Why Do Tongue Lesions Occur and How Are They Treated?

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Tongue lesions can be the result of several different etiologies. Sometimes lesions may resolve on their own if they're the result of a mechanical, thermal or chemical injury. However, any pain or lesion of the tongue that does not resolve in 14 days should be evaluated by a dentist. If your tongue isn't looking or feeling quite right, here are some potential causes and some treatment options your dentist may recommend.

What Causes Them?

A report published by the Indian Journal of Clinical Practice (IJCP) lists some possible causes of a lesion on the tongue other than an injury:

  • Bacterial, viral or fungal infection. Side effects of tuberculosis, scarlet fever and syphilis (all of which are bacterial infections) include ulcers. Viral infections include herpes vesicles and hairy leukoplakia that may appear on the side of the tongue in patients with HIV. The tongue is a common site for fungal infections with the overgrowth of candida albicans. The fungal infection will usually develop on the surface.
  • Precancerous or cancerous involvement. Premalignant lesions may present as leukoplakia, which appears as white or gray patches on the underside of the tongue in high-risk cancer situations that cannot be wiped away. Squamous cell carcinoma is the most common oral, malignant tumor. It may arise from leukoplakia and presents on the sides of the tongue and the dorsum.
  • Immune disorders. Immune disorders can also appear as tongue lesions, such as recurrent aphthae ulcers (also known as canker sores) and lichen planus, which are benign lesions but may be chronic. Lichen planus may itch or burn.
  • Dietary issues. Severe dietary issues like iron deficiency or vitamin deficiency may lead to a painful and red tongue.
  • Nonpathological changes in the appearance of the tongue. Tongue appearance varies from individual to individual. Two conditions that account for an abnormal tongue surface are geographic tongue and fissured or scrotal tongue. The geographic tongue is where patches of the tongue are red, raised, and bordered by yellow or white lines. The IJCP describes it as a "wandering rash of the tongue," and the areas change in size over time, thus the term geographic tongue. Scrotal tongue presents as deep grooves. It's a life-long condition, and there's no way to prevent it as it sometimes accompanies certain conditions like Down syndrome and Melkersson-Rosenthal syndrome.

How Does a Dentist Treat Tongue Lesions?

A dentist's main concern with the tongue is the development of precancerous or cancerous lesions. A chronic white or red area surrounded by a white border may be a precancerous lesion. The white lesion leukoplakia needs to identified by a biopsy to distinguish it from chronic irritation. The biopsy is performed by surgically removing the tissue and evaluating it under a microscope or removing a layer of cells using a brush called a brush biopsy. A biopsy is also required to identify any chronic lesion of the tongue especially a non-healing ulcer. Squamous cell carcinoma is a common malignant tumor of the tongue. There is usually no pain associated with the lesion in the early stages of the cancer.

If cancer is ruled out, a dentist may prescribe a topical steroid or special mouthwash to ease discomfort or treat the tongue lesion. In the cases of infections or nutritional deficiency, the underlying cause of the lesions must be addressed, sometimes by a physician rather than a dental professional. Hopefully once the source is treated, the affect it has on the tongue will resolve.

Tongue oral hygiene is also important, especially if you have scrotal tongue. Bacteria may hide in the grooves and result in bad breath or fungal infections. You should brush your tongue whenever you brush your teeth with a toothbrush like the Colgate 360° Advanced 4 Zonetoothbrush, which has an innovative cheek and tongue cleaner design.

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