A sore on the tongue can be caused by injury to the tongue, like a burn from eating or drinking very hot foods or accidentally biting your tongue while chewing. It can also be caused by medication use, infections (like oral thrush or leukoplakia), or even cancer.

Depending on the underlying cause, a sore on the tongue may present with other symptoms, like local swelling, white patches in the mouth, and difficulty swallowing.

If you notice sores on the tongue, you should see your dentist, family doctor or gastroenterologist for assessment so that treatment can be started as necessary.

What causes sores on the tongue?

A sore on the tongue can be caused by:

1. Tongue injury

Some injuries, like burns from hot food or drinks or biting the tongue, can cause sores, swelling, pain, discomfort, bleeding, or even blisters on the tongue.

What to do: If you burn your tongue immediately drink cold water and rinse your tongue in cold water for a few minutes. It is important to consult your general practitioner or dentist to assess the degree of the burn if it is severe. Treatment for a severe burn may involve analgesics or anti-inflammatories. Tongue bites, can be treated with ice or cold water.

2. Use of medication

Some medications can causing burning in the throat as a side effect. These medications can cause discomfort to the tongue, palate, gums, inner cheeks and throat, which can last for the full duration of treatment.

What to do: It is important to report medication side effects, like burning, to your doctor so that the doctor can evaluate the need to discontinue, swap or alter the dose of your medication.

3. Oral thrush

Oral thrush is a fungal infection caused by Candida albicans fungus. This fungus can grow and spread in the mouth and throat, and cause symptoms like white plaques within the mouth, sore throat, difficulty walking and cracks in the corners of the mouth.

Orla thrush usually emerges when the immune system is weakened. This is why this condition is commonly seen in babies, older adults, in people with are immunosuppressed (e.g. AIDS patients), and in those with a history of diabetes or cancer treatment.

What to do: Treatment for oral thrush should be monitored by a doctor, who will likely prescribe antifungals, like nystatin or miconazole. This medication can be provided in liquid, cream or gel form for direct application to the sores.

4. Aphtous stomatitis

Aphtous stomatitis is characterized by the presence of canker sores, blisters or wounds in the mouth that emerge more than twice a month. The canker sores develop as small wounds that are white or yellow in color with a red border. They can occur on the inner cheeks, lips, gums and throat.

This condition can emerge due to a sensitivity to specific foods, or due to a vitamin B12 deficiency, hormonal changes, stress or a weakened immune system.

What to do: It is important to consult a doctor or dentist if you commonly experience canker sores. Treatment is aimed at relieving pain and discomfort and well as healing the wounds. The doctor or dentist may recommend anti-inflammatories, analgesics, and in some cases, antibiotics. These can be prescribed as an oral rinse to disinfect the entire mouth and relieve pain.

5. Oral herpes

Oral herpes is a viral infection that causes blisters and crusting lesions. These sores usually appear on the lips, but can also grow below the nose, on the chin or even on the tongue or inner mouth, making it difficulty to swallow. Oral herpes blisters can rupture, and any fluid released can contaminate surrounding areas.

What to do: Oral herpes is not curable, however symptoms can be managed and a flare-up can be prevented. The doctor may prescribe a topical antiviral cream, like acyclovir.

6. Leukoplakia

Oral leukoplakia is characterized by the emergence of small white plaques that grow on the tongue and can spread to the inner cheeks or gums. These plaques usually do not cause any symptoms and disappear without any treatment.

Leukoplakia can be caused by a vitamin deficiency, inadequate oral hygiene, dental work, ill-fitting dentures, cigarette use, HIV infection or Epstein-Barr infection.

What to do: It is important to consult a doctor if you notice white plaques in the mouth, so that they can be assessed and treated as necessary. Treatment depends on the underlying cause. If the doctor suspects it is related to mouth cancer, the doctor may order a biopsy to remove and analyze the affected cells, as well as cryotherapy. It can also be treated with antiviral medications, like valacyclovir or fancyclobir, or medications that contain podophyllum resin or tretinoin.

7. Xerostomia

Xerostomia, popularly known as dry mouth, is characterized by a decrease or interruption in saliva production or a change in saliva composition. If left untreated, it can lead to very severe mouth and tongue dryness, and cracks, ulcers or sores on the tongue or along mucous membrane of the mouth.

Sores on the tongue in these cases are usually accompanied by other symptoms, such as thick saliva or difficulty chewing. These are usually related smoking, stress, anxiety or other health conditions, such as anemia, lupus or multiple sclerosis.

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What to do: it is important to drink plenty of water throughout the day and to hydrate the tongue and mucous membranes to reduce discomfort. You are also advised to avoid smoking. In moderate to severe cases, your doctor or dentist may prescribe artificial saliva to help reduce symptoms and discomfort.

8. Hand, foot and mouth disease

Hand, foot and mouth disease is a highly contagious disease that most commonly affects children under 5 years of age. It leads to the appearance of painful sores or blisters on the tongue. They usually start off as red spots but can develop into blisters that appear on the hands, feet and mouth.

Hand, foot and mouth disease is caused by viruses of the Coxsackie group, which can be transmitted from direct person-to-person or indirect contact through contaminated food or objects.

What to do: you should consult your pediatrician or general practitioner if you suspect you may have this condition. It can be treated with analgesics, anti-inflammatories, anti-itch medications and ointments for mouth ulcers.

9. Mpox

Mpox, is an infection caused by an Orthopoxvirus genus virus, and results in symptoms such as fever, chills, blisters or sores on the tongue or mouth. These can spread to the skin in any area of the body, including the genitals.

Monkeypox can be transmitted from person to person through contact with respiratory secretions, direct contact with secretions from blisters and sores, contact with contaminated objects, or contact with lesions in the oral or genital region, which also increase the risk of transmission through sexual intercourse.

What to do: you should consult a gynecologist or infectious disease specialist to confirm the diagnosis and indicate treatment with antivirals, such as tecovirimat, or medications to relieve symptoms such as paracetamol or dipyrone, for example. In addition, the doctor should recommend isolation to prevent transmission of the disease to other people.

10. HPV in the mouth

An HPV infection in the mouth can cause sores on the tongue, which are typically noted on the edge of the tongue. These sores may appear red or pink, and may result in mouth ulcers or mouth ulcers, as well as sores or warts on the lips or any other surface of the mouth.

HPV can be transmitted to the mouth through unprotected oral sex, however, it is also possible for transmission to occur through kissing, especially if the uninfected person already a lesion in the mouth.

What to do: Treatment for HPV in the mouth should be done under the guidance of a general practitioner or stomatologist, who may recommend laser, surgery or medications such as trichloroacetic acid or interferon alpha.

11. Tongue cancer

Tongue cancer may not present with any symptoms in its early stages, but as the disease progresses it can lead to symptoms on the tongue, such as a red spot that does not improve, a lump that does not go away, a burning sensation, bleeding, or sores or ulcers on the tongue that do not heal.

This type of cancer can be caused by smoking, excessive alcohol consumption or HPV infection.

What to do: Treatment for tongue cancer should be guided by an oncologist who may prescribe surgery, chemotherapy or radiation therapy.