If you are living with multiple sclerosis (MS), it can affect your daily life in many ways. MS can also affect your oral health. Tongue sores, also called tongue ulcers, ulcerations, or canker sores, are no exception. “I get sores on my tongue that are pretty painful,” one MyMSTeam member shared. In this article, you will learn about the common symptoms of tongue sores, how they may develop in MS, and how to manage and prevent them.

What Do Tongue Sores in Multiple Sclerosis Feel Like?

Tongue sores with MS are often described as discomfort, burning, or soreness of the tongue: “My tongue hurts as if I burned it,” said one MyMSTeam member. “It is difficult to eat because my tongue is painfully sore. It even hurts to swallow my own saliva.”

You may feel that certain foods make symptoms worse.“Salty, acidic, and crunchy textured foods seem to bother me most,” one MyMSTeam member explained. “My tongue feels as if it has been burned with hot food or a beverage!” Another wrote, “My tongue feels raw sometimes, especially after eating anything with cinnamon in it. Spicy and rough foods tear my mouth up.”

How Common Are Tongue Sores With MS?

Tongue sores aren’t among the most well-known symptoms of MS. Currently, there is no research on how common tongue sores are in people with MS. However, there are numerous studies on oral problems associated with MS that share the symptom of tongue sores (or may increase the risk of tongue sores). About 2 percent to 3 percent of people living with MS experience oral symptoms, such as mouth sores and gum pain. About one-third of people with MS have difficulty swallowing. Some MS medications may cause dry mouth, which may lead to tongue sores.

What Causes Tongue Sores in Multiple Sclerosis?

MS is an autoimmune disease in which the immune system attacks the central nervous system (CNS). MS specifically attacks myelin, which is the protective coating around nerve fibers in the CNS.

Myelin is found throughout the CNS, which includes the brain, spinal cord, and optic nerve. The process of demyelination (destruction of the myelin) results in lesions throughout the CNS. These lesions disrupt messages between the brain and the body, affecting different parts of the body. Symptoms of MS, its common complications, and even medications used to treat MS can all cause or worsen problems in the mouth and negatively affect a person’s quality of life.

Infections, inflammation, and some injuries can all trigger an MS flare-up. In turn, MS symptoms and MS relapses can make it quite difficult to maintain good oral hygiene, leading to tongue sores, inflammation in the mouth, bacterial infections, and other oral problems.

Inflammation secondary to MS can directly affect the nerves in the mouth and face. Inflammation can also affect the inner lining (also called mucous membranes) of the mouth. Such inflammation often results in pain, sensory changes (temperature and taste), and tongue ulcers (oral lesions) to name a few.

MS Symptoms and Oral Health

MS symptoms can limit or prevent proper oral hygiene and contribute to tongue sores. Symptoms of MS such as dizziness, lightheadedness, depression, fatigue, muscle spasms or spasticity, muscle weakness, numbness and tingling, and sensory changes can all cause difficulties with maintaining good oral health.

MS Medications and Oral Side Effects

Disease-modifying drugs (DMDs) are widely used as a treatment option for MS. However, one study found that some DMDs and other medications used to manage MS symptoms have oral side effects that may increase the risk of tongue sores in some people living with MS. Oral side effects include:

• Tongue ulcerations
• Burning tongue
• Tongue discoloration
• Oral herpes (cold sores)
• Dry mouth

Some mouth and tongue problems associated with specific DMDs for MS include:

• Glatiramer acetate (Copaxone) — Dry mouth, tongue discoloration, burning sensation on the tongue, and mouth ulceration
• Alemtuzumab (Lemtrada) — Mouth pain, oral herpes
• Mitoxantrone (formerly sold as Novantrone) — Oral mucositis (inflamed tissue that leads to mouth and tongue sores and pain)
• Methotrexate — Oral mucositis, ulcerations of the oral mucosa

Tongue ulcerations were also found to be caused by other MS treatments such as imipramine (Tofranil), an antidepressant. Corticosteroids like prednisone are often used to treat MS flare-ups. Steroids have been found to also increase the risk of fungal infections, including oral yeast infections (Candida), especially with long-term steroid use. In some cases, an individual can develop oral thrush, which causes creamy white lesions to form on the tongue.

Everyone reacts differently to medications. Some people may experience a negative side effect of a medication, and others may never experience that same reaction. If you are concerned that you may be experiencing a side effect, speak to a health care professional like a pharmacist or your neurologist who can help determine if a side effect is to blame for your symptom.

What Else Could Cause Tongue Sores in MS?

People with MS are more likely to develop other autoimmune disorders. Some autoimmune conditions have been found to also cause tongue lesions and other oral problems, such as:

• Amyloidosis — May cause tongue lesions
• Anemia — May cause burning of the tongue
• Thyroid disease — May cause tongue swelling
• Diabetes — May cause fungal infections and dry mouth
• Sjögren’s syndrome — May cause dry mouth

Managing Tongue Sores in MS

Although tongue sores may not be one of the most common symptoms of MS, it is important to keep your MS well managed and controlled if you want to improve your oral health. Speak with your health care provider to determine the exact cause of your tongue sores. If your oral symptoms are worsening or don’t improve, let your health care provider know. They can work with you to try to pinpoint a cause and develop an effective treatment plan.

Lifestyle Changes

These suggestions may make tongue sores easier to manage:

• Drink plenty of fluids with a straw.
• Avoid spicy or acidic foods.
• Eat foods that are cold or at room temperature.
• Try soft, tender, or pureed (beaten or blended) foods.
• Avoid dry or coarse foods.
• Cut food into small pieces.
• Rinse your mouth with water or a mouthwash recommended by your health care provider several times a day.
• Avoid mouthwash that contains alcohol.

Maintain Good Oral Hygiene

Make sure to prioritize good oral hygiene to prevent tongue sores and other oral health problems. Some ways to maintain good oral health include:

• Have regular dental check-ups and cleanings, and report any oral concerns to your dentist or health care provider.
• Brush teeth twice daily.
• Use a tongue scraper or brush to clean your tongue daily.
• Wear a weighted glove while brushing, if you have tremors.
• Replace toothbrushes every three to four months.

Symptom Management

There are many ways to treat and control tongue sores. Those options include both simple, at-home solutions and medical management.

Here are tips for treating your tongue sores:

• Use topical numbing agents, like Anbesol.
• Avoid any foods — like spicy dishes — and drinks that aggravate your tongue.
• Rinse your mouth regularly with an alcohol-free antiseptic rinse.
• Use a protective paste to minimize irritation.
• Treat oral herpes outbreaks with an antiviral medication.

Try managing dry mouth by:

• Chewing sugar-free gum or sucking on sugar-free candies
• Staying hydrated with lots of water and other clear, sugar-free beverages
• Using mouth moisturizers (offered as gels and mouth rinses)
• Applying lip balm to keep lips moist.
• Sipping on liquids during the day to help keep the mouth moist.

Meet Your Team

MyMSTeam is the social network for people and their loved ones who are living with multiple sclerosis. This platform connects more than 186,000 people who share a diagnosis of MS and understand the unique challenges of living with MS. By signing up for a free account, you’ll have the opportunity to share your thoughts and experiences with people who can truly relate to your experience.

Have you experienced tongue sores with your MS? Share your story in the comments below or by posting on MyMSTeam.