Why Do I Have Red Spots on My Tongue


Why do I have red dots or spots on my tongue or what causes them? Get insight on possible causes for both the small or big, painful or painless that can appear on any part of your tongue. 

Anyone can have red spots on tongue i.e. the problem can affect children (babies, infants, newborns or toddlers) as well as adults. However, some causes such as Kawasaki disease or hand foot and mouth is known to affect children, especially those below 5 years.

The appearance might vary in size, shape, and color (e.g. light or bright red or dark red spot ). Most people have reported small red spots on their tongue while a few report big ones.

Furthermore, the dots or spots may be many (clustered or evenly distributed), a few or even just one small or two dots.

Finally, they may be bumpy (raised above) or flat and they can be located on a part of on the entire tongue surface. In some instances, they can also be on the roof of the mouth, on gums, inner cheeks, inner lips, or even on your lips.


The obvious symptom or sign is the appearance of the red spots or dots. They could be painful or painless or have a burning sensation (feeling like you got burnt).

Other symptoms will depend on what is behind the appearance of the spots. We will give you specific symptoms while looking at each of the possible causes. This will make diagnosis much easier.


A red-spotted tongue is nothing anyone wants to have especially due to the many rumors associating such spots with STDs like HIV or cancer. Before you worry yourself to death for no reason, here are some of the common causes: 

1. Inflamed papillae

A more common cause of red dots on the tongue that hurt (painful) is inflamed papillae. This can be due to “burns, traumatic injury, eating spicy/hot food or beverages, or accidentally bitings. Smokers commonly get these dots that usually resolve themselves” [healthtap.com].

2. Strawberry tongue

Another common cause is a condition known as strawberry tongue.  It is characterized by a change from normal pink color to reddish or has the strawberry color “with enlarged, red taste buds dotting the surface” [webmd.com] i.e. your taste buds enlarge making them appear as red dots.

Possible causes of-of this condition include lack of vitamin B-12 and folic acid, benign migratory glossitis, or scarlet fever.

3. Scarlet fever

One of the possible cause could be scarlet fever. Scarlet fever is a bacterial throat infection caused by the various strains of Streptococcus. When you have scarlet fever, your “tongue may become pale but coated with red spots” [patient.co.uk].

The small red rash will normally begin showing on your upper chest and neck before spreading to other body parts including your tongue, lips, nose, etc. and they feel like sandpaper.

Other symptoms of scarlet fever include a sore throatfeverheadache, feeling unwell, nausea, among others.  Treatment is by a 10-day phenoxymethylpenicillin course or other antibiotics.

4. Kawasaki Disease

This is a viral disease that affects mainly children who are below the age of 5 years that affects their lymph nodes, skin and mouth. It causes fever, swollen feet soles and palms that turn purple, swollen lymph nodes, “swollen tongue with a white coating and big red bumps” [kidshealth.org], red, dry cracked lips, rash on the chest, genital, and stomach, severely red eyes, etc.

If untreated, it could cause complications including blood vessels inflammation or arrhythmias where heartbeat pattern is interfered with. Treatment is by “intravenous (IV) doses of gamma globulin (purified antibodies)” [kidshealth.org]

6. Oral cancer

Oral cancer tends to affect various parts of your mouth, lips,  under or on the two-thirds of your front tongue. The one of on the back or base is considered part of neck and throat cancer.

In early stages, mouth cancer does not cause any pain and it can start as a small spot or sore on any part of your mouth including your tongue i.e. “flat, painless, white or red spot or a small sore" [bangordailnews.com]. It is easy to confuse cancer with a cold sore mouth that won’t go away.

To be certain it is cancer, the symptoms you should look for include:

  • Sores in your mouth including sores on the tongue that won’t go away easily and tend to bleed quickly.
  • Tenderness, pain, and numbness in any part of your mouth or lips
  • Eating, chewing, speaking and jaw and tongue movement problems and pain
  • “A sore throat or feeling that something is caught in the throat that does not go away”
  • Squamous cells (flat cells on mouth surface).

Most people often confuse canker sores to be cancerous since they are painful but that is not the case. Canker sores should heal after two weeks. If they do not go away after that period, you need to see a dentist for extermination. Oral cancer treatment is by chemotherapy, radiation therapy, surgery and targeted drug therapy.

