Q. I have a bumpy painful tongue with patches. What could it be?

Answered by
Dr. Nasir
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 18, 2020

Hello doctor,

I am 31 years old. A few months ago, I seemed to catch a virus where I had to force myself to eat for weeks because I had no appetite. After my appetite came back, I had a patchy tongue (geographic tongue). It hurt on the right side randomly and still does to this day, unfortunately. I saw a Naturopath, and I changed my diet to no wheat, milk, sugar, and limited some fruits as he thought that could trigger some allergic reaction. She thought it could be allergies, or I could have candida.

After four months, the patchy redness went away except for the sides of my tongue. They still looked scalloped and bumpy, and the diet made me lose weight where I was already thin, and I still had the pain on the right side of my tongue. I saw a dentist, and he checked everything and could not find any problems, except my teeth showed erosion. He suspected silent reflux was the cause. I always used to eat at night, but since seeing the Naturopath, I stopped.

I also do not have any other symptoms related to reflux/silent reflux. I talked to an online doctor, and he prescribed me Tecta for reflux, but after reading it is only a bandaid solution. I did not take them. Also, I did not feel the silent reflux would cause only the right side of my tongue pain. I feel I still do not have an answer after months of trying so many options. It seems to come and go and sometimes affects my throat on the right side. I talked to another doctor, and he suspected burning mouth syndrome. So I have been taking B complex for almost four weeks now. I have noticed less discomfort, but the pain still comes and goes, and the bumps on the side of my tongue are still there. They do not hurt to touch, and the underneath of my tongue there are three bumps, and my tongue is swollen. I do not have any other symptoms, and I am healthy. I do not trust any food now and cannot say any trigger for me.

I used to smoke weed, and it was my only vice in life, but even when I smoked, it would irritate my mouth, so I had to stop that. I have yet to see an ENT. I will send you the pictures of my tongue if you need them. Please help.



Welcome to

It would be really helpful if you send the picture of your tongue along with picture of the teeth. Kindly send the picture of the tongue (few months back when it started if you have) because you said it has changed a little. I will try my best to help you out.

Thank you doctor,

When it started it looks as patchy red tongue.



Welcome back to

The picture that you have sent looks glossitis to me (attachment removed to protect patient identity).

Basically, geographic tongue is also a kind of glossitis which is benign and migratory, meaning it ships in places/location and is a benign condition.

Geographic tongue is not treated actively, but glossitis is treated. There are various causes for this glossitis. We have to find that cause and treat it.

Any bacterial, viral, and fungal infection can cause glossitis. The most common being fungal infections. Some diseases such as celiac disease, pernicious anemia, and protein malabsorption or deficiency can also cause glossitis. The most common nutritional deficiency to cause glossitis is vitamin B12, which I think you are already being treated for.

Do you have any other symptoms such as abdominal pain, loose stools, vomiting when you eat wheat, barley, and oats? Have you ever had episodes of abdominal pain?

You will have to get tested for celiac disease. Try giving up wheat, barley, and see if it helps.

For immediate relief:

1. Keep the oral cavity clean.

2. Brush twice a day with mild toothpaste.

3. Do not eat spicy food.

4. Continue vitamin B12 supplement.

5. Take multivitamins if possible.

6. Avoid wheat, barley, and oats.

7. Use Zytee gel on the sides where the lesion is for pain relief.

8. Use anesthetic gargles to relieve pain.

Thank you doctor,

I have given up wheat for five months. Now I do not have a lot of abdominal pains. Sometimes when I have a bowel movement, I feel mentally overwhelmed and negative, but normally they are not loose like before when I saw the Naturopath. I have no vomiting. Do you think this has nothing to do with silent reflux? What about my throat irritation? If I am avoiding wheat, why would I need to get tested for celiac disease? I do not have many of the symptoms associated with celiac disease or silent reflux. I do not understand why my tongue hurts on one side for almost the whole year. It is depressing at times. It is good to know it is nothing serious but it feels like I am not improving fast enough for something I took seriously and tried many methods. Is this something common to have marks on the tongue?



Welcome back to

Geographic tongue is very common. What you are getting are kind of ulcers on the tongue which are painful. These are mostly aphthous ulcers which are easily treatable with analgesic and nutritional supplementation.

It may not be silent gastritis as if acid reflux has taken place then you will develop bad odour and bitter taste in mouth. If throat irritation is also severe, then I recommend getting a video laryngoscopy done.

For now try the symptomatic medicines that I told you and improve your diet.

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