Treatment of Bumps on the Tongue
The treatment of bumps on the tongue depends entirely on the underlying cause, which must be identified through careful history and examination before initiating therapy—most benign tongue conditions require no treatment, while infectious causes respond to targeted antimicrobials and suspicious lesions require biopsy.
Initial Clinical Assessment
The diagnostic approach requires specific attention to:
- Onset and duration of the bumps, including rate of growth 1
- Associated symptoms including pain, burning sensation, taste changes, or paresthesia 1, 2
- Tobacco and alcohol use history, as these are risk factors for premalignant and malignant lesions 3, 1
- Medication review to identify drug-related causes 4
- Systemic disease history including diabetes, immunosuppression, and autoimmune conditions 4
Physical examination must document:
- Location, size, and morphology of the lesions (exophytic, infiltrating, or ulcerative) 3
- Presence of cervical lymphadenopathy with assessment of size, mobility, and number 3
- Tongue mobility and any infiltration of adjacent structures 3
Treatment by Specific Diagnosis
Benign Conditions Requiring No Treatment
Geographic tongue, fissured tongue, and hairy tongue are the most common tongue problems and do not require treatment 1. These conditions are benign and self-limited.
Fungal Infections (Candidiasis)
For oral candidiasis causing bumps or burning:
- First-line topical therapy: Nystatin oral suspension 100,000 units four times daily for 1 week, or miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 5
- For resistant cases: Fluconazole 100 mg/day for 7-14 days 5, 6
- Median rhomboid glossitis (associated with candidal infection) responds to topical antifungals 1
Nutritional Deficiency-Related Lesions
Atrophic glossitis is often linked to nutritional deficiency and resolves with correction of the underlying condition 1:
- Check complete blood count, vitamin B12, iron studies (ferritin, serum iron, TIBC), folate, riboflavin, and niacin levels 4, 1
- Supplement the specific deficiency identified 1
Viral Infections
Oral hairy leukoplakia (caused by Epstein-Barr virus, marker of immunodeficiency):
Inflammatory Conditions
For symptomatic relief of oral inflammation:
- Emollient application: White soft paraffin ointment to affected areas every 2-4 hours 3, 5
- Anti-inflammatory rinse: Benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating 3, 5
- Antiseptic oral rinse: 0.2% chlorhexidine digluconate twice daily to reduce bacterial colonization 3, 5
- Topical corticosteroids may reduce oral inflammation in blistering conditions 3
Suspicious or Persistent Lesions
Any tongue growth, persistent lesion, or lesion with concerning features requires biopsy to differentiate benign lesions (granular cell tumors, fibromas, schwannomas, lymphoepithelial cysts) from premalignant leukoplakia or squamous cell carcinoma 3, 1, 2.
Indications for biopsy include:
- Lesions persisting beyond 2-3 weeks 1
- Rapid growth 2
- Ulceration or induration 3
- Fixed cervical lymphadenopathy 3
- History of heavy tobacco/alcohol use 3
Common Pitfalls to Avoid
- Do not assume all bumps are benign: Squamous cell carcinoma can present as exophytic masses and requires early biopsy for diagnosis 3, 7
- Do not delay biopsy of persistent or suspicious lesions—early detection significantly impacts prognosis for malignant lesions 3
- Do not overlook systemic causes: Many tongue conditions reflect underlying nutritional deficiencies or systemic disease 4, 1
- Avoid chronic use of petroleum-based products on the tongue, as they promote mucosal dehydration and increase secondary infection risk 5
When to Refer
Refer to oral and maxillofacial surgery, head and neck surgery, or dentist experienced in oral pathology for: