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Lumps, Bumps & Ulcers

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Tongue bumps can appear for all kinds of reasons. Accidentally biting your tongue can result in bumps, or they could be due to something more serious. If you're concerned about a bump on your tongue that isn't going away, schedule an appointment with your dentist.

Papillae are the small, natural bumps that cover the surface of the tongue. The four types of papillae are:

  • Filiform
  • Fungiform
  • Circumvallate
  • Foliate

All of the types except filiform contain taste buds. Filiform papillae mostly appear at the back and centre of the tongue, fungiform papillae are located on the sides and tip, circumvallate papillae appear at the back of the tongue and foliate papillae sit just in front of them and on the sides of the tongue

Causes of Enlarged Tongue Bumps

Circumvallate and foliate papillae are normally large enough to be seen with the naked eye, but sometimes a papilla grows unusually large due to irritation or inflammation. This condition is called transient lingual papillitis. An accidental bite to the tongue or irritation from foods or chemicals can cause enlarged papillae. Transient lingual papillitis may also be caused by nutritional deficiencies, smoking, alcohol consumption, plaque build-up or dental appliances. The condition is temporary and often resolves on its own.

Tongue bumps can appear as blisters, ulcers and lumps. Other causes of bumps on the tongue include canker sores, bacterial infections, oral herpes, allergies, immune system disorders and oral cancer. A bump can also develop on the side of the tongue in the space created by a missing tooth. Although most cases of bumps on the tongue are harmless, unexplained white or red areas, sores or hard lumps on the tongue should be examined by a dentist as soon as possible.

These oral blisters are one of the most common oral problems, and most people experience them at some point in their life. They're usually small, less than one-third of an inch in diameter and form on the inside surface of your cheeks, under the tongue or on your gums – if not on the tongue itself. The sores may be white or yellow in the centre with a red border, or start as painful red spots or bumps that develop into open ulcers.

Canker sores usually carry a general sense of discomfort. And although the pain usually goes away on its own in seven to 10 days, it can take three or more weeks for the ulcers themselves to heal. Canker sores can be caused by emotional stress, hormonal shifts, a lower immune system and Celiac disease. If your mouth sores become infected, however, additional problems such as swollen lymph nodes can arise, so it's best to address mouth sores as early as possible to prevent an infection from worsening. See your doctor if you develop any of the following at the same time:

  • Joint pain
  • Fever
  • Rashes
  • Diarrhoea

Maintain good oral hygiene through daily brushing and flossing, and rinse your mouth with an antibacterial mouthwash whose bubbling properties clean the mouth gently while reducing the irritation to promote quicker healing.

Also known as thrush, candidiasis is an overgrowth of the Candida fungus, which grows naturally in your mouth. It develops whenever the bacteria protecting your oral tissues are compromised, either through the use of antibiotics, medication-induced dry mouth or ill-fitting dental appliances. Symptoms of oral thrush can include any of the following:

  • A bad or reduced sense of taste
  • White, cheesy-looking patches of fungus
  • Tongue blisters or red, inflamed patches of tissue, often hidden by fungi
  • Cracked, red areas of skin at the corners of your mouth

Candidiasis usually clears up in seven to 10 days with consistent treatment. If it extends beyond this time or recurs frequently, however, your doctor may recommend testing for conditions such as diabetes, HIV or cancer.

Physicians commonly prescribe antifungal treatments for candidiasis, either in the form of lozenges or mouthrinses for mild cases or a regimen of tablets for more severe conditions. Over time, patients have been known to develop immunity against these treatments, so doctors are careful about recommending them for every case of the fungus.

Nevertheless, maintain good daily oral hygiene, avoid the use of antibiotics unless absolutely necessary and make sure your mouth remains well hydrated. Many prescription products contain minor doses of sodium fluoride to help reduce your risk of these dry mouth-related conditions.

Injuries to your tongue can also result in sores resembling tongue blisters. For example, eating crunchy foods such as potato chips, sucking hard candies, biting your tongue or sipping an excessively hot beverage can all cause the tongue to develop blisters, cuts and burns. These may result in painful ulcers that take time to go away, but unless infection develops, they usually aren't a cause for concern.

If your tongue is sensitive and prone to injury, avoid foods that generally cause damage. Practice daily oral hygiene and use warm salt water or a mouthrinse to promote healing and protect the natural bacteria balance in your mouth.

