Tongue Issues: Causes and Concerns in ENT Health

Tongue issues?

Hello doctor, around July, I noticed a small red patch under my tongue, approximately 1 cm long and 0.5 cm wide.
It felt like the mucosa of the tongue was damaged, but it didn't hurt.
It has been almost two weeks without improvement, although it has become less red.
I visited an ENT specialist who performed a physical examination and said there was nothing to worry about, just to observe it and avoid spicy and fried foods.
Another ENT doctor I consulted also said it was just tongue inflammation and not a concern.
After nearly a month, the red area finally returned to the normal color of my tongue.

However, since August, I have experienced three more occurrences in the same area.
These instances were sometimes smaller than the first, but they were still red and painless.
I applied oral ointment, and it gradually faded and returned to the normal tongue color.
I am very worried about the recurring nature of this issue and whether it could indicate something serious.
I tend to be anxious by nature, so I am now extremely attentive to my tongue.
I avoid spicy foods and do not stay up late.
I have been taking B vitamins.

I would like to know why this is happening.
Over the past two months, I have changed my toothpaste; could that be related? I have a habit of licking between my teeth because I have large gaps that trap food debris.
Could this be a factor? Additionally, I had a urinary tract infection in August, and I underwent a liver transplant in 2000.

Wenwen, 40~49 year old female. Ask Date: 2018/08/21

Dr. Zheng Jueyi reply Otolaryngology

Hello, if multiple physicians have examined you and found no significant abnormalities or ulcers, and if there is self-improvement, it is mostly a benign condition.
It is recommended to continue monitoring and maintain a good routine.
Wishing you peace and health.
Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare, Dr.
Cheng Jue-Yi.

Reply Date: 2018/08/21

More Info

Understanding tongue issues, particularly those that manifest as discoloration or inflammation, can be quite complex. Based on your description, it seems you have been experiencing recurrent episodes of redness and inflammation under your tongue, which have not been painful but have raised concerns about potential underlying issues.
Firstly, it is important to recognize that the tongue is a highly vascularized organ, and its mucosal surface can be sensitive to various stimuli, including irritants, infections, and even stress. The fact that you have experienced this condition multiple times over a short period suggests that there may be an underlying cause that needs to be addressed.

Possible Causes of Tongue Issues
1. Irritation or Trauma: Frequent licking of the tongue or aggressive brushing can lead to irritation or microtrauma, which may cause localized inflammation. If you have recently changed your toothpaste, it could also be a factor, especially if the new product contains ingredients that you may be sensitive to, such as sodium lauryl sulfate (SLS), which is known to cause irritation in some individuals.

2. Nutritional Deficiencies: Deficiencies in certain vitamins, particularly B vitamins (like B12, folate, and riboflavin), can lead to changes in the tongue's appearance, including redness and soreness. Since you mentioned taking B vitamins, it might be worth discussing with your healthcare provider whether your current supplementation is adequate.

3. Allergic Reactions: Allergies to certain foods, dental products, or even medications can manifest as inflammation or changes in the tongue's color. If you have introduced any new foods or products into your routine, consider whether they could be contributing to your symptoms.

4. Infections: While you have not reported pain, viral infections (like herpes simplex) or fungal infections (like oral thrush) can cause changes in the tongue's appearance. These infections can sometimes be asymptomatic, especially in their early stages.

5. Systemic Conditions: Given your history of a liver transplant, it is crucial to monitor any changes in your health closely. Certain systemic conditions, including autoimmune disorders or liver-related issues, can manifest as oral symptoms. Regular follow-ups with your healthcare provider are essential to ensure that any potential complications are addressed promptly.

Recommendations for Management
1. Observation: Since your healthcare provider has advised observation, it is important to monitor the changes in your tongue. Keep a diary of when the symptoms occur, any associated activities (like dietary changes), and any other symptoms that may arise.

2. Avoid Irritants: Continue to avoid spicy or acidic foods that may exacerbate the condition. If you suspect your toothpaste may be a contributing factor, consider switching back to a previous brand or using a toothpaste designed for sensitive mouths.

3. Maintain Oral Hygiene: Good oral hygiene is crucial. Use a soft-bristled toothbrush and be gentle while brushing your tongue. Regular dental check-ups are also important to rule out any underlying dental issues.

4. Consultation with Specialists: If the symptoms persist or worsen, consider seeking a second opinion from an oral medicine specialist or a dermatologist who specializes in oral health. They may provide additional insights or recommend specific tests to rule out any serious conditions.

5. Stress Management: Since you mentioned being a person who tends to worry, managing stress through relaxation techniques, mindfulness, or counseling may also help alleviate some of your concerns and potentially reduce the frequency of your symptoms.

Conclusion
In summary, while the recurrent redness under your tongue may be concerning, it is often manageable with careful observation and lifestyle adjustments. Given your medical history, it is essential to maintain open communication with your healthcare providers and ensure regular follow-ups. If you notice any new symptoms or significant changes, do not hesitate to seek medical advice. Your health and peace of mind are paramount, and addressing these concerns proactively is the best approach.

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