Tongue Ulcers: Causes, Symptoms & Treatments

Tongue ulcers, also known as mouth sores or oral ulcers, are small but often painful lesions that develop on the surface of the tongue [1]. While they are usually harmless, these ulcers can significantly interfere with eating, speaking, and maintaining oral hygiene.

From minor irritations to potential symptoms of underlying health conditions, tongue ulcers have many causes. Understanding these causes is crucial for choosing the right treatment and management approach. In this article, we’ll explore the causes, symptoms, and evidence-based treatments for tongue ulcers, along with tips on prevention and when to seek medical help.

Types of Tongue Ulcers

Tongue ulcers can be broadly classified based on their origin and characteristics. The most common types include:

1. Aphthous Ulcers (Canker Sores)

Aphthous ulcers are the most common type of oral ulcer [1]. These small, round sores can appear individually or in clusters on soft tissues like the tongue. They are generally not contagious [1]. Minor canker sores are typically less than 1 centimeter in diameter and usually heal within one to two weeks [2]. Major canker sores are larger (over 1 cm) and can take several weeks or even months to heal, potentially leaving a scar [2]. Although these ulcers often heal on their own, they can be painful and may require over-the-counter pain relief.

2. Traumatic Ulcers

Traumatic ulcers are caused by direct physical injury to the tongue [1], such as accidentally biting it, injuries from sharp dental procedures, or repeated rubbing from broken fillings or orthodontic devices. These ulcers typically heal quickly once the source of the trauma is removed [1]. A specific, rare type called traumatic ulcerative granuloma (TUG) can occur due to persistent trauma and may clinically resemble oral cancer, necessitating a biopsy and medical attention for accurate diagnosis and management.

3. Infectious Ulcers

Infectious ulcers are caused by pathogens like viruses or fungi. For instance, Herpes Simplex Virus (HSV) can cause ulcers on the tongue and other parts of the mouth, known as herpetic stomatitis [1]. Another common cause is oral thrush (candidiasis), a fungal infection that can cause ulcers or white patches with a red, smooth patch on the tongue’s upper surface, particularly in infants, the elderly, or those with weakened immune systems [2]. Hand, foot, and mouth disease (HFMD) can also result in tongue ulcers, particularly in children [1].

Causes of Tongue Ulcers

Tongue ulcers are often multifactorial, meaning they can be caused by a variety of factors, including physical trauma, stress, infections, and certain systemic medical conditions. Let’s explore some of these causes in more detail:

1. Physical Trauma

The most frequent cause is mechanical injury, such as biting the tongue or rubbing from sharp dental work or dentures [1].

2. Stress and Lifestyle

Emotional or psychological stress is a recognised trigger for the onset or recurrence of aphthous ulcers [3], and may be due to an altered immune response [2].

3. Nutritional Deficiencies

A deficiency in Vitamin B12, folate, or iron can contribute to the development of oral ulcers [5]. These nutrients are essential for healthy cell turnover in the mouth lining.

4. Gastrointestinal Conditions

Celiac Disease, which triggers an autoimmune response to gluten, can lead to oral manifestations, including recurrent tongue ulcers [1]. Similarly, Crohn’s Disease, an inflammatory bowel disease, can cause oral lesions and ulcers due to systemic inflammation [6].

5. Systemic Diseases

Behçet’s Disease is a rare, chronic disorder that involves inflammation of blood vessels and frequently causes recurrent oral and genital ulcers [1].

6. Food Sensitivities or Allergies

In some individuals, food allergies or sensitivities to substances like cinnamon flavoring, gluten, or certain preservatives may trigger ulcer formation [2].

7. Oral Cancer

While rare, oral cancer can manifest as a persistent ulcer on the tongue that does not heal [2]. Risk factors include smoking, heavy alcohol consumption, and Human Papillomavirus (HPV) infection [1].

Signs and Symptoms of Tongue Ulcers

If you have a tongue ulcer, you may experience one or more of the following:

• Pain or discomfort that may worsen when eating or speaking
• Visible round or oval sores on the surface or sides of the tongue, often with a white or yellow center and a red border [2]
• Redness and inflammation surrounding the ulcers
• Difficulty chewing or swallowing (dysphagia) due to the pain
• Increased sensitivity to spicy, acidic, or sharp foods

In some cases related to systemic infection or illness, you may also experience a fever or swollen lymph nodes in the neck [1].