Prevention
You can prevent tongue bumps by avoiding the triggers that cause them. Take care when chewing your food and wear a mouth guard while playing sports to avoid accidentally biting your tongue. Avoid eating foods that cause mouth irritation to lower your chances of developing enlarged papillae. Maintain a good oral care routine, including brushing your tongue when you brush your teeth.

Healing Time
Treatment is rarely necessary for most cases of tongue bumps, including canker sores and enlarged papillae due to tongue injury. Drinking plenty of water and rinsing with warm salt water can assist the healing process. Topical over-the-counter treatments like oral numbing gels and canker sore medication may help numb any discomfort. However, if the condition persists for longer than a week or becomes more severe, visit a dental professional for an evaluation. Bumps on the tongue can be annoying and tedious, but most bumps are harmless and disappear without any treatment. See a dentist if you have a bump on your tongue that doesn't go away or that gives you another cause for concern.

An ulcer is any breakdown of the lining of the mouth, which includes the cheeks, tongue, gums, lips and roof of the mouth. The raw area of an ulcer is often very sensitive and painful.

Some ulcers appear as single ulcers; some ulcers arrive in groups. Some heal quickly leaving no mark behind, and some heal leaving a scar that may be noticeable for some time. Some ulcers appear and then disappear never to return, others may keep coming back again and again.

A single ulcer, which is not healing and which has been present for more than 10 days should be looked at by your dentist. If there is no good reason for the ulcer not healing, it should be investigated further to exclude a possible cancer. Most ulcers however are not malignant and can be explained after the dentist has asked about different features of the ulcer.

Single ulcers that heal are often caused by some minor damage to the lining of the mouth, such as a scratch from sharp food such as potato crisps, or damage from a sharp broken tooth or filling. Alternatively, a burn from hot food could cause a blister that breaks down to leave an ulcer. Occasionally, an ulcer may arise from a chemical burn; for example, if an aspirin is left to dissolve on the gum next to a painful tooth (this will not stop the toothache). Also, the frequent and prolonged use of some toothache or teething gels can result in an ulcer in the area to which they are applied.

Other single ulcers may result from a cold sore, or much less often, a recurrence of chicken pox (shingles) affecting the mouth. More rarely, there are some conditions that can affect the mouth and cause ulceration (e.g. lichen planus, gluten sensitivity and other rare conditions).

Recurring ulcers are known by different names: recurrent oral ulceration, recurrent aphthous (pronounced 'af-thus') ulceration and sometimes recurrent aphthous stomatitis. These recurrent ulcers can be divided into three groups depending on their appearance and duration.

The most common type of recurrent ulcers is minor recurrent oral ulceration. The name is given because the ulcers are small, about 3-5mm in diameter. These ulcers often come in groups of half-a-dozen or so. They appear in the mouth over two or three days, last about five to seven days, and then heal over the next couple of days. They most commonly affect areas towards the front of the mouth; the lips, tongue and gums, and when they heal there is no sign of where they have been.

Much less common are major recurrent oral ulcers. These ulcers tend to occur towards the back of the mouth, for example, the back and sides of the tongue, roof of the mouth and in the area of the tonsils. These ulcers are usually single and large (about 1cm in diameter), and may last for many weeks. They slowly heal and leave a scar where the ulcer used to be.

Also, very uncommon are herpetiform ulcers. These ulcers are tiny (1mm in diameter) and may appear in all areas of the mouth. There are often many dozens of tiny ulcers appearing together. These will heal in a few days, do not leave a scar, and recur infrequently. The name, herpetiform, is because of the appearance of the ulcers. They do not have anything to do with the virus of a similar name that can cause cold sores.

No treatments are available which will cure the ulcers. Medications can be bought over the counter in a pharmacy that can help to lessen the discomfort, these include:

  • Chlorhexidine mouthwash (e.g. Corsodyl) – an antiseptic mouthwash that helps to keep the mouth clean
  • Difflam – a mouthwash or spray that can temporarily numb the lining of the mouth and reduce the soreness
  • Adcortyl in Orabase – a paste application of a mild steroid. The paste acts as a protective covering over the ulcer and the steroid part helps to reduce the inflammation and discomfort.

A dentist can look at ulcers about which there are worries. If the dentist feels it is appropriate, they may refer to a hospital specialist, such as a consultant in Oral Medicine, for further investigation and/or treatment.

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