Your tongue is a pretty important accessory - it helps you taste and swallow your food, talk non-stop to anyone who will listen, and is fun to stick out when someone annoys you. But you probably (and understandably) don’t think much about its significance until something happens to it, like when it swells up out of nowhere.
It doesn’t take long to notice when your tongue is suddenly too large for your mouth. Your first instinct might be to freak out, but fear not: “Swelling of the tongue can be caused by a variety of different problems, most of which are self-limiting and not serious,” says GP Dr Clare Morrison.
However, if the swelling happens quickly, or is severe and accompanied by throat-tightness, difficulty breathing, and dizziness or feeling faint, then you should seek medical attention right away, as it may indicate a life-threatening situation.
Likewise if the swelling persists (say, 10 days or longer), gets worse, or you’re experiencing other concerning symptoms, such as fatigue, pain, or fever, then definitely check in with your doc for a consult.
As for what might be causing your tongue to puff up? Below, experts share 10 possible culprits.
1. Your tongue is recovering from an injury.
“The tongue is vulnerable to trauma from the teeth, due to accidental or compulsive biting, sharp edges of broken teeth, and from dental work such as braces, false teeth, and rough fillings,” says Dr Morrison. Hot or sharp pieces of food can cause tongue irritation and swelling too, especially if those eats are acidic (like hard lollies) or hot and spicy (chillis and curries).
The obvious solution is to nix the causative factor of your puffy tongue (in some cases, you may need an assist from your dentist, says Dr Morrison), while soothing the injury by sucking on an ice cube, popping ibuprofen, and using a gentle mouthwash to prevent infections.
2. Your mouthwash may be causing problems.
Certain toothpaste and mouthwash ingredients can cause tongue swelling that won’t resolve until the inciting ingredient is discontinued, says dermatologist Dr Tsippora Shainhouse. The most common culprits to cause oral contact dermatitis? Hydrogen peroxide (teeth-whitening), alcohol (mouthwashes), baking soda (toothpaste), and cinnamates (chewing gum).
If you’re not sure which ingredient is giving you 'tude, your dermatologist can perform an allergy patch test to suss it out, adds Dr Shainhouse.
3. It’s a sign of an allergic reaction.
Allergic reactions are caused by the immune system over-reacting to something it’s exposed to. Think: fruit, nuts, shellfish, milk, or even an insect bite. The allergic response involves the release of histamine, narrowing of small blood vessels, and the accumulation of fluid in the tissues, says Dr Morrison. When an allergy causes swelling of the tongue, lips, and face, it’s known as angioedema.
Allergic reactions can be treated with antihistamines or oral steroids. Serious reactions can ultimately restrict breathing, which is why people who know they can react to specific foods or bites must carry an EpiPen and administer it immediately.
⚠️ If you or someone near you experiences signs of a life-threatening allergic reaction, including tongue swelling, do not hesitate to call for help. “This is an absolute emergency and 000 must be called ASAP,” says Dr Morrison.
4. …or a side effect of certain medications.
The medications best known for causing allergic reactions - and associated tongue swelling - are blood pressure medications known as ACE-I inhibitors. “They can cause potentially life-threatening tongue swelling that can occur at any time during therapy,” says otolaryngologist and laryngologist Dr Omid Mehdizadeh. “It doesn’t necessarily occur when first taken.”
Anti-inflammatories (like aspirin and ibuprofen) and antibiotics (penicillin, antivirals), can also trigger an allergic reaction. “If affected, it’s important to stop the offending medication,” says Dr Morrison. Treatment must be sought right away, and depending on severity, can include antihistamines, steroids, and intramuscular adrenaline.
5. A vitamin deficiency could be to blame.
Lack of vitamin B12 and folate can cause a swollen, red, beefy-looking tongue. “You may also get tingling in the hands and feet, fatigue, and weakness,” says Dr Morrison. Meanwhile, an iron deficiency can cause the tongue to become sore, smooth, and pale, and is likely to be accompanied by fatigue, shortness of breath, and super-pale skin.
Increasing your intake of these vitamins by eating foods like meat, fish, eggs, leafy greens, beans, and lentils, can relieve symptoms, but major vitamin and mineral deficiencies should ultimately be investigated by your doctor, says Dr Morrison. They’ll want to look into how the deficiency arose, and replace the missing nutrients through specific supplements and dietary changes.
6. Acid reflux is irritating your tongue.
Stomach acid that travels to the throat (laryngopharyngeal reflux, or LPR), may irritate the tongue and cause swelling. “You may notice an acidic or bitter taste in your mouth, throat burning, or the sensation of a lump in your throat,” says Dr Mehdizadeh. Steering clear of acidic or spicy foods and drinks can be help with keeping LPR in check - so can popping antacids, eating smaller, more frequent meals, and wearing looser-fitting clothes.
7. Your tongue is infected.
Bacterial infections can arise from a cut - say, from teeth biting or rubbing on the tongue - that bacteria then use as an entry point. Your tongue might feel red and sore, says Dr Morrison, and if the infection is deep, it can cause an abscess that results in painful swelling.
Occasionally, STDs, like syphilis and gonorrhoea, can affect the tongue. Bacterial infections will require a round of antibiotics from your doctor - and in the case of a large abscess, hospital admission and surgical drainage.
Viral infections of the tongue include herpes (the cold sore virus). “The first infection is the worst, and may be associated with multiple painful blisters inside the mouth, including the surface of the tongue, as well as fever and malaise,” says Dr Morrison.
HPV (human papillomavirus) and canker sores can also mess with your tongue. These usually clear up without treatment, but medical guidance should always be sought if you’re feeling particularly awful.
8. An underactive thyroid could be stirring up symptoms.
When circulating levels of thyroid hormone are low (which is common in women, and often autoimmune-related, says Dr Shainhouse), there are specific signs to watch out for, including fatigue, unexplained weight gain, constipation, cold-intolerance, hair thinning, and (surprise!) tongue swelling.
Fortunately, hypothyroidism can be diagnosed with a blood test. “If confirmed, it’s treated by taking prescription medication to replace the thyroid hormone,” says Dr Morrison. From there, regular blood tests will be required to check the dose, which will be adjusted on an as-needed basis.
9. Your pituitary gland is acting up.
The pituitary gland is an itty bitty organ that’s located at the base of the brain. It makes and ships a variety of different hormones to the rest of the body, and tells other glands when to do the same. “If the pituitary gland produces too much growth hormone, there will be gradual swelling of several parts of the body, including the tongue, hands, feet, and face,” says Dr Morrison.
Docs call this disorder acromegaly. Usually caused by a benign tumor in the pituitary gland, other symptoms can include headaches, deepening of the voice, irregular periods, skin tags, and enlarged facial features.
Because acromegaly develops slowly, you might not notice the changes to your appearance at first - but the second you suspect it to be a problem, it’s important to check in with your doctor for a blood test to confirm and subsequent treatment, as life-threatening complications can strike if left untreated, says Dr Morrison.
10. It could be a sign of tongue cancer.
Tongue cancer starts off superficially, typically with a white or red patch, or a small lump or ulcer on the tongue. “It usually arises at the site of a previous infection with HPV, which may have occurred many years earlier,” says Dr Morrison, and is more common in people who smoke or drink alcohol.
“If removed at this stage, it’s completely curable,” says Dr Morrison. That’s why it’s so important to seek medical attention if you have persistent tongue soreness or a lump that won’t quit - a biopsy can determine if it’s cancerous so you can be treated right away.