What Causes a Swollen Tongue?

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A swollen tongue is a type of angioedema, a buildup of fluid in the lower layer of the skin or mucous membranes in various parts of the body. In medical terms, tongue swelling is known as glossitis and usually is accompanied by redness and other symptoms depending on the cause.

Allergies, infections, underlying medical conditions, or even certain medications can trigger tongue swelling. While the condition usually isn't an emergency, the sudden onset of swelling extreme enough to obstruct breathing is likely a sign anaphylaxis, which is considered a medical emergency

If you or someone you're with experiences tongue swelling of this degree, go to the nearest emergency room or call 911.

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 minor cases, swelling can interfere with eating or talking, or if your taste buds are affected, cause an unusual taste in your mouth.

Continued swelling can block your airway, so it’s important to seek medical attention if you ever feel that your tongue is fatter or larger than usual. If your doctor notices swollen tissue under your tongue or around the floor of the mouth, you may need a breathing tube immediately.

Rapid, severe swelling can be a sign of anaphylaxis, which may be accompanied by swelling of your face or lips, hives, difficulty breathing, bluish coloration of the lips (cyanosis), nausea, and vomiting.

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

Causes

There are common reasons as well as some rare conditions that may cause your tongue to swell.

Allergic Reactions

The leading causes of a swollen tongue are food or chemical allergies. You might only have a mild reaction. However, if the swelling is a result of anaphylactic shock, it 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 have reactions to flavorings, dyes, and chemical additives in toothpaste, mouthwash, denture cleansers, and other oral care products.

Medication

Next to food allergies, reactions to medications are the most common cause of angioedema of the face, lips, or tongue seen in emergency rooms. Such cases aren’t always due to allergies.

The reaction can be a result of the body releasing too many bradykinins, which are immune-system chemicals normally needed to open blood vessels. They cause swelling if they are overproduced. 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.

In fact, 20% to 40% of emergency room visits related to drug-related angioedema are a result of reactions to ACE inhibitors.

In rare instances, other drugs can cause tongue swelling, including depression medication, pain relievers such as NSAID, or drugs that treat high cholesterol.

Skin Conditions

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

  • Pemphigus: A group of potentially fatal autoimmune diseases that cause mouth sores and skin blisters
  • Oral lichen planus: A little-understood disease that causes rashes on the skin or in the mouth
  • Oral psoriasis: Leads to geographic tongue and fissured tongue, creating a feeling of swelling or discomfort

Trauma

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

Serious injuries, and, in some cases, oral piercings result in a bacterial infection known as Ludwig's angina in which the area under the tongue swells. With this condition, your airway may be completely blocked if you don't receive treatment.

Infection

The mouth is also susceptible to a host of infections, including sexually transmitted infections that can be passed on to a partner during oral sex. Sores, warts, and swelling in the mouth can develop from syphilis, gonorrhea, and the human papillomavirus (HPV), resulting in some swelling or inflammation 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.

Sjogren’s Syndrome

An autoimmune disease associated with dryness of the eyes and mouth, Sjogren’s syndrome can cause a host of oral problems including enlargement of salivary glands and parotid glands (large saliva-producing glands that sit on each side of the cheeks). In the midst of these symptoms, the tongue may swell or at least feel like it’s swollen.

Melkersson Rosenthal Syndrome

Melkersson Rosenthal syndrome is a rare neurological disorder that primarily affects the facial muscles. Edema, including tongue swelling, may occur, although facial paralysis is a more common symptom. 

Diagnosis

To determine the cause of tongue swelling, your doctor will examine your tongue and the tissue around it, checking immediately to make sure your airway is clear. They will also consider the following:

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

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

Treatment

If your tongue is only slightly swollen, you can see your regular doctor for treatment. If the swelling is accompanied by signs of anaphylaxis, you should go right to the emergency room. Treatment will initially focus on reducing the swelling to ease breathing problems or discomfort, but your doctor should also work with you to prevent future incidents.

Medications

In up to 15% of patients, angioedema quickly leads to airway blockage. This usually is 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 doctor may use one of the following treatments:

  • For a reaction associated with too much bradykinin, you may be given a drug that stops its production, which may be administered orally or via injection.
  • 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 doctor will also proceed with treatments that are appropriate for managing the overall condition.  

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 possibly reduce swelling. 
  • Practice good oral hygiene such as brushing and flossing, but avoid irritating mouthwashes (typically those containing alcohol).
  • Rinse 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.

A variety of products have also recently come on the market to help relieve dry mouth. You can ask your doctor about oral drugs available by prescription that increase saliva production. There are also over-the-counter rinses and sprays that act as artificial saliva to add moisture to your mouth.

A Word From Verywell

Your tongue plays a major role in eating, speaking, and breathing, so any swelling can have a significant impact on your immediate health and quality of life. Even if it seems minor, it could be a sign of an infection or health condition that might cause long-term problems.

If you or someone you're with suddenly feels their tongue is puffing up, get medical help right away. Even if swelling is slight or gradual, talk to your doctor to find out if you're having a minor allergic reaction or you have another medical problem.

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