Knots in Mouth Under Tongue: Causes, Symptoms and Treatment Options

Knots or bumps can appear on the floor of the mouth or underneath the tongue and occur as a result of different factors. They can be completely harmless or indicative of an underlying complication, so it is important to be aware of what is normal inside your mouth and when something feels different.

Finding a knot or bump under your tongue can be distressing and uncomfortable, and if you feel concerned you should consult your dentist as soon as possible.But while it’s easy to worry that a lump or a bump inside your mouth or underneath the tongue may be a sign of mouth cancer or other complex oral health concern, the good news is that most knots in the mouth occur as a result of benign and manageable conditions, such as mucoceles, ranulas or transient lingual papillitis.

Common Causes

Bumps or knots in the mouth under the tongue can be the result of many different factors. They are commonly caused by transient lingual papillitis, also known as “lie bumps.” This is when the papillae, or the surface of the tongue, becomes irritated, resulting in small, painful red or white bumps. This may be caused by spicy or hot food, or stress or hormonal changes in the body.

Knots or bumps can also be caused by an injury such as biting your tongue, or burns from hot liquids or foods. This usually causes swelling or bumps which are likely to disappear in two or three days. Knots in the mouth are also caused by mucous cysts, for example mucoceles and ranulas, where blocked or damaged salivary glands cause saliva to accumulate under the tongue. Mucous cysts should be painless and mostly disappear spontaneously without treatment. 

Infections and allergies can also cause bumps or knots in your mouth under the tongue. Oral herpes, for example, is characterised by painful blisters, and allergic reactions to certain foods or substances can result in swelling and irritation in the mouth.In rare cases, bumps or knots under the tongue may be cancerous. Oral cancer, including squamous cell carcinoma, manifests itself as a persistent lump in the mouth which may be sore or bleed when touched, or even asymptomatic to begin with. It is important to seek medical attention if you develop a knot or bump that is persistent or causes discomfort.

Symptoms to Watch For

If you find a bump or knot in your mouth, including under your tongue, there are several symptoms that you should look out for. If your knot or bump is painful or you develop a fever or swollen lymph nodes, this could indicate that you have transient lingual papillitis (lie bumps) or another type of infection. If these bumps do not go away in a few days or seem to change in colour or size then it is important to visit your dentist for diagnosis. Early detection is optimal for more serious conditions and will promote a quicker and more successful recovery. If bumps make it difficult for you to eat or drink, or are affecting your speech, you should visit your dentist as soon as possible. Itching, extreme sensitivity, or a burning sensation in the mouth – which can be associated with transient lingual papillitis or allergic reactions – should not be ignored. If the bumps are filled with fluid and appear bluish or pink, they might be mucous cysts such as ranulas. In rare instances a gray, pink, or red lump could be a sign of oral cancer. Although it is most likely these lumps or bumps will go away by themselves, it is always advisable to have them checked and rule out a more serious diagnosis.

Diagnosis and Tests

Initial Examination

Each time you visit the dentist, even for a routine appointment, they carry out a thorough examination of the inside of your mouth. You can make your dentist aware of any lumps or bumps which may be of concern to you. They will then look for visible abnormalities and examine the size, colour and texture of the bumps.

Further Testing

If your dentist is unable to diagnose the cause of the bump or knot in your mouth or they suspect a more serious condition, further testing may be necessary. This could include a biopsy, which involves removing a small tissue sample for examination. X-rays and CT scans can also help examine a knot or lump further. If your dentist suspects that you may have an allergic reaction or infection they can refer you back to your GP or healthcare provider. Blood tests can help identify infections such as syphilis or tuberculosis, which can also cause bumps on the tongue.

Management and Treatment

Non-surgical Treatments

The good news is that in many cases, bumps or knots under the tongue are harmless and asymptomatic. 

Here are some preventative measures you can take to maintain good dental hygiene:

• Brush your teeth at least twice a day, floss after meals, visit the dentist on a regular basis and maintain a healthy lifestyle. 
• Eat a nourishing diet to support healthy teeth and gums, including fresh fruits and vegetables and reducing the intake of sugar, sticky treats, spicy foods and junk food. 
• Avoid smoking and reduce any alcohol consumption. 
• Keep hydrated and gargle with warm salt water or baking soda to sanitise the mouth and help prevent infections. 

Over-the-counter (OTC) topical treatments like canker sore medications or oral numbing gels can offer relief from any pain or soreness caused as a result of lumps or bumps in the mouth, as can medicated mouthwashes.

For transient lingual papillitis and similar issues, cold foods such as ice lollies can help alleviate pain and inflammation.

If you have a viral infection, such as oral herpes, your doctor will prescribe antiviral medication to help control the symptoms.

Surgical and Other Procedures

In some instances, bumps and knots in the mouth and under the tongue may require medical treatment or surgery, as is the case with ranulas and mucoceles.

Cancerous tumours within the mouth need to be surgically removed, along with some of the surrounding tissue as a precaution. In these instances, you may also require radiotherapy or chemotherapy.

Bumps and knots in the mouth and under the tongue are very often harmless. But if you detect any abnormalities in the mouth, the next best step is to schedule an appointment with your dentist.