What Causes a Swollen Tongue?

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There are many potential causes of a swollen tongue. They can be obvious, like trauma or allergies, or something that's not that easy to immediately pinpoint, like an underlying health condition or a medication side effect. Some causes may have a relatively mild effect, while others are potentially life-threatening.

Knowing more about each of the causes of a swollen tongue can help you respond appropriately and know when it's time to seek immediate medical care.

This article explores the many diverse causes of a swollen tongue and explains how doctors diagnose and treat them. It also offers some self-help tips to aid with recovery.

swollen tongue
Verywell / Jessica Olah

Swollen Tongue Symptoms

Depending on the cause of the swelling, one or both sides of your tongue may become enlarged. In some cases, the swelling can interfere with eating or talking.

If your taste buds are affected, it can cause an unusual taste in your mouth and may even be itchy or painful.

Serious effects of swollen tongue include:

  • Progressively worsening swelling can block your airway, so it’s important to seek medical attention if you find yourself gasping for breath or gulping for air. In some situations, you may need a breathing tube placed immediately.
  • Rapid, severe swelling can be a sign of a potentially deadly, whole-body allergy known as anaphylaxis. The swelling of the tongue may be accompanied by swelling of your face or lips, hives, difficulty breathing, cyanosis (bluish discoloration of the lips), nausea, and vomiting.

Call 911 or go to the emergency room right away if your swollen tongue is accompanied by difficulty breathing, drooling, or swallowing difficulties.

Recap

A swollen tongue may affect one or both sides of the tongue and be accompanied by itching, pain, drooling, and a change of taste. The rapid, severe swelling of the tongue may be a sign of a potentially life-threatening allergy known as anaphylaxis.

Causes

Many different conditions and situations can cause your tongue to swell.

Allergic Reactions

Food or chemical allergies are the leading causes of a swollen tongue. You might only have a mild allergic reaction. However, if the swelling is a result of anaphylaxis, the reaction can be fatal.

Symptoms of an allergic reaction usually start within minutes or hours of coming into contact with an allergen, such as peanuts, tree nuts, milk, eggs, sesame seeds, fish, and shellfish.

Increasingly, dentists are seeing patients who experience reactions to flavorings, dyes, and chemical additives in toothpaste, mouthwash, denture cleansers, and other oral care products.

It's important to note that it's possible to come in contact with a particular allergen many times in the past without issue only to have an allergic reaction later on in life.

Medication

Angioedema is swelling underneath the skin, most often due to an allergy. After food allergies, medication reactions are the most common cause of angioedema of the face, lips, or tongue seen in emergency rooms.

The reaction can be a result of the body releasing too many bradykinins, which are immune-system chemicals normally needed to open blood vessels. A variety of prescription and over-the-counter drugs can cause this type of non-allergic tongue swelling.

A swollen tongue is an uncommon drug side effect, but it is a risk with certain medications.

Angiotensin-converting enzyme (ACE) inhibitors, frequently prescribed to lower blood pressure, are the most likely to cause angioedema of the tongue. Between 20% and 40% of emergency room visits related to drug-related angioedema are the result of ACE inhibitors.

In rare instances, other drugs can cause tongue swelling, including antidepressant medications, pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs), or drugs that are used to treat high cholesterol.

Skin Conditions

Diseases that affect the skin can cause tongue irritation that may cause slight swelling. For instance, mouth sores and tooth erosion occur with these disorders, causing the tissue around the tongue to puff up:

  • Pemphigus: A group of potentially fatal autoimmune diseases in which the immune system attacks the skin and mucus membranes, causing skin blisters and mouth sores
  • Oral lichen planus: A little-understood disease that causes rashes on the skin or in the mouth
  • Oral psoriasis: An autoimmune condition that can cause geographic tongue (in which the hair-like projections on surface of the tongue get stripped away) and fissured tongue (in which deep grooves develop on the surface of the tongue)

Trauma

Consuming hot foods or drinks, biting down on the tongue, or piercing the tongue may cause temporary swelling, which should disappear within about five days. If it doesn't, see your healthcare provider.

Serious injuries or oral piercings can lead to a bacterial infection known as Ludwig's angina, with swelling of the area under the tongue. With this condition, your airway may be completely blocked if you don't receive treatment.

Infection

The mouth is susceptible to a host of infections, including sexually transmitted diseases (STDs) that can be passed during oral sex.

Syphilis, gonorrhea, and the human papillomavirus (HPV) can cause inflammation, sores, warts, or swelling of the tongue and nearby tissue. 

