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Transient Lingual Papillitis

What Is It, Causes, Symptoms, and More

Author: Lily Guo

Editors: Alyssa Haag, Józia McGowan, DO, Kelsey LaFayette, DNP, RN

Illustrator: Jessica Reynolds, MS

Copyeditor: David G. Walker

What is transient lingual papillitis?

Transient lingual papillitis (TLP), also known as lie bumps, refers to a common condition where small, red-white, painful bumps appear on the tongue. It commonly occurs due to inflammation of the fungiform papillae, which are the structures that protrude on the top and sides of the tongue . Fungiform papillae contain taste buds and are able to sense temperature. Transient lingual papillitis can oftentimes lead to pain and discomfort with eating and drinking; however, it typically resolves after two to three days without treatment. 

There are several forms of transient lingual papillitis. The classic form is the most common, with 50% of the population in the United States experiencing it at some point in their lifetime. It is characterized by a single, painful red or white bump, usually on the tip of the tongue. Other types include a papulokeratotic form (i.e., multiple white bumps) and an eruptive form (i.e., multiple bumps accompanied with an enlarged and inflamed tongue). 

What causes transient lingual papillitis?

Transient lingual papillitis is an inflammatory disease; however, specific underlying causes remain unclear. It is thought that foods with high acidity or high sugar content may cause inflammation of the fungiform papillae, leading to the raised bumps on the tongue. Spicy foods and food allergies are also thought to play a role. Trauma to the tongue, including biting the tongue accidentally or burning the tongue on hot food, can also incite an inflammatory response and lead to lingual papillitis. Dental professionals believe chronic irritation from the teeth due to plaque build-up, fillings, or dental appliances can be additional initiating factors. Underlying bacterial infection, high levels of stress, sleep deprivation, and poor nutrition can all contribute to an inflammatory response, increasing the chances of transient lingual papillitis. Lastly, a viral cause has been suggested since children in contact with other children at daycare or school appear to be more likely to develop this condition. It is possible that the virus causing TLP can be contracted in childhood and cause recurrent episodes throughout life. 

What are the signs and symptoms of transient lingual papillitis?

Individuals may describe transient lingual papillitis as pimples on the tongue that can feel swollen, uncomfortable, painful, and itchy. They may experience sensitivity to hot foods, distorted taste, and an associated dry mouth. It can affect all genders and can be seen in children as young as three years old. There are typically no other accompanying symptoms for those with the common type of transient lingual papillitis. In contrast, the papulokertatotic variant of transient lingual papillitis presents as multiple white or yellow bumps appearing over the entire tongue and is typically non-painful. Lastly, eruptive lingual papillitis can cause systemic symptoms, such as fever and lymph node enlargement accompanied by painful bumps on the tongue. 

How is transient lingual papillitis diagnosed?

A clinician can diagnose transient lingual papillitis by inspecting the lesions, evaluating the tongue thoroughly, and taking a thorough health history. They may ask about diet, dental hygiene habits, and levels of stress.  In order to rule out other conditions, the clinician may perform diagnostic tests, including swabbing and staining cultures from the inner cheek, to detect viral, fungal, or bacterial infections. While it is generally diagnosed clinically, based on presentation, the clinician may also take a biopsy of the mucosa, which would reveal inflammation of the fungiform papillae to confirm transient lingual papillitis. 

How is transient lingual papillitis treated?

Treatment is typically not necessary since transient lingual papillitis usually resolves on its own. However, it may help to rinse the mouth with warm salt water or use mouthwash to reduce bacteria in the mouth. One should also avoid spicy or acidic foods, and brush the teeth in between meals if they frequently experience lingual papillitis. Additionally, over-the-counter topical mucosal treatments, such as anesthetics and corticosteroids, can help reduce pain and swelling. Acetaminophen and ibuprofen can also be taken to relieve symptoms.

How long does transient lingual papillitis last?

Transient lingual papillitis typically lasts hours or days. At the maximum, they should only last around two to three days. An individual should avoid popping a lie bump since it may be painful and generally unnecessary. If the condition persists for several weeks, the bumps frequently return or bleed when touched, or the individual develops a fever or swollen lymph nodes, they should seek guidance from a healthcare provider. 

What are the most important facts to know about transient lingual papillitis?

Transient lingual papillitis refers to an inflammatory condition of the tongue that presents as painful, small bumps that are red-white in appearance. It is not well known why individuals get these bumps on the tongue; however, it is thought to be associated with hot and spicy foods, stress, and any source of trauma to the tongue (e.g., biting or burning it). When an individual gets transient lingual papillitis, they may feel pain when trying to eat or drink, and they may have sensitivity to hot foods. Diagnosis is typically made by physical exam; however, a mucosal biopsy can be done to confirm the diagnosis. The condition resolves on its own after two to three days, but clinicians can suggest over-the-counter topical mucosal anesthetics and corticosteroids to relieve discomfort. 

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