Trained in dentistry, Sree is currently pursuing lab sciences. She loves researching and sharing information on various health topics.
Seeing the formation of a clear bubble under tongue can be disheartening - even scary - for many, especially if they don't know what it exactly is and why it's there. The important thing is to not panic right away and try to treat the cyst on your own. This might only cause more damage than good. In order to know what to do in such cases, it is important to know the causes and proper remedies for this condition.
What is a Clear Bubble under Tongue?
Clinically speaking, the formation of a clear bubble under tongue is referred to as a mucocele or a mucous cyst. This is formed once the salivary glands in the mouth become clogged or plugged with mucus. They are a mild problem, in most cases, but it is always safest to have them checked out to rule out any other possibly serious complications. The mucocele is a swelling found in the oral cavity that is filled with fluid. Majority of cases are located on the lower lip, but it is possible to find them anywhere inside the oral crevice, including under the tongue. Often, they are asymptomatic - with no pain felt - and go away fairly quickly. In rare occasions, complications may arise, causing them to be permanent, especially if without prompt and apt treatment.
Clinical Presentation and What to Expect
The cysts are asymptomatic and painless with a quick onset. They vary (and may fluctuate) in size. It is not uncommon for them to increase in size all of a sudden. Patients may also notice involution when the insides rupture into the mouth. The cysts can last for three to six weeks; still, there are extreme cases where they can resolve as quickly as a couple of days or persist for as long as a few years.
It is a common finding for patients to have had trauma to the face or mouth recently. Another contributing factor is the habit of biting the lip. Related to this, some patients report having the habit of tongue thrusting, which can only aggravate the condition (even more so if trauma is evident) - this is the usual case for the formation of the clear bubble under tongue. There is no one definite cause, though, because in many circumstances, there are zero insults identified.
They are most common in the age bracket of 10-25 and are equally evident in both men and women.
These are the hallmark characteristics that you might expect with a clear bubble under tongue:
- May range from 0.1 cm to 4 cm in size
- Can be found anywhere in the oral cavity
- A painless, mobile, dome-shaped cyst
- Superficial cysts can have a bluish to translucent shade
- Deeper cysts can take the color of the surrounding mucosa
- Bleeding may be expected, particularly into the swollen part
- If patient has a habit of sucking on the cyst, the surface may present as a rough, whitish surface
- If expressed, mucus will be observed
- Upon palpation, the mass can be felt but it will not blanch when compressed
- Unless irritated, it will not look inflamed
In descending order, the following are the common areas where the cysts are found: lower lip, floor of the mouth, under the tongue, inside lining of the cheeks, palate, and the retromolar space.
The most common and direct cause of mucous cyst formation is trauma to the area. Examples include:
- Lip biting
- Cheek biting
- Salivary gland rupture (accidental)
- Chronic damage caused by teeth adjacent to the lesion
Some practices can also contribute to the formation of the cyst, including:
- Poor dental hygiene
- Cheek or lip biting (due to stress)
- Adverse reaction to certain tartar-control toothpastes
Superficial vs Deep Cysts
The symptoms of the cysts themselves vary depending on the severity of the case, the location of the cyst, and the reoccurrence rate. More often than not, they are merely uncomfortable - not painful. Below is a table comparing the signs and symptoms of superficial and deep cysts:
Raised, swollen lesion
Round in shape
Less than 1 cm in size
More than 1 cm in size
Consulting a Physician
As a general rule, it is recommended that you consult your doctor for any cyst - or whatever foreign formation - in or around the oral cavity. This will not only help you arrive at the correct diagnosis, but can also give you the opportunity to seek proper and prompt treatment. Also, by being able to rule out any serious problems in the beginning, complications can be avoided.
If the cyst has become bigger and painful or uncomfortable, it is even more imperative that you seek medical help. Although they are often less than 1 cm in size, they can grow larger due to a number of factors. The smaller and painless ones are often undetected until your dental visit. In such cases, the dentist will likely refer you to a medical doctor or specialist for further testing and check-ups.
In the majority of cases, physicians will advise you to let the clear bubble under tongue heal on its own. If it persists for as long as two months, it is best to return to the clinic and have it re-evaluated.
The main way to diagnose mucous cysts is through the signs and symptoms experienced by the patient. This is coupled with taking the patient's history, where he will be asked for any history of trauma or habits such as lip biting. Being completely honest with the doctor is essential in coming up with the most accurate diagnosis, which means that you'll get the most appropriate treatment plan as well.
For some patients, it might be required to undergo a biopsy of the lesion. During the biopsy, a small tissue sample will be removed from the cyst. This will be tested in the laboratory, which will help the doctor come up with the final diagnosis, including whether the lesion is malignant or not. The following cases will prompt the doctor to order a tissue biopsy:
- If the size is bigger than 2 cm
- If the cyst resembles the appearance of either a lipoma (fat cyst) or adenoma (cancer)
- If the patient reports no history of trauma
The apt course of treatment depends on the gravity of the condition. In some cases, no treatment is required at all - the cyst will eventually heal on its own. This is especially true for superficial cysts. For patients with cysts that occur frequently, further medical treatment may be necessary.
More severe cases may necessitate the following treatment courses:
- Laser therapy - the cyst is removed using a tiny, directed light beam
- Intra-lesional corticosteroids - steroids are injected into the lesion in order to facilitate healing and eliminate inflammation
- Cryotherapy - the cyst is removed through freezing
- Surgery - may be suggested by the doctor for especially serious cases and/or for recurrence (to remove the cyst or even the whole salivary gland)
Once the physician recommends surgical removal of the cyst (possibly, together with the adjacent salivary glands involved), there is minimal to zero risk of recurrence. Cysts which are especially larger in diameter may undergo marsupialization in order to avoid the excessive loss of functioning tissue and traumatizing more nerves than necessary. Some lesions undergo dissection, particularly if the fibrous wall is thick - this also requires the removal of adjacent salivary glands.
If airway obstruction is an issue (for severe cases), it will be recommended to consult an anesthesiologist.
As mentioned earlier, other therapies include laser ablation and cryosurgery. Another method is electrocautery. These treatment methods have been used for conventional presentations with varying success rates.
Depending on the surgical method performed, it can take anywhere between one week to two years for the treatment and the healing to be concluded. Of course, the severity of the case and the type of the cyst are factors in how easily and quickly the healing process will be.
Depending on the surgical procedure done, it may be necessary to change your lifestyle, including the food that you eat. Oral surgeries, in particular, will make it difficult to ingest food and drink. As such, a liquid or soft bland diet is often given to the patient, especially immediately after the surgery. If the surgery involves the removal of salivary glands, an especially modified diet may be necessary for a longer time frame. In addition, smoking (and use of tobacco products in general) is strictly prohibited until the affected area has fully healed.
For as long as several weeks right after surgery, and depending on what procedure was conducted, strenuous activities are discouraged. This is to prevent bleeding and rupture, and to help speed up the healing process.
As discussed earlier, it is common for the clear bubble under tongue to resolve on its own. All it takes is some time and avoiding any aggravating activities. You simply need to check the affected area to ensure that there is no infection and increase in size. It may help to use warm saline rinses to provide relief and facilitate healing.
It is also best to try and stop the habits of lip or cheek biting. For many, it helps to keep a journal and record how often the biting happens. This is useful in determining if the biting is stress-related, or if it is triggered by something else, such as boredom or anxiety. Identifying the triggers can help you come up with ways to manage the habit. It can be an effective alternative to chew on sugarless method, for example. This satisfies the need to bite without causing further damage to the cyst.
These are home remedies that have proven helpful in most cases of cysts, but remember that self-diagnosis is a definite no-no. Always seek medical help to get proper diagnosis and treatment.
After prompt diagnosis and treatment, these cysts have a high recovery rate. Most are benign (not cancerous) lesions, so long-term health problems are not an issue. Still, there might be complications such as discomfort and pain. If you think you have a clear bubble under tongue or anywhere else in or around your mouth, it is imperative to have it diagnosed and treated appropriately.
Superficial cysts usