Pain In The Tongue : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 13/07/2022

Pain in the tongue can be the result of microtrauma, irritation of the mucous membrane, occurs with glossalgia, some glossitis, abscess and phlegmon of the tongue, acute oral candidiasis, xerostomia, neuralgia, dental problems, pernicious and iron deficiency anemia, allergic reactions. More often burning, raw, tingling, tingling. With purulent processes - sharp, bursting, twitching, pulsating. It is diagnosed on the basis of complaints, examination data, instrumental and laboratory studies. Treatment includes rinsing, applications, the appointment of physiotherapy techniques, general drugs, and sometimes surgery.

Why does the tongue hurt

Physiological causes

Pain in the tongue is often the result of minor injuries: superficial burns with too hot liquid, accidental biting, damage by hard pieces of food, fish bones. Pain is combined with numbness or, conversely, hypersensitivity. Disappear within a few minutes or hours, less often - days.

Burning, soreness of the tongue can also be provoked by the intake of spicy foods, some spices, and the use of strong alcoholic beverages. In smokers, the sensitivity of the tongue increases due to the constant action of tobacco smoke on the mucous membrane, which leads to the frequent occurrence of pain under the influence of other stimuli.

Traumatic injuries

More serious injuries occur due to biting the tongue during an epileptic attack, sports, accidents. Abrasions, wounds in the form of teeth marks are found on the tongue. Depending on the severity of the injury, pain persists from several days to 1-2 weeks. In patients with improperly selected orthodontic constructions, ill-fitting removable dentures, pain is the result of chronic irritation of the tongue. With advanced caries, the organ is systematically injured by the sharp edges of the teeth.

Glossitis

The pain syndrome is not observed in all glossitis, it is more typical for infectious lesions. The inflammatory process of bacterial etiology is manifested by hyperemia, swelling, increased local temperature, aching, aching pains. With viral glossitis, vesicles form, which subsequently open with the formation of painful erosive defects.

Pain in the tongue

 

Abscess and phlegmon of the tongue

An abscess develops against the background of microtrauma or becomes a complication of bacterial glossitis. Rapid onset and progression of symptoms are characteristic. Superficial abscesses are localized under the mucosa, usually in the back area. They are an area of ​​limited edema with painful induration in the center. Accompanied by sharp pain when moving the tongue, swallowing, sometimes with irradiation to the ear.

Deep abscesses are located in the thickness of the organ. Manifested by hyperthermia, intoxication syndrome, in some cases - chills, an increase in regional lymph nodes, profuse salivation. The tongue is so swollen that it can hardly fit in the mouth, making speech and breathing difficult. The pains are sharp, jerking, bursting, throbbing, aggravated by movement, swallowing, touching.

In patients with phlegmon, the zone of purulent inflammation is not limited, it quickly spreads to the entire tongue, the bottom of the mouth, and the neck. Febrile fever, chills, regional lymphadenitis are observed. The pain syndrome is intense, diffuse, depriving of sleep. Eating is very difficult or impossible. Speech is slurred. Due to the overlap of the airways due to swelling of the soft tissues of the oral cavity and oropharynx, asthma attacks develop.

oral candidiasis

Painful sensations are more often observed in acute candidiasis, uncharacteristic of the chronic form of the disease. Children, the elderly, debilitated patients with severe somatic pathologies suffer. A loose or dense milky-white cheesy coating is formed on the tongue, spreading to the palate, cheeks, lips. When plaque is removed, a bleeding eroded or macerated mucous membrane is exposed.

When eating, there is pain, burning. In the absence of therapeutic measures, transformation into atrophic candidiasis is possible. The tongue becomes shiny, fiery red. The papillae atrophy. The mucous membrane of the oral cavity is edematous, hyperemic, dry, thinned. Patients complain of severe pain in the affected area. Plaque is not detected or insignificant.

glossalgia

Glossalgia is a pathology accompanied by unpleasant sensations in the tongue in the absence of organic changes. Occurs in diseases of the liver and gastrointestinal tract, vascular, endocrine diseases, pathologies of the central and peripheral nervous system. Painful sensations without a clear localization, diffuse, have a burning, tingling or raw character, are more pronounced in the tip and sides, less often appear on the root, back of the tongue. May be episodic or regular. As a rule, they are combined with neurotic disorders.

Xerostomia

Pain in the tongue worries at the final stage of the disease. Against the background of complete inhibition of the function of the salivary glands, glossitis develops. Constant dryness of the mucous membrane leads to the formation of erosions and ulcers. Painful sensations are aggravated by talking, eating, combined with constant dryness in the mouth. Patients with xerostomia may present with multiple caries.

neuralgia

Pain in the two anterior thirds of the tongue is characteristic of the defeat of the third branch of the trigeminal nerve (n.mandibularis), combined with pain in the chin, lower jaw, lower lip, gums, buccal mucosa. The pain syndrome has a paroxysmal character, it is a series of impulses resembling an electric shock. Provoked by cold exposure, shaving, chewing, speech, laughter.

With neuralgia of the glossopharyngeal nerve, pain appears at the root of the tongue, from where it spreads to the tonsils, soft palate, pharynx, and sometimes the ear, eye, and lower jaw. The attack is provoked by swallowing, chewing, yawning, coughing, talking, accompanied by dryness in the throat, which, at the end of the paroxysm, is replaced by increased salivation.

Neuralgia of the hyoid node is characterized by pain in the anterior parts of the tongue, the hyoid zone: boring, burning, pulsating, paroxysmal. It lasts from several minutes to 1 hour. It radiates to the lower jaw, temple, occiput, lateral surface of the neck, shoulder girdle, sometimes to the arm, upper chest. It is aggravated by talking, eating, especially plentiful or spicy.

Anemia

Pain in the tongue is typical for pernicious anemia, due to glossitis. The tongue becomes "varnished", acquires a crimson color. Weakness, tachycardia, dizziness are observed. Typical symptoms are shortness of breath, pale skin, puffiness of the face. Appetite loss, hepatomegaly, stool instability are found. Neurological disorders are detected: muscle weakness, changes in gait, stiffness, numbness of the extremities.

Sometimes painful sensations in the tongue occur with iron deficiency anemia. Glossitis is combined with dysphagia, angular stomatitis, atrophic gastritis. The prevailing symptoms are weakness, tinnitus, dizziness, shortness of breath, palpitations. Dry skin, nail deformity, hair loss are noted.

Other reasons

Pain in the tongue is sometimes detected in the following conditions:

  • Allergy . Soreness, paresthesia, severe itching are caused by food allergies, less often by a reaction to plant pollen, animal hair. Combined with sneezing, lacrimation, swelling of mucous membranes.
  • The initial stages of cervical osteochondrosis. Vague pain sensations in the tongue are complemented by awkwardness, restrictions on neck movements, and pain in the neck.
  • ischemic heart disease. Pain in the tongue, mouth, lower jaw can be observed with an atypical course of an attack of angina pectoris, myocardial infarction.

Oral examination

 

Diagnostics

The cause of the symptom is determined by the dentist. If there are indications, patients are referred for a consultation with a gastroenterologist, therapist, neurologist, and other specialists. The doctor establishes when the pain first appeared, what symptoms accompanied it, how the disease developed. To clarify the diagnosis, the following procedures are performed:

  • Inspection . During the physical examination, general changes (for example, pallor and dryness of the skin with anemia) are sometimes determined. When examining the tongue, edema, hyperemia, discoloration, the presence of erosions, ulcers, and infiltrates can be detected. With neuralgia, pain zones indicate damage to one or another nerve. During a dental examination, carious teeth, defects in prostheses, orthodontic structures can be detected.
  • Instrumental Techniques . Sialography and ultrasonography are recommended to exclude xerostomia and assess the condition of the salivary glands. If you suspect a pathology of the gastrointestinal tract, provoking glossalgia, perform esophagogastroduodenoscopy, a contrast study of the stomach. With neuralgia, electromyography is indicative.
  • Laboratory tests . Confirm the presence of pernicious or iron deficiency anemia. As part of the differential diagnosis, saliva is examined. With candidiasis, bacterial lesions, the discharge is sown on nutrient media. For viral infections, PCR is performed.

Treatment

Help at the prehospital stage

It is recommended to refuse too hot, cold, spicy and spicy dishes. You should eat soft foods that do not injure the tongue, preferably stewed, boiled, steamed. The best option is a diet that includes mashed potatoes, mucous porridges, pureed soups. Before and after eating, you need to rinse your mouth with weak solutions of chlorhexidine and potassium permanganate or a solution of furacilin. With severe pain, the surface of the tongue can be lubricated with local anesthetics.

Conservative therapy

An important part of the treatment is the rehabilitation of the oral cavity, if necessary, the replacement of prostheses and orthodontic structures. The list of therapeutic measures is determined by the nature of the pathology:

  • Glossitis . Rinsings, applications with anesthetics are shown. With intense pain, lubrication with a mixture of glycerin and anesthesin is effective. Plaque is removed with a swab with proteolytic enzymes. Produce treatment with antiseptics. Local healing preparations are used.
  • Phlegmon and abscess of the tongue . With superficial abscesses, rinsing with antiseptic solutions is carried out, antibacterial agents are prescribed, and if ineffective, surgical interventions are performed. With deep abscesses and phlegmon, conservative therapy is an auxiliary method of treatment, carried out against the background of operations, includes antibiotics, analgesics, antihistamines, anti-inflammatory drugs.
  • Candidiasis . Alkalinizing solutions for rinsing are used as local remedies. The oral cavity is lubricated with antifungal ointment, treated with solutions of iodinol, lugol, fucorcin. The therapeutic regimen also includes general antifungal drugs, in severe cases - immunotherapy.
  • Glossalgia . It is recommended to take light tranquilizers, motherwort, valerian. A good result is achieved when carrying out trimecaine blockades of the lingual nerve, injecting B vitamins. Unpleasant sensations are eliminated by oral baths, applications with anesthetics. Produce treatment of the underlying pathology, neurotic disorders.
  • Xerostomia . Advise quitting smoking and drinking alcohol, using soft-bristled toothbrushes, drinking frequently to keep your mouth moist, and sucking on sugar-free lozenges to stimulate saliva production. The oral cavity is lubricated with a solution of vitamin A. Novocaine blockade of the salivary glands is performed, vibration massage, drug electrophoresis, and galvanotherapy are prescribed.
  • Neuralgia . Apply anticonvulsants, non-narcotic analgesics, vitamin complexes. With severe pain, antidepressants, hypnotics, sedatives, antipsychotics are recommended. Carry out therapeutic blockade. Lubricate the tongue with a solution of cocaine. Patients are given a referral for SMT, galvanization, diadynamic therapy.
  • Anemia . With iron deficiency anemia, treatment of the underlying disease, good nutrition with a high content of heme iron, and ferropreparations are required. With pernicious anemia, the provoking pathology is corrected, vitamin B12 is prescribed.

Surgery

Operations are indicated for patients with phlegmon and abscess. An abscess is opened by a longitudinal incision of the tongue or a skin incision under the chin. The cavity is washed with a solution of antibiotics and proteolytic enzymes. Perform drainage. With neuralgia caused by compression of the nerve by a tumor, blood vessel, or tight walls of the bone canal, surgical interventions are required to eliminate compression.

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