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) can cause chronic irritation at the back of the throat. In some cases, this leads to an enlargement of the tongue at its base.

Sjögren’s Syndrome

Sjögren's syndrome is an autoimmune disease associated with dryness of the eyes and mouth. It can cause a host of problems, including enlargement of the salivary glands that produce spit and the lacrimal glands that produce tears.

The tongue may also swell or feel like it’s swollen.

Melkersson-Rosenthal Syndrome

Melkersson-Rosenthal syndrome is a rare disorder of the central nervous system (the brain and spinal cord) that primarily affects the facial muscles.

Edema, including tongue swelling, may occur, although facial paralysis is a more common symptom. 

Recap

Among some of the more common causes of tongue swelling are trauma, allergies, GERD, infections, oral lichen planus, and medications. Less common causes include autoimmune diseases like psoriasis and Sjögren's syndrome.

Diagnosis

If your tongue is only slightly swollen, you can see your regular healthcare provider for treatment. If the swelling is rapidly worsening or accompanied by signs of anaphylaxis, you should go right to the emergency room.

To determine the cause of tongue swelling, your healthcare provider will examine your tongue and the tissue around it. They will pay special attention to making sure your airway is clear.

They will also consider the following:

  • Is there an immediate risk to your breathing?
  • Do you have an underlying condition such as an autoimmune disease?
  • Do you have other symptoms such as hives?
  • What is your medical history, current medications, diet, and lifestyle?

If your healthcare provider suspects an allergy, drug reaction, or underlying medical problem, additional testing may be necessary.

Recap

A swollen tongue is diagnosed based on a physical examination of the tongue as well as a review of your medical history and symptoms. Based on the initial findings, the doctor may order additional tests to narrow the causes.

Treatment

Treatment will initially focus on reducing the swelling to ease any breathing problems or discomfort. Your healthcare provider will also work with you to prevent future incidents.

Medications

Up to 15% of people who have angioedema quickly experience airway blockage. This is usually a sign of anaphylaxis and requires a life-saving injection of epinephrine. In less severe allergic reactions, an oral antihistamine may be given instead.

When tongue swelling is not related to an allergy, your healthcare provider may use one of the following treatments:

  • For a reaction associated with too much bradykinin, you may be given an antihistamine, epinephrine, oral corticosteroids, or a preventive drug like Berinert (C1-esterase inhibitor concentrate) that stops its production.
  • For oral sores and inflammation, you may be given topical corticosteroids or retinoic acid to relieve lesions.

For a swollen tongue related to an infection or pre-existing disease, your healthcare provider will also prescribe treatments for managing your underlying issue. For example, this may include a course of antibiotics if you have a bacterial STD or the use of immunosuppressants if the underlying cause is autoimmune.

A variety of products have also come on the market to help relieve dry mouth. You can ask your healthcare provider about prescription oral drugs that increase saliva production, like Salagen (pilocarpine) or Evoxac (cevimeline).

There are also over-the-counter rinses and sprays that act as artificial saliva to add moisture to your mouth.

At-Home Remedies

For a mildly swollen tongue that isn’t getting worse, you may try some simple things at home to reduce swelling:

  • Eat and drink something cool or suck on ice chips to soothe your mouth and attempt to reduce swelling. 
  • Practice good oral hygiene such as brushing and flossing, but avoid irritating mouthwashes, such as those containing alcohol.
  • Rinse your mouth with a warm saltwater solution.
  • Avoid very acidic or extremely salty foods.

If dry mouth is causing tongue discomfort, chew sugar-free gum or suck on sugar-free hard candy. Drink plenty of fluids.

Recap

The treatment of a swollen tongue varies by the underlying cause but may include antihistamines, antibiotics, saliva stimulants, topical or oral corticosteroids, oral or injected immunosuppressants, or injected epinephrine. Good oral hygiene and saltwater mouth rinses may also help.

Summary

The causes of a swollen tongue are many and may include allergies, infections, trauma, GERD, oral lichen planus, drug reactions, autoimmune diseases, or rare disorders such as Melkersson-Rosenthal syndrome.

Treatment depends on the underlying cause. Good oral hygiene may be enough in some cases, but medications like antibiotics, antihistamines, corticosteroids, and other drugs may also be necessary.

The most important thing to remember is that severe and rapid swelling of the tongue may be a sign of a potentially life-threatening allergy known as anaphylaxis. This is an emergency, so do not delay seeking immediate medical attention.

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