Tongue discomfort includes both pain and burning sensations, often caused by irritation.
(See also table Oral Findings in Systemic Disorders in topic Systemic Disorders and the Mouth.)
The most common causes of tongue discomfort are
Certain foods, especially acidic ones (eg, pineapple)
Certain ingredients in toothpaste (eg, sodium lauryl sulfate), mouthwash, candy, or gum
Certain medications (commonly, those that cause dry mouth: antihistamines, antipsychotics, tricyclic antidepressants; less commonly, angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, or chemotherapeutic agents such as methotrexate, bleomycin, 5-fluorouracil)
Accidental trauma to tongue during mastication or due to nocturnal bruxism, or trauma from broken restorations or sharp teeth
Other causes of tongue discomfort include
Atrophic glossitis
Burning mouth syndrome (glossodynia)
Oral candidiasis (thrush)
Submandibular space infection (Ludwig's angina): involves sublingual, submandibular, and submental spaces and can cause elevation of tongue.
Celiac disease (tongue is the most commonly affected oral site; presents as painful burning sensation)
Atrophic glossitis sometimes causes a burning sensation of the tongue; it has many causes, including deficiency of iron or vitamin B12 and dry mouth (xerostomia). Burning mouth syndrome causes no visible signs, but patients have burning pain and paresthesia of the tongue and often of the mouth and lips.
Evaluation of tongue discomfort must first exclude submandibular space infection, which is life-threatening due to potential airway obstruction. Many other causes, such as a sharp tooth edge or candidiasis, are readily apparent on examination. Identifying irritant causes often requires sequential elimination of possible causes. Burning mouth syndrome is a diagnosis of exclusion once other causes have been ruled out.
Tongue discomfort not caused by infection is usually treated by eliminating the cause (eg, changing brands of toothpaste, particularly to a brand that does not contain sodium lauryl sulfate), avoiding irritating/acidic/spicy foods, or having a sharp or broken tooth repaired. Warm salt-water rinses may help. Identified underlying conditions are treated.