Other conditions to watch for include:

  • Erythroleukoplakia - These are red and white patches that tend to be cancerous. In case you have them and they last for more than two weeks, get checked.
  • Erythroplakia – These are velvety bright red patches on the mouth and tongue that are precancerous i.e. “75 to 90 percent of cases, erythroplakia are cancerous, so don’t ignore any vividly colored spots in your mouth” [healthline.com]

7. Digestive disorders such as acid reflux

Having acid reflux is known to result in red dots or bumps when the acid regurgitated from the stomach reaches your tongue surface. Common symptoms of acid reflux include a heartburn, regurgitation, bloating, bloody stool, hiccups, dysphagia, etc.

8. Allergic reactions

Allergic reaction to various allergens such as pet dander, food, medication, etc. can cause swelling as well as red dots.

Allergic reactions will have other symptoms such as itching mouth, swollen lip, face or throat, wheezing, trouble in breathing, nasal congestion, dizziness, hives, etc.

9. Vitamin deficiency and pernicious anemia

Lack of vitamins, especially vitamin B-12 is known to cause this problem. Ensure you have foods rich in vitamin B-12 that include shellfish, liver, mackerel fish, crustaceans, fortified soy products, fortified cereals, red meat, skimmed milk, cheese, and eggs.

There is an association between these dots or spots and anemia, especially pernicious anemia. The most common symptom of pernicious anemia is a smooth red beefy tongue, heartburn, nausea, depression, confusion, weight loss etc. It is caused by a deficiency in vitamin B12 and iron deficiency.

10. Canker sores

Your painful blister-like red spots could be due to canker sores especially if they have a yellow or white center and a red ring surrounding it. Canker sores will have other symptoms such as malaise, fever, swollen lymph nodes.

11. Strep throat

If you notice you have prickly tiny red dots (petechiae) on your tongue, especially at the back of your part, you could be having strep throat (a bacterial throat infection).

These small dots will be either dark red or bright red i.e. “you will commonly see a swollen uvula, tiny red dots along the back of the tongue and throat” [fastmed.com]

Common symptoms of strep throat include throat pain, headache, and rash, tiny red spots on the hard and soft palate, swollen tonsils with white patches, swallowing difficulties, among others.

12. Lie bumps or transient lingual papillitis

Another possible cause of little white or red spots or bumps lie bumps i.e. “little white or red bumps form when papillae become irritated and slightly swollen” [healthline.com]. They are commonly caused by stress, local trauma, splitting taste buds, acidic or sour foods, smoking, menstruation, etc.

13. Is it STD? 

Sometimes, the problem could be caused by STDs. For instance, during initial stages, one is likely to have small (little or tiny) painless sore on the tongue, vulva, vagina, lips, cervix, or the point where the bacteria causing the disease enters the body. The “rash can look like rough, red, or reddish brown spots” [cdc.gov]. At the secondary stage, lesions and sores in the mouth are also common.

However, they are are not a sign of HIV but a weakened or compromised immunity could allow other infections to cause the spots.

14. Hand-Foot and Mouth Disease

This is a disease that affects children who are under the age of 5 years. Hand foot and mouth disease causes “red spots on the tongue, gums or inside of the cheeks” [livestrong.com].  

These spots will ten to form ulcers or blisters that are very painful and it has other symptoms that include reddish rashes on feet sole, buttock, palm, sore throat and fever.

15.  Other causes

  • Eczema - Excessive irritation due to eczema can make bacteria in your mouth to attach your taste buds
  • Geographic tongue -  Its characterized by a map like an appearance and when small, you will have reddish spots on the tongue with white ring bordering it. This problem is painless. In case of pain, see a doctor.
  • Prolonged alcohol consumption or excessive smoking
  • Eating hurt and spicy foods
  • Physical injury or trauma including piercing
  • Asthma
  • Excessive body heat
  • Oral thrush
  • Cold sores
  • Ulcers

These are not the only causes. It is advisable to see a dentist for diagnosis and treatment in case your red spots do not disappear quickly.

Where they appear 

We have seen the possible causes. It is time to consider where you expect to have these dots or bumps: 

1. Under the tongue? 

Some of the common probable cause include general irritation, canker sores, allergic reaction, trauma or injuries, salivary duct stones and oral cancer. Any of the other causes discussed above could also be behind the problem.

Effective treatment requires a correct diagnosis of the underlying cause. Once you are certain what causes it, you need to ensure it is treated. Furthermore, proper oral hygiene is paramount.

2. On the tip 

If you have dots on the tip which could be small (tiny or little) or big, they can be due to a number of causes. Some of the likely causes of such spots include inflamed taste buds, trauma or injuries,  cold sores, scarlet fever, geographic tongue, oral herpes, earlier stages of syphilis (uncommon), allergic reactions, cancer, etc. Carefully look at other accompanying symptoms to be able to tell the cause.

3. On the backside

Why do I have red dots on the back of my tongue? Having them on this part can be due to a number of causes. The common ones being strep throat,  trauma, allergies, canker sores, syphilis, cold sores, Kawasaki disease (in children), leukoplakia, scarlet fever, throat cancer, among others.

To be able to tell what causes them, you need to look at the other symptoms accompanying the dots (e.g. a sore throat, swallowing difficulties, fever, etc.,) as well as their size and appearance i.e. big red spots, dark red spots, etc.

For instance, if you have red spots on the back of the tongue and a white coating, it is likely you have oral thrush while big red ones can be canker sores or Kawasaki disease, 

4. On the side 

Having these spots or dots is not specific to a certain disease or condition but it could be caused by any of the many causes we have discussed including trauma and injuries from tongue biting and dental appliances.


On their characteristics, they can be small or big, painless or painful. Let us see more details on each of these characteristics of red bumps on your tongue. 

1. Small tiny, or little 

The common causes of small (tiny or little) red spots include scarlet fever, initial stages of oral cancer, lie bumps, STDs, strep throat, geographic tongue and or any other cause we have already discussed above. In most instances, they are not caused by oral cancer unless accompanied by other symptoms discussed above.

In case of having this problem and metallic taste, it might be due to allergic reactions (especially as a result of the use of some medications) or excessive exposure to alkaline or acids. Cancer treatment, pregnancy, and gum diseases are also associated with metallic taste in the mouth.

To know what could be causing these dots, you need to look at the accompanying symptoms such as fever, sore throat, fever, soreness (whether the tinny red spots hurt or not), etc.

2. Painful or sore

Having sore reddish spots could be an indication of a number of diseases and conditions that will include oral cancer, canker sores, foot-hand and mouth, inflamed papillae, trauma (injuries), etc. Try various home remedies such as chewing ice to soothe those that hurt as well as taking anti-inflammatory medications.

3. Painless

When painless they can be due to a number of cases. In fact, most of the causes we have discussed except cancer, canker sores, inflamed papillae or injuries, foot-hand, and mouth, do not cause any pain. Causes such as excessive smoking, alcohol consumption, a geographic tongue, etc. are not commonly accompanied by pain.

4. Big spots 

If you have big red spots, the most probable cause is Kawasaki disease if the affected person is a child. Otherwise, it could be cancer, canker sores, geographic tongue, among others.

5. with a sore throat

Having these spots and sore throat could indicate a throat infection such as strep throat which is known for small red spots back of the tongue and sore throat. It is accompanied by other symptoms such as fever, headache, swollen neck lymph nodes, throat pain, cough, etc.

Other conditions including oral cancer, scarlet fever, and Kawasaki disease are also known to cause this problem accompanied by a sore throat.

When on toddlers

This spots on babies or children could be due to canker sores, inflamed papillae, Kawasaki disease, strep throat, and hand foot and mouth disease. They can make feeding difficult for the child. See a pediatrician for diagnosis if the red dots on a child do not go away after a few days.

Sources and references
  • http://www.patient.co.uk/health/scarlet-fever-leaflet
  • http://www.webmd.com/oral-health/guide/tongue-problem-basics-sore-or-discolored-tongue-and-tongue-bumps?page=2#
  • http://bangordailynews.com/2012/04/12/health/how-to-tell-if-you-have-oral-cancer/
  • http://www.cancercenter.com/oral-cancer/types/tab/tongue-cancer/
  • http://www.healthline.com/health-slideshow/what-does-mouth-cancer-look#6
  • https://www.healthtap.com/user_questions/484041
  • http://www.fastmed.com/health-resources/related-searches/strep-throat-what-it-looks-like
  • http://www.healthline.com/health/dental-and-oral-health/tongue-bumps#LieBumps2
  • http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm

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