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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?

Some possible causes of a lesion on the tongue other than an injury:

  • Bacterial, a 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.
  • Precancerous or cancerous involvement. Premalignant lesions may present as leukoplakia, which appears as white or grey 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 tumour. 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 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.

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 be 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 tumour of the tongue. There is usually no pain associated with the lesion in the early stages of 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 effect it has on the tongue will resolve.