infections and issues with oral hygiene."

How to treat it: "Cracked tongue does not usually require treatment," notes Middleton. "However, if you are worried then consult a health care professional." Indeed, a dentist can clean out the fissures and recommend the best oral hygiene practices, including a tongue scraper and the best toothpaste for your needs.

2. Tongue pain with canker sores

It could mean: You're feeling stressed. 

Canker sores - also called ulcers - 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.

"The exact cause of ulcers is unknown," notes Middleton. "It could be a problem with the immune system or due to bacteria or viruses. Stress and tissue injury are the most common triggers of the simple variety. Nutritional deficiencies in iron and B vitamins may also be behind them." 

As such, she says you can try warding them off in the future by adjusting your diet on taking supplements on the advice of a doctor or dietitian. Additionally, learning how to deal with stress effectively in the long-term may also help.

How to treat it: "Most ulcers will disappear within ten days, but anything that does not heal within three weeks should be reviewed by a dental professional to rule out any potential malignancy," advises Middleton. "Avoid spicy, salty, acidic, and rough foods. You can also rinse with hot salt water and there are various ulcer gels on the market. Try a sodium lauryl sulfate-free toothpaste." If you experience them along with a fever, you have difficulty swallowing or the sores last for more than three weeks, then visit your doctor as soon as possible for medical advice. 

3. Tongue pain with white lumps

It could mean: You have thrush.

"A white tongue can be a sign of oral thrush," Middleton says. This is a yeast infection caused by an overproduction of candida, which manifests as white lumps on the tongue. There are many causes of thrush but in the case of an oral yeast infection, the condition is often linked to antibiotics. 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 it may also affect people with autoimmune diseases, diabetes that isn't well-controlled, chemotherapy patients, and the elderly.

How to treat it: Oral thrush may be uncomfortable but it's nothing too serious, just be sure to head to the doctor as this type of yeast infection can't be treated with over-the-counter products. "And never self-diagnose," warns Middleton, "Always see a health care professional for advice." 

4. Burning tongue

It could mean: You are menopausal or need to tweak your diet.

A burning tongue is one of the lesser-known symptoms of perimenopause, affecting around four in ten women who are menopausal, according to research by Poznan University of Medical Sciences. It's also often accompanied by dry mouth, a hypersensitivity to some food compounds, and some taste disorders, really emphasizing the importance of looking at symptoms other than hot flushes if you think you're entering the early stages of menopause.  

While less common, a burning tongue could also 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 general practitioner and specialist in physiology. 

Then there's a burning tongue caused by irritation or nutritional deficiencies, he says. Drinking too many irritating fizzy or alcoholic beverages, overbrushing your tongue, or overusing your mouthwash can irritate the mouth tissues. Deficiencies in B vitamins and minerals, including iron and zinc, can also contribute to it by affecting the health of your oral tissues.

How to treat it: If you experience a burning sensation in your mouth, try to drink fewer or less acidic drinks and sip on plenty of water. Make sure you are eating a healthy, balanced diet with fresh fruits and vegetables, whole grains, dairy, nuts, seeds, and lean proteins. It may be worth visiting your doctor to establish if you are experiencing any nutritional deficiencies. 

5. Tongue pain with white patches

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

"It may be experiencing a condition called leukoplakia, which is accompanied by thick white patches on the tongue you cannot rub off," explains Dr Foster, who also works with H3 Health. 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. 

How to treat it: Leukoplakia often goes away on its own but in five to 17% of cases, it can develop into oral cancer, so it's always best to get it checked out if you have concerns. Small, white patches can be removed by your doctor or dentist using a scalpel or laser, while larger areas will require oral surgery.

6. Tongue pain with redness

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

"In some cases, you may have a sore, red tongue due to certain vitamin deficiencies or anemia," says Hussain Abdeh, a superintendent pharmacist who specializes in various chronic conditions. Indeed, if that discomfort is accompanied by a glossy, red tongue then it could point to a lack of vitamin B12 or iron.

Both of these nutrients are needed to mature papillae on the tongue and if your body doesn't absorb enough of them, then you can lose the papillae, which can make your tongue appear very smooth. In severe cases, this 'balding' red tongue can cause further pain when eating hot liquids or spicy foods, explains Abdeh, who is also the clinical director at Medicine Direct.

How to treat it: If your tongue is a strawberry red color, ask your doctor for advice on supplements. It can also be worth making some changes to your diet. "Ward off iron deficiency by eating more leafy green vegetables, fortified cereals, eggs and nuts," recommends Abdeh. "Get more vitamin B12 by consuming more eggs, fish, meat, poultry, and dairy products." If you are vegetarian or vegan it is important to explore plant-based sources.

7. Tongue pain with red patches

It could mean: You've got geographic tongue.

"A condition called geographic tongue is the second most common cause of tongue pain," says Dr Foster. "It is inflammatory, but non-cancerous, and leaves patches on the surface of the tongue where the normal tongue papillae appear as smooth, red islands of sorts, 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 the geographic tongue. There have not been any reports of the condition causing cancer, the general practitioner says. And in most cases, biopsies are not necessary to establish a diagnosis.

Occasionally, it 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. If you are concerned, it is best to seek medical advice.

8. Tongue pain with ulcers

It could mean: Nothing at all.

Tongue ulcers are very common and rarely a sign of anything serious, apart from the pain they can cause. "They may be triggered 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 reason remains just being run down. "

How to treat it: In most cases, there is no need for treatment of ulcers unless they last longer than three weeks and keep coming back, in which case see your doctor for advice. Regarding tongue pain at night in particular, Middleton adds, "See your doctor or a dental professional if you have persistent pain and you haven't accidentally bitten or burnt your tongue."

Tongue cancer symptoms - how to tell if your tongue pain is more serious

In some cases, your symptoms could indicate something much more serious going on - like oral cancer. "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," notes Dr Martina Hodgson, dentist at The Dental Architect. 

Pharmacist Abdeh agrees, "Although this condition is rare and often unheard of by the public, it is a possibility. You may also experience pain when swallowing food and drinks, and numbness in your mouth.”

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, as always, if you have any concerns then ask for medical advice. 

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