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Lie Bumps - Transient Lingual Papillitis: Guide

Do you frequently get those painful and annoying white or red bumps on your tongue? Perhaps its your first time getting them. What is it? How did it get there? Is it harmful and do you need to do anything about it? This is a guide for everything that you need to know about transient lingual papillitis.



Table of Contents:



What are lie bumps?

Lie bumps is a common but often painful inflammatory condition that affects the fungiform papillae on the tongue. The scientific name for it is transient lingual papillitis but it is commonly referred to as lie bumps by the general population. Sometimes it can also go by other names as well.

  • Lingual funfigorm papillae hypertrophy

  • Fungiform papillary glossitis

  • Liar's bumps

  • Photocopier's papillitis

  • Eruptive lingual papillitis

  • Eruptive familial lingual papillitis

  • Eruptive lingual papillitis with household transmission

Lie bumps (transient lingual papillitis) happens when one or more of the fungiform papillae become inflamed. The condition typically has an acute onset and is very painful but fortunately it is transient in nature. This means that it only lasts for a short duration of time before it goes away, hence the transient in its name.



What are fungiform papillae?

Fungiform papillae are small club shaped bumps on the surface of the tongue. They can be found on the tip and sides of the tongue. Appearance wise, they typically look red in color.


Lingual Papillae

They are one of four lingual papillae that exist on the tongue to give it texture.

  • Filiform papillae

  • Fungiform paillae

  • Foliate papillae

  • Curcumvallate papillae


Out of the four lingual papillae, fungiform papillae are one of the three papillae that contain taste buds. The exception is the filiform papillae, which do not contain any taste buds. The taste buds within allow us to distinguish the five tastes.

  • Sweet

  • Sour

  • Bitter

  • Salty

  • Umami

An interesting fact about them is that females have more than males do. They also become more numerous once women experience menopause. On the other hand, any injury to your taste buds may reduce the number of them.



Is it contagious?

The only two forms of this condition, which are contagious are eruptive familial lingual papillitis and eruptive lingual papillitis with household transmission.


One study found that the mean age of diagnosis was with 3.5 years old children. The average time that the condition lasted was about 7.3 days and about 53% of the cases were transmitted to family members.


A second study found that the condition affected infants just barely over a year old and it lasted approximately 6-7 days. A few days after it resolved, researchers noted that one or several relatives also became affected by the condition.


Therefore yes, transient lingual papillitis can be contagious and affect nearby family members.




Signs and symptoms of lie bumps

The most noticeable symptom are large inflamed bumps on the surface of the tongue that feel painful to the touch. In addition to that, here are some other signs.

  • Pain

  • Tingling sensation

  • Itching

  • Difficulty in feeding

  • Dry mouth - Xerostomia

  • Burning mouth

  • Altered taste - Dysgeusia

  • Redness of the bumps - Erythema

  • Sometimes they could be white or yellow in color

In some cases, there could be no symptoms at all and the bumps on the tongue don't even feel painful.



Clinical variations of transient lingual papillitis

There are multiple clinical presentations for this condition and they all look different but they are all variations of inflamed fungiform papillae. Lie bumps can only be found on the tip, sides, back and top of the tongue because that is where the fungiform are. They don't exist underneath the tongue so you can't get lie bumps under the tongue. Basically you can find them anywhere on the tongue with the exception of underneath of it.



Classic form

The classic form of transient lingual papillitis usually appears as a single inflamed red or white bump on the tongue. It is often found near the tip and is very painful. Fortunately, it only lasts for a few days and then goes away on its own. There have even been reports where they disappeared after a few hours on the same day.


Here are some pictures of the classic form of lie bumps:



Papulokeratotic variant

The papulokeratotic variant is very similar to the classic form with the exception that it affects multiple fungiform. What it looks like is an array of white or red bumps all over the tongue. It could be on the tip and also all over the sides of the tongue. Here are two photos of of this variant with one of them showing side tongue transient lingual papillitis.

The lie bumps in the pictures above were caused by the patient eating an Atomic Fireball candy. These are hard candies that are highly acidic and burn upon contact.



Eruptive lingual papillitis

This variant typically involves children and is relatively rare since there aren't very many case studies on it. It is usually associated with a fever, burning sensation, difficulty eating, and excessive salivation. What it looks like is multiple papules of red to yellow bumps all over the tongue.

The picture above shows what it looks like on the day of clinical presentation and also how it looks 7 days later. The cause and etiology isn't really known.



Transient U-shaped lingual papillitis

This is often associated with swelling of the tongue and happens to be the most reported oral condition in COVID-19 patients. The theory is that it may be due to the SARS-COV-2 infection. This is basically transient lingual papillitis COVID.

COVID-19 oral manifestations

In fact Covid-19 has many oral symptoms:

  • Transient anterior u-shaped lingual papillitis 11.5%

  • Apthous stomatitis 6.9%

  • Burning mouth 5.3%

  • Mucositis 3.9%

  • Glossitis with patchy depapillation 3.9%

  • White tongue 1.6%

  • Enanthema 0.5%

  • Most of the patients all reported a change in taste (dysguesia)




Diagnosis

Transient lingual papillitis is usually diagnosed based on clinical presentation. Your dentist or doctor can tell based on purely what it looks like and what symptoms you are feeling.


