Sore Tongue and Tongue Pain (Glossodynia or Glossalgia)

What is a sore tongue?

A sore tongue is a common term to describe discomfort, an ache, burning and/or pain of the tongue. The medical term for a sore tongue or tongue pain is glossodynia or glossalgia. It usually extends to the surrounding structures in the mouth. The tongue is one of the most sensitive parts of the body with receptors for taste, temperature and touch. Apart from housing the apparatus for the sense of taste, it also plays several other roles particularly in swallowing, talking, chewing and cleaning the mouth of food particles. It is a muscular organ with an outer covering laden with receptors. As with any part of the body, the tongue is prone to various diseases which can give rise to discomfort or pain, commonly referred to a sore tongue. Some of these conditions may also cause visible features like fissures or plaques while at other times soreness is present without any abnormality of the tongue.

Meaning of a Sore Tongue

A sore tongue is usually a symptom of irritation or inflammation of the surface or deep tissue of the tongue. The tongue is one of the several parts of the mouth cavity and any disease that affects the tongue may also involve the other structures like the lips, gum, teeth, inner cheek lining, palate and back of the throat. However, there are cases where the soreness of the tongue occurs on its own without involving the other structures of the mouth cavity, or where the soreness is most severe in the tongue. Soreness can also occur in the absence of any disease of the tissue of the tongue. This may be related to nerve pain – either irritation of the nerve or referred pain from surrounding structures with a common nerve supply.

A sore tongue is a symptom of some underlying disease and not a condition on its own. It is important to understand the basic structure and different parts of the tongue in order to identify the location of the soreness and other tongue symptoms that may be present.

  • The tongue is pinkish-red organ, with a rough surface and often coated with white reside of food that can easily be cleaned away.
  • The tongue is broadly divided into three parts – apex, body and root.
  • The front (anterior) part of the tongue comprises the apex and body while the back (posterior) part if made up entirely of the root of the tongue.
  • The front of the tongue has a groove running in the middle of it which is known as the midline groove.
  • Most of the surface of the tongue is rough due to the presence of papillae.
  • The papillae mainly contain the taste buds but also the receptors for touch and temperature.
  • There are two main groups of muscles in the tongue :
    • Intrinsic muscles which do have any outside attachments and are responsible for altering the shape of the tongue.
    • Extrinsic muscles which attach outside of the tongue and are responsible mainly for tongue movements but may also contribute to changes in the shape of the tongue to some degree as well.
  • The sensory functions (taste, temperature and touch) are through the following nerves :
    • Anterior two-third : chorda tympani (branch of CN VII) for taste and lingual nerve (branch of CN V) for touch and temperature.
    • Posterior one-third : lingual branch of glossopharyngeal nerve (CN IX) for taste, touch and temperature.

Signs and Symptoms

A sore tongue on its own is not indicative of a specific pathology. It is therefore important to consider other signs and symptoms of diseases that may cause a sore tongue.

Tongue Symptoms

  • Loss of taste or at least diminished taste.
  • Strange tastes (dysgeusia).
  • Loss of sensitivity of the tongue to temperature or touch (numbness).
  • Abnormal sensations such as prickling, tingling or burning of the tongue.
  • Difficulty or inability to move the tongue as one normally would.
  • Swollen tongue.
  • Discoloration of the tongue.
  • Patches, plaques, cracks, sores or other lesions on the tongue.
  • Difficulty chewing, swallowing or talking.

Mouth and Face Symptoms

  • Difficulty or inability to open the mouth.
  • Mouth pain, including the lips, gum, teeth or inner lining of the cheek.
  • Throat pain or sore throat.
  • Redness of the mouth.
  • Redness of the throat.
  • Swollen tonsils.
  • White coating on the inside of the mouth.
  • Other lesions like patches, plaques, cracks or ulcers.
  • Excessive salivation or diminished salivation.
  • Difficulty chewing, swallowing or talking.
  • Facial tenderness.
  • Facial swelling.
  • Facial palsy.
  • Bad breath.

If there is soreness or swelling of the tongue associated with itching of the throat, difficulty breathing, sweating and anxiety, then it could be a sign of an anaphylactic reaction. Immediate medical attention is therefore required or it could be severe enough to cause death.

Causes of a Sore Tongue

A sore tongue is often associated with mouth pain and the causes may therefore overlap. It is a common feature of glossitis – inflammation of the tongue. Glossitis typically presents with a redness of the tongue, swelling and a burning sensation. It may be caused by infections, allergies or other causes particularly mechanical or chemical trauma to the tongue. However, it is not uncommon for soreness of pain of the tongue to exist on its own with no other signs and symptoms being present. Glossitis may be part of inflammation of the mouth (stomatitis) or throat (pharyngitis).

Injury

The most common cause is injury to the tongue. This may be due to :

  • Biting the tongue
  • Tongue piercing
  • Dentures or braces
  • Jagged teeth
  • Foods which are acidic or spicy
  • Hot food or drink which may burn the tongue
  • Tobacco chewing
  • Areca nut and betel leaf chewing
  • Excessive alcohol consumption
  • Narcotics like crack cocaine and crystal meth
  • Repeated vomiting
  • Foreign body, usually sharp bones or tongue ring

Two causes that are fairly common but often overlooked is gastroesophageal reflux disease (GERD) and chronic snoring. The tongue being a muscular organ is prone to muscle pain if there is excessive movement of the tongue, strain or other muscle injury. Similarly restraining the tongue or pushing it out for long periods of time as is the case with dental procedures and medical examinations may cause soreness of the tongue afterwards.

Infections

Tongue infections are not uncommon. It is often associated with an infection in the mouth (stomatitis) and/or throat (pharyngitis). Sometime the infection of the surrounding structures may be perceived as tongue pain or or soreness despite not involving the tissue of the tongue itself.

  • Herpes simplex virus – oral herpetic stomatitis
  • Strep throat infection
  • Viral pharyngitis
  • Tonsillitis
  • Vincent’s stomatitis (trench mouth or acute necrotizing ulcerative gingivitis)
  • Yeast infection – oral thrush
  • Syphilis of the mouth

The mouth harbors scores of bacteria which are rarely pathogenic but can become so if there is severe injury to the tongue in the presence of poor immune defenses such as with HIV/AIDS and poorly controlled diabetes mellitus. Therefore infectious causes of tongue soreness is more commonly seen in these patients.

Skin Diseases and Surface Lesions

A number  of conditions may cause visible lesions on the surface of the tongue in addition to soreness and pain. Sometimes the entire tongue is not sore apart from the site of the lesion. The different types of tongue lesions may include :

  • Mouth ulcers or canker sore – aphthous stomatitis
  • Oral lichen planus
  • Hairy leukoplakia is usually not painful but there may be injury to the mouth with excessive brushing in an attempt to remove it.
  • Pemphigus vulgaris
  • Erythema multiforme
  • Geographic tongue

Other Causes

  • Allergies
  • Burning tongue syndrome
  • Bechet’s syndrome
  • Celiac disease
  • Dental abscess
  • Inflammatory bowel disease
  • Leukopenia
  • Pernicious anemia (vitamin B12 deficiency)
  • Reactive arthritis