What causes sores on the tip of the tongue and how are they treated?

Sores on the Tip of the Tongue: Causes and Treatment

For sores on the tip of the tongue, start with protective barrier ointment (white soft paraffin or petroleum jelly) applied every 2 hours, combined with warm saline rinses and benzydamine hydrochloride spray every 3 hours before eating. 1, 2, 3

Most Common Causes

The tip of the tongue is particularly vulnerable to several types of sores:

• Traumatic ulceration from accidental biting, sharp tooth edges, dental work, or thermal burns (hot food/drinks) is the most common cause and can be diagnosed by matching the ulcer location to the trauma source 4, 5
• Recurrent aphthous ulcers (canker sores) present as well-demarcated, oval or round ulcers with white/yellow pseudomembrane and surrounding red halo, often triggered by stress, nutrient deficiency, or minor trauma 4, 6
• Viral infections including herpes simplex can cause painful ulcerations on the tongue tip 6, 7
• Nutritional deficiencies (iron, B12, folate) can lead to atrophic glossitis with painful ulceration 5

First-Line Treatment Protocol

Immediate Protective Measures

• Apply white soft paraffin ointment or petroleum jelly to affected areas every 2 hours to create a protective barrier and promote healing 1, 2, 3
• Rinse mouth with warm saline solution daily to reduce bacterial load and debris 1, 2

Pain Management

• Use benzydamine hydrochloride oral rinse or spray every 3 hours, especially before meals for anti-inflammatory pain relief 1, 2, 3
• Apply Gelclair mucoprotectant gel three times daily to coat ulcerated surfaces and reduce pain 1, 2
• For severe pain, use viscous lidocaine 2% (15 mL per application) up to 3-4 times daily as a topical anesthetic 1, 2, 8

Anti-inflammatory Treatment

• For persistent or severe ulcers, use betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a 3-minute rinse-and-spit preparation four times daily 4, 1, 2
• For localized lesions, apply clobetasol propionate 0.05% mixed with equal amounts Orabase directly to dried ulcer once or twice daily 4, 2

When to Escalate Treatment

Indications for Further Evaluation

• Any ulcer persisting beyond 2 weeks requires biopsy to rule out malignancy or systemic disease 4
• Ulcers not responding to 1-2 weeks of appropriate treatment warrant histopathological examination 4
• Before biopsy, obtain blood tests including complete blood count, coagulation studies, fasting glucose, and consider HIV/syphilis serology if risk factors present 4

Secondary Infection Treatment

• If white coating suggests candidal superinfection, treat with nystatin oral suspension 100,000 units four times daily for 1 week 1, 2
• Alternative antifungal: miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 1, 2
• Use antiseptic rinses (0.2% chlorhexidine digluconate or 1.5% hydrogen peroxide) 10 mL twice daily to prevent bacterial colonization 1, 2, 3

Critical Pitfalls to Avoid

• Never use alcohol-containing mouthwashes as they cause additional pain and tissue irritation 1, 3
• Do not dismiss persistent ulcers as "just canker sores" without proper evaluation—squamous cell carcinoma can mimic benign ulcers 7
• Avoid inadequate pain management which can impair nutrition and hydration, particularly in elderly patients 1
• Do not overlook nutritional deficiencies in recurrent cases—check iron, B12, and folate levels 5

Expected Timeline and Follow-up

• Traumatic ulcers should show improvement within 7-10 days of removing the causative factor 4
• Aphthous ulcers typically heal within 10-14 days with supportive treatment 6
• If no improvement after 7 days of treatment, stop and reassess diagnosis 8
• Reevaluate within 2 weeks if symptoms persist or worsen to consider alternative diagnoses or escalate therapy 1, 3