Management for Tongue Ulcers: Medical and Home Care

Treatment aims to manage pain, prevent secondary infection, and accelerate natural healing.

Home Management (for minor ulcers):

• Oral Rinse: Rinse your mouth gently with warm, slightly salted water (a half teaspoon of salt in a cup of water) or a baking soda solution several times daily [2].
• Dietary Modification: Avoid spicy, salty, sour, acidic, or abrasive foods (like chips or nuts) until the ulcers heal to prevent irritation and pain [2].
• Topical Relief: Use an over-the-counter topical anaesthetic (such as one containing benzocaine or lidocaine) for temporary, localized pain relief.

Medical Management (Consult a Doctor/Dentist):

For large, persistent, or recurring ulcers, a healthcare professional may recommend stronger therapies, often after ruling out underlying conditions [1]:

• Topical Corticosteroids: Gels, pastes, or mouthwashes containing steroids (e.g., fluocinonide, triamcinolone acetonide) are considered the mainstay of treatment for aphthous ulcers to significantly reduce inflammation and accelerate healing [7], [8].
• Antimicrobial Rinses: An alcohol-free mouthwash containing chlorhexidine may be prescribed to prevent secondary bacterial infection [1].
• Prescription Agents: Sucralfate suspension (to coat the ulcer) or prescription-strength topical anesthetics may be used in severe cases [1].
• Addressing Underlying Cause: If a deficiency (like Vitamin B12) or systemic disease is identified, treatment for the underlying condition is the primary medical approach [5].

How to Prevent Tongue Ulcers: Simple & Effective Tips

Prevention focuses on minimizing known triggers and maintaining optimal oral and general health:

• Gentle Oral Hygiene: Brush your teeth gently with a soft-bristle toothbrush and mild, non-SLS (sodium lauryl sulfate) toothpaste [2]. Floss daily.
• Injury Prevention: Fix sharp tooth edges or broken dental work that may repeatedly injure the tongue [1]. Ensure orthodontic appliances are smooth and well-fitting.
• Nutritional Balance: Eat a well-balanced, nutrient-rich diet to prevent deficiencies in vitamins and iron that are known to contribute to ulcers [5].
• Stress Management: Incorporate stress-reduction techniques like mindfulness, yoga, or meditation, as stress can be a trigger for aphthous ulcers [3].
• Avoid Irritants: Identify and avoid specific foods (such as overly acidic fruits, highly spicy dishes, or known allergens) that seem to trigger ulcers for you.

When to Contact a Doctor?

Tongue ulcers usually heal completely within 1-2 weeks. Seek medical advice immediately if an ulcer:

• Persists for longer than three weeks [1], [9].
• Is unusually large or recurs frequently [2].
• Is accompanied by severe symptoms such as high fever, difficulty swallowing, unintended weight loss, or persistent swollen glands [1].
• Presents as a hard lump or a red/white patch that doesn’t disappear, as these are red flags for potential underlying issues, including oral cancer [9].

Ulcers caused by medication side effects, oral thrush, or other specific infections require a tailored diagnosis and prescription treatment from a healthcare professional.

Takeaway

Tongue ulcers, while common and uncomfortable, are most often minor and manageable at home. Identifying the cause, whether it is physical trauma or a systemic trigger, is the essential first step to effective management. By adopting gentle oral hygiene practices, avoiding irritants, and addressing potential stress or nutritional gaps, you can accelerate healing and minimize recurrence. Remember: any oral ulcer that does not show signs of healing after two weeks requires professional evaluation by a dentist or physician.

Expert Insight:

“Most tongue ulcers heal on their own within a fortnight, but persistent, unusually painful, or recurring sores could be a significant sign of an underlying health issue. You must visit your dentist or primary care physician for a thorough examination. Early diagnosis and appropriate oral care are crucial to prevent complications and address serious conditions quickly.”

– Dr Lakshmi Vaswani

Frequently Asked Questions (FAQs)

Which deficiency causes tongue ulcers?

Deficiencies in Vitamin B12, folate, or iron are strongly associated with the formation of oral ulcers [5]. If you experience persistent or recurring ulcers, consult your doctor to check for underlying nutritional deficiencies.