It is typically not necessary to biopsy the lesions since they do resolve on their own when given enough time. Although if a biopsy is performed, it would show chronic inflammation of the fungiform papilla as well as severe hyperparakeratosis. Staining techniques will also fail to detect any viral, fungal, or bacterial infections. It mostly just shows up as inflammation.



What causes transient lingual papillitis?

It is not completely clear as to what causes lie bumps on the tongue. There are many theories about what the causes could be.

  • Local irritation. You could've ate something or drank something that irritated the taste buds.

  • Trauma. If you were eating and happened to injury the taste buds. Alternatively you could have fractured teeth or damaged dental restorations that can cut the tongue.

  • Stress. Sometimes lie bumps will randomly occur and it was theorized it could be due to stress. The classic form of transient lingual papillitis affects over 50% of the population.

  • Hormone fluctuations

  • Gastrointestinal upset

  • Acidic and spicy foods. Certain foods may trigger their reoccurence such as very spicy or acidic foods. There have been reports of sour candies that can trigger it.

  • Viral. The eruptive familial lingual papillitis seems to affect young children of school age. They tend to develop it and then a week later, family members will contract it as well. The theory is that it may spread similar to herpes simplex virus or cold sores.

  • COVID-19. Transient U-shaped lingual papillitis has been reported as one of the oral manifestations of COVID-19 patients.

  • Other related medical conditions. This condition is often associated with patients who concurrently have a history of eczema, asthma, or hayfever.

These are all of the proposed causes of lie bumps. No one is certain what the exact cause is but these are all probable. What we do know is that there are certain foods that can trigger it such as sour candies. These patients seem to have recurring episodes of transient lingual papillitis returning periodically.


Of course that doesn't mean if you eat sour candies you will get lie bumps because not everyone gets it, only some people get it.




How long does transient lingual papillitis last?

Lie bumps can last anywhere from a few hours to around 7 days on average. This condition is painful but it tends to go away on its own without any intervention. Due to the fact that it is self-resolving, the condition has the word "transient" in it.



Lie bumps treatment

There is no transient lingual papillitis treatment that will permanently cure the condition since we don't even know what causes it. In fact, a lot of people report it to be periodically recurring and will come back once in awhile.


Even though there is no cure, most of the treatments that are available are centered around alleviating the pain associated with it.

  • Salt water rinse. Salt is a natural antiseptic and will also help reduce inflammation. Since the taste buds are inflamed, rinsing frequently with salt water will help reduce it and keep the lesions clear of food debris.

  • Cold fluids or drinks. The bumps are very painful even without touching them and only get worse if you do. Drinking cold liquids can help numb the bumps so that you don't feel it as much.

  • Easy to eat foods. Most of the patients with the condition report having difficulty eating since the bumps are painful to touch. This means you should eat soothing foods like yogurt or mashed potatoes that are more gentle.

  • Antiseptic mouthwashes. A prescription mouthwash like chlorhexidine may help.

  • Avoiding trigger foods. Acidic and spicy foods can trigger the appearance of transient lingual papillitis. What you should do is avoid these trigger foods so you don't get them as frequently. If you already have them, it is still wise to avoid these foods so that it doesn't irritate it.

  • Topical steroids. Getting a prescription steroid will alleviate the pain and may also lessen the duration of the lesions. Some common topical steroids used to treat this condition are Flucinonide, Clobetasol, and Triamcinolone.

The above methods are the recommended treatments for the condition and they're all focused around decreasing the pain. Since it goes away on its own, you just need to make it comfortable enough that you can survive through however long it lasts.



How to get rid of lie bumps fast

Alternatively if you did NOT want to wait for it to heal because it is so painful, you can have the transient lingual papillitis removed. Your dentist can get rid of the lie bumps by cutting them off but many clinicians avoid doing that since it goes away by itself.


We've also heard first hand accounts about how some patients try to pop the lie bumps with either tweezers or nail clippers. They literally cannot handle the pain and try to remove it by clipping them off. That sounds incredibly painful and grotesque... we would advise against that. It is usually sufficient if you see your doctor and get prescribed a topical steroid to apply on it. It'll relieve the pain enough that you can wait for the self healing to finish.


So yes, you can remove them but we typically do not do it.




Takeaway

Transient lingual papillitis is a painful oral condition that affects the taste buds on your tongue but fortunately it is self resolving. The causes for it are still unknown but for some people, there are triggers which makes them reappear. If that is the case for you, you should do your best to avoid whatever these triggers are for you since it isn't the most pleasant condition to have.


Last but not least, don't forget to go in for your 6 month dental check up and cleaning! If you have any further questions, don't hesitate to contact us.


Author: Written by Dr David Chen, a dentist in long island city.













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