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A tongue swells, or increases in size, when it is inflamed. Medically known as angioedema, tongue enlargement occurs due to fluid accumulation in the tongue tissues.
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 similar to hives, except that angioedema occurs in the deeper layers of tissue instead of appearing on the skin surface.
Causes of a Swollen Tongue
Several conditions can lead to tongue swelling:
- Allergic reaction to a food or medication
- Insect bite
- Oral allergy syndrome – A condition that occurs when the body reacts to raw fruits, nuts, and vegetables that contain proteins similar to those found in pollen.
- Acromegaly – A condition of excessive growth hormone in the body, resulting in tissue and bone overgrowth. (1)
- Amyloidosis – 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.
- Hypothyroidism – A disorder wherein 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 – These can lead to some complications in the tongue, including pain and swelling. Occasionally, a portion of the metal of the tongue jewelry can become embedded in the tongue and cause swelling. (3)
- Sjogren’s syndrome – An autoimmune disorder that eventually destroys the salivary glands. The tongue can become inflamed and enlarged due to a lack of saliva.
- Abscess – 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 – An example is a bite to the tongue.
- Glossitis – Inflammation of the tongue. Vitamin B12 deficiency, infection, pernicious anemia, and iron deficiency can all cause glossitis.
- Oral yeast infections – Thrush, an oral yeast infection, can cause tongue inflammation, sores, and redness.
Symptoms Accompanying 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 blockage of the airway and the inability to breathe. This can happen in an allergic reaction and must be taken care of immediately.
Medical Treatment for a Swollen Tongue
The treatment for tongue swelling chiefly depends on the cause. As the first line of treatment, however, the doctor may prescribe anti-inflammatory drugs and analgesics to help relieve the swelling and pain until a conclusive diagnosis is obtained.
- If your condition is caused by mild allergies, antihistamines can help. However, in the case of anaphylaxis, it is essential to administer epinephrine injection into a muscle immediately. Thus, you must visit the hospital or call 911 if you experience severe tongue swelling.
- 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)
- Acromegaly is a condition that arises from a tumor in the pituitary gland. 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 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)
- For swollen tongue caused by Sjogren’s syndrome, 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. Sometimes, steroid-containing ointments can be applied.
- Tongue swelling from a vitamin B12 deficiency has been found to improve with supplements. (9)
Diagnosing the Cause of a Swollen Tongue
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.
Risk Factors for 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.
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. Moreover, 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.
When to See a Doctor
A doctor should be consulted 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.
Your tongue plays a key role in speaking, breathing, and eating. Therefore, any problems in the tongue can bring about a great deal of discomfort and impact the quality of your daily life.
Often, a swollen tongue is indicative of an infection or a health condition that should be checked by a doctor. Timely and proper treatment can help prevent any further complications.