Diagnosis
The doctor first asks the patient about the exact symptoms, the quality and localization of the pain and any accompanying symptoms. He then takes a look at the oral cavity. He palpates the 3 large salivary glands and tests their functionality by stroking them.
He also palpates the lymph nodes in the neck and lower jaw. If an infection is suspected, a smear is taken and the signs of inflammation in the blood are checked. If an allergic reaction is suspected, an allergy test is performed.
In order to differentiate between possible salivary stones, abscesses and tumors, an ultrasound examination can be useful in the case of a suspected diagnosis. In rare cases, a tissue sample must be taken or x-rays of the salivary glands must be taken using a contrast medium (sialography). In exceptional cases, other imaging procedures such as computed tomography and magnetic resonance imaging are used for pain under the tongue.
Associated symptoms
Depending on the cause, different symptoms can occur in addition to the pain under the tongue. Infections can cause swelling of the lymph nodes, fever, difficulty swallowing, skin rash, sore throat, pain radiating to the ear and fatigue. If a herpes simplex virus causes the pain under the tongue, characteristic blisters usually appear in addition (see: blisters in the mouth).
If the cause is bacterial, purulent secretion can escape. In both cases, very unpleasant bad breath can develop. If the pain is caused by a so-called angioedema, the entire throat may swell.
This can lead to life-threatening shortness of breath and is an absolute emergency! The pain under the tongue can significantly impede the intake of food. If there is also swelling, swallowing difficulties add up.
The pain when chewing and swallowing can increase due to increased salivation, if salivation has caused the symptoms. Liquid and soft foods such as yoghurts and soups are often preferred. Despite the difficulty in swallowing, sufficient fluid intake should always be ensured.
A mouth rot in the context of a herpes infection is usually indicated by 1-4 mm large blisters under the tongue. Children and adolescents are often affected. The blisters usually burst shortly after they have formed and lead to painful, spot-like mucous membrane injuries at the base of the mouth and possibly in the entire mouth area.
If the pain under the tongue is caused by an inflammation, the lymph nodes may swell. They may remain swollen for a while after the inflammation has subsided. A medical examination is recommended if the size of the lymph nodes exceeds two centimeters, and if they have been swollen or feel hard for more than 3-4 weeks.
If, in addition to the pain under the tongue, other symptoms such as visible skin changes in the area of the swollen lymph nodes, fever, night sweats, sudden unclear weight loss and breathing difficulties occur, a doctor should also be consulted. If the pain under the tongue is caused by an inflammation, this can also lead to sore throat. On the one hand, the accompanying sore throat can be caused by the protective and defensive reactions of the palatal tonsils, and on the other hand, by a general spread of infection. If the pain under the tongue is caused by a tongue piercing, sore throat can develop in the form of a kind of “sore muscle”. As the tongue is pulled far out of the oral cavity during the procedure, the throat area may be painful afterwards.