How do I prevent getting ulcers on my tongue?

To prevent tongue ulcers, avoid known irritants like acidic or spicy foods, use a soft-bristle toothbrush with a mild toothpaste, and practice stress management techniques [3].

What drink is good for tongue ulcers?

Drinking cool liquids, such as water or non-acidic beverages, can help ease the discomfort associated with tongue ulcers. Avoid hot drinks and fruit juices high in acidity (like orange or lemonade) [2].

What causes ulcers on the tongue?

Tongue ulcers can be caused by direct injury (like biting or dental trauma), infections (viral or fungal), and underlying systemic medical conditions (like Crohn’s disease or nutritional deficiencies) [1].

How do you treat a tongue ulcer?

Treatment includes using over-the-counter topical numbing gels for pain, avoiding irritating foods, maintaining excellent oral hygiene, and using prescribed topical steroids for persistent inflammation [7]. For ulcers caused by underlying conditions, the treatment must target that primary cause [5].

How long do mouth ulcers last on the tongue?

Minor aphthous ulcers typically heal within 1 to 2 weeks [2]. Larger or major ulcers can take longer, up to 4 weeks. If any ulcer persists longer than three weeks, you must seek medical advice [9].

Can tongue ulcers be removed?

Tongue ulcers usually resolve by themselves and do not require surgical removal. However, a biopsy (a type of removal) may be necessary if a healthcare provider suspects a traumatic ulcerative granuloma (TUG) or oral cancer [1].

Should I brush my tongue ulcer?

Use a soft toothbrush to gently clean the surrounding areas, but do not brush directly on the ulcer, as this may cause further irritation, pain, and potentially delay healing [2].

What is the fastest way to cure mouth ulcers?

There is no single “fastest cure,” but you can promote optimal healing by minimizing irritation (avoiding spicy/acidic foods), maintaining meticulous oral hygiene, and using topical treatments to manage discomfort [1]. If symptoms persist, consult your family physician or dentist for guidance.

References

[1] Mouth sores: MedlinePlus Medical Encyclopedia. (n.d.). https://medlineplus.gov/ency/article/003059.html

[2] Website, N. (2024, March 13). Mouth ulcers. nhs.uk. https://www.nhs.uk/conditions/mouth-ulcers/

[3] Verma, S., Srikrishna, K., Srishti, Shalini, K., Sinha, G., & Srivastava, P. (2023). Recurrent oral ulcers and its association with stress among dental students in the Northeast Indian population: a Cross-Sectional Questionnaire-Based survey. Cureus, 15(2). https://doi.org/10.7759/cureus.34947

[4] Scully, C. (2008). Ulcers. In Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment (2nd ed., pp. 131–139). Churchill Livingstone. https://www.scirp.org/reference/referencespapers?referenceid=3745809

[5] Wray, D., Ferguson, M. M., Hutcheon, W. A., & Dagg, J. H. (1975). Recurrent aphthae: Treatment with vitamin B12, folic acid, and iron. British Medical Journal, 2(5969), 490–493. https://doi.org/10.1136/bmj.2.5969.490

[6] Pecci-Lloret, M. P., Ramirez-Santisteban, E., Hergueta-Castillo, A., Guerrero-Gironés, J., & Oñate-Sánchez, R. E. (2023). Oral Manifestations of Crohn’s Disease: A Systematic review. Journal of Clinical Medicine, 12(20), 6450. https://doi.org/10.3390/jcm12206450

[7] Brocklehurst, P., Tickle, M., Glenny, A. M., Furness, S., Crean, S., Hutton, J., & Downie, F. (2012). Systemic interventions for recurrent aphthous stomatitis (mouth ulcers). Cochrane Database of Systematic Reviews, (9). https://doi.org/10.1002/14651858.CD005437.pub3

[8] Liu, C., Zhou, Z., Liu, G., Wang, Y., & Deng, B. (2012). Efficacy and safety of dexamethasone ointment on recurrent aphthous ulceration. The American Journal of Medicine, 125(3), 292–301. https://doi.org/10.1016/j.amjmed.2011.08.019

[9] Health Service Executive (HSE). (2024, January 10). Mouth ulcers: Symptoms, causes, types and treatments. https://www2.hse.ie/conditions/mouth-ulcers/