Papillitis means ‘inflammation of a papilla’ or papillary inflammation. Temporary lingual papillitis indicates inflammation of the taste buds on the tongue. Symptoms include red or white bumps on the tongue and pain. Lingual papillitis is a common painful inflammatory condition of one or more fungiform papillae on the tongue. The fungiform papillae are small, mushroom-shaped papillae with a pink to deep red color, what we commonly call the ‘taste buds’. Although the cause of papilitis is not yet known with certainty, it probably occurs as a result of local trauma (rubbing, scraping or biting), but it may also occur in response to certain foods. Inflamed papillae are not contagious and the discomfort is relatively minor. Usually these lesions heal within a few days without treatment.

• What is papillitis?
• What are fungiform papillae?

• Small, mushroom-shaped papillae
• Men and women

• Who suffers from inflamed papillae?

• Classical papillitis
• Fungiform papillary glossitis
• Eruptive lingual papillitis

• Symptoms of inflamed papillae

• Red or white bumps on the tongue
• Eruptive lingual papillitis
• Tip of the tongue

• Ordinary papillitis versus eruptive lingual papillitis
• Causes of papillitis
• When to consult a doctor?
• Examination and diagnosis
• Treatment of papillitis
• Forecast and prospects

What is papillitis?

Papillitis refers to inflamed papillae. Very little has been written about papillitis in scientific articles or textbooks. In 2023, it is not entirely clear what the cause is. Possible causes include: stress, gastrointestinal problems, menstruation, acidic or spicy foods, smoking and local trauma to the tongue. With papillitis, small, white bumps are visible on the base of the tongue. Inflamed papillae is a harmless problem, without further complications.Strawberry tongue in scarlet fever / Source: Afag Azizova, Wikimedia Commons (CC BY-SA-3.0)

What are fungiform papillae?

Small, mushroom-shaped papillae

Fungiform papillae are small, mushroom-shaped papillae on the surface of the tongue. Fungiform papillae contain taste buds, temperature receptors and have a good blood supply. That is why they have a deep red color. They are distributed over the top and sides of the tongue, mainly towards the tip. Usually they cannot be seen clearly because they are flat and pink to deep red.

Men and women

The number and size of fungiform papillae varies. Women have more fungiform papillae than men and they become even more numerous after menopause. Nerve damage can result in a reduced number of fungiform papillae and reduced taste sensation. Fungiform papillae can be clearly seen in a number of conditions, the best known being the ‘strawberry tongue’ in scarlet fever.

Who suffers from inflamed papillae?

Classical papillitis

Classical papillitis affects more than 50% of the population at some point in life. It appears to be most common in young women, but all age groups can develop it. The most likely cause of inflamed papillae is local irritation or trauma to a fungiform papilla. However, many other possible triggers have been suggested including stress, hormone fluctuations, gastrointestinal complaints and specific foods.

Fungiform papillary glossitis

Fungiform papillary glossitis (glossitis means tongue inflammation) occurs in people with a history of eczema, asthma or hay fever. It looks a lot like ‘normal’ papillitis.

Eruptive lingual papillitis

Eruptive lingual papillitis is probably caused by a virus and mainly affects (young) children.

Symptoms of inflamed papillae

Red or white bumps on the tongue

The symptoms of papillitis or inflamed papillae are:

• red or white swollen bumps on the tongue
• these bumps resemble pimples
• the bumps can be painful even if you don’t eat or drink
• sometimes burning sensations
• sometimes itchy sensations
• sometimes tingling in your tongue

You may also not experience any symptoms at all apart from the bumps on the tongue.

Eruptive lingual papillitis

If papillitis is accompanied by other symptoms, you may experience eruptive lingual papillitis. Eruptive lingual papillitis has the same noticeable red or white painful bumps, but may be caused by a virus. This means it is contagious. It is accompanied by swollen glands and fever and is most common in children. This form of papillitis can take up to two weeks to heal, instead of a few days with the classic form.

Tip of the tongue

Acute papillitis generally affects the tip of the tongue, either in an isolated area or on both sides. The bumps may appear in the normal color of the tongue, or they may be red, white, or yellow. The condition comes on suddenly, causing acute pain, burning, tingling or itching. It can also cause dry mouth, eating problems and discomfort while eating hot foods. The inflammation and symptoms can last from a few hours to a few days to several weeks, depending on the case.

Ordinary papillitis versus eruptive lingual papillitis

If you experience additional symptoms, this may indicate eruptive lingual papillitis. The bumps on the tongue in eruptive lingual papillitis may look the same as in ‘normal’ papillitis. Eruptive lingual papillitis differs from classical papillitis in the following ways:

• it can take up to 2 weeks
• it can be caused by a virus
• it is contagious
• it can cause swollen glands
• it may be accompanied by fever
• it is more common in children than in adults

Causes of papillitis

In 2023, it is not known exactly what causes both types of papillitis. However, they are known to occur more often in people who consume a lot of highly acidic foods (including fruits and vegetables) and sugary foods. Other possible causes include:

• excessive stress, which can cause an inflammatory response
• trauma, for example by biting your tongue or burning the tongue
• eating spicy food
• digestive problems, including constipation
• food allergy

Papillitis is considered an inflammatory disease. The underlying causes of the condition remain unclear. Although the pathogenesis of the condition is poorly understood, the condition is benign and does not lead to complications.

When to consult a doctor?

In case of persistent or frequently recurring papillitis, it is wise to make an appointment with your doctor or dentist. Also consult a doctor in the following cases:

• the bumps do not go away on their own within a week
• papillitis recurs frequently
• the affected area is very painful
• the spot bleeds when touched

Examination and diagnosis

Your doctor (or dentist) will examine the bumps on the tongue and will likely diagnose them based on appearance. If the doctor is unsure whether the bump indicates papillitis or another condition, he may take a biopsy to test for a differential diagnosis. This is done under local anesthesia. The doctor then removes a small part of the bump to examine it under a microscope.

Treatment of papillitis

Papillitis usually goes away on its own after 2 or 3 days. Treatment of papillitis consists of the following self-care measures:

• rinse and gargle with salt water (or baking soda)
• Brushing, flossing and flossing your teeth at least twice a day and using mouthwash (baking soda based) to rid the mouth of harmful bacteria
• avoiding acidic or spicy foods

In case of pain, paracetamol can help.

Forecast and prospects

Although papillitis can be painful, the bumps often resolve quite quickly after appearing, without any form of treatment. Self-care measures can help relieve the symptoms.

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