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A tongue swells, or increases in size, when it is inflamed. Fluid accumulates in the tissues of the tongue and causes it to enlarge. The term “angioedema” is used to describe this enlargement.
When you eat or swallow a substance you are sensitive to, your immune system responds by filling your blood with chemicals and fluids that leak from narrowed blood vessels in the tongue.
Angioedema is very much a reaction similar to hives, except that angioedema occurs in the deeper layers of tissue instead of appearing on the surface of the skin.
What are the causes of a swollen tongue?
Several conditions can lead to tongue swelling:
- An allergic reaction to a food or medication may cause the tongue to swell. An insect bite can also cause the tongue to enlarge.
- Oral allergy syndrome is a condition that occurs when the body reacts to raw fruits, nuts, and vegetables that contain proteins similar to the proteins in pollen. The tongue can enlarge from this reaction.
- Acromegaly refers to a condition of excessive growth hormone in the body. It results in tissue and bone overgrowth. The hands, feet, and tongue become enlarged. (1)
- Amyloidosis is a condition caused by proteins that change in the body and then deposit in organs and tissues. The faulty proteins can build up in the tongue and make it swell.
- Hypothyroidism occurs when the thyroid gland does not produce enough hormones and is considered underactive. Macroglossia, a term used for an enlarged tongue, can occur with this disorder. (2)
- Tongue piercings can lead to some complications in the tongue. Pain and swelling of the tongue are just two. Occasionally, a portion of the metal of the tongue jewelry can become embedded in the tongue and cause it to swell. (3)
- Sjogren’s syndrome is an autoimmune disorder that eventually destroys the salivary glands. Dry mouth is the result of decreased saliva. The tongue can become inflamed and enlarged due to this lack of saliva.
- An abscess can form in the tongue due to infection in the tonsils or teeth. This enlargement can rapidly become dangerous. (4)
- A burn or mechanical injury such as a bite to the tongue can cause swelling.
- Glossitis is a term used for inflammation of the tongue. This inflammation can change the color of the tongue to bright red and can shrink the bumps on the surface of the tongue. The tongue can swell. Vitamin B12 deficiency, infection, pernicious anemia, and iron deficiency can all cause glossitis.
What symptoms accompany a swollen tongue?
The symptoms that can accompany a swollen tongue depend on the cause of the swelling.
Pain and bleeding certainly occur with an injury or burn on the tongue. If there is an autoimmune disease such as Sjogren’s syndrome, dry mouth is usually a symptom. Problems with chewing, swallowing, and speaking may occur.
The color and shape of the tongue may be altered and a burning or itching sensation may be felt.
The most concerning symptoms are the blockage of the airway and the inability to breathe. This can happen in an allergic reaction and must be taken care of immediately. It can become life-threatening.
How is a swollen tongue diagnosed?
The diagnostic terms for a swollen tongue are glossitis, angioedema, macroglossia, and oral allergy syndrome.
Your physician or dentist can help determine the cause of an enlarged tongue. They will examine the tongue, looking for loss of bumps on the surface, ulcerations, and change in color. Blood tests may be necessary, along with other types of scans.
The doctor will ask about any recent trauma to the tongue, toothaches, new foods that were eaten, or even a change in toothpaste or denture adhesive. Occasionally, a biopsy of the tongue may be helpful in making a diagnosis.
What are the medical treatments for a swollen tongue?
Treatment for tongue swelling depends on the cause:
- The most severe swelling of the tongue is due to anaphylaxis. This is a life-threatening reaction in response to an allergen. This reaction can have skin, breathing, heart, or gastrointestinal symptoms.Anaphylaxis usually requires a call for emergency services (911) or a trip to the hospital. Epinephrine given by injection into a muscle is the typical medical treatment for this condition. Adrenaline is another name for epinephrine.Other treatments after the epinephrine injection may also be given, such as inhaler therapy and steroid administration. Antihistamines are often prescribed.
A biphasic reaction rarely can occur in this condition, in which the symptoms return after treatment. Patients should be monitored for 4-6 hours before leaving the hospital. (5)
As the tongue swells, the airway must be maintained in an emergency situation. CPR may have to be started, and oxygen may need to be administered.
- Acromegaly is a condition that arises from a tumor in the pituitary gland. It can cause an overgrowth of bones and tissues including the tongue. This develops slowly over time.The treatment goal for acromegaly is getting growth hormone levels to a safe level. This can be accomplished with surgery to the pituitary gland, radiation to the pituitary gland, and medications. (6)
- Amyloidosis is a protein disorder that disrupts the tissues in the body. It is now treated by managing the symptoms of impaired organs, organ transplantation, and medications. (7)
- Hypothyroidism is treated with a medication called levothyroxine, which is a hormone replacement for the decreased amount the thyroid is making. There are also other medications that can be used for this condition. (8)
- Sjogren’s syndrome causes a lack of saliva, resulting in a dry mouth and potentially a swollen tongue. There are over-the-counter mouth rinses and lozenges that are specifically designed to increase moisture in the mouth.
- When the tongue is swollen due to an infected piercing, mechanical injury, abscess, or burn, the cause of the swelling must be determined and treated.An embedded piece of metal from a piercing must be removed. An abscessed tooth will need to be removed or treated potentially with root canal therapy and antibiotics.Eating and drinking cold items will help soothe the pain. Sucking on ice can calm the discomfort and reduce the tongue swelling. Sometimes, steroid-containing ointments can be applied.
- If the tongue is swollen from a vitamin B12 deficiency, supplements have found to improve this. (9)
Who is at risk of tongue swelling?
The most at risk of a swollen tongue are those that have allergies or oral allergy syndrome.
Individuals who have hypothyroidism, Sjogren’s syndrome, acromegaly, amyloidosis, and lack of saliva are also at risk of a swollen tongue. Tongue piercings also place individuals at risk.
What are the complications of a swollen tongue?
The complications of a swollen tongue are increased decay and periodontal disease if there is a lack of saliva in the mouth. If there is an injury, speech and swallowing can be difficult. Nutritional deficits can occur eventually.
The mere sensation of the tongue swelling can cause a great deal of anxiety.
The most serious complication is, of course, an anaphylactic reaction, in which breathing is impaired or stopped.
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When to see a doctor?
A doctor should be seen when the cause of a swollen tongue is not known. If there is a rapid swelling of the tongue, emergency services should be called and a trip to the hospital may be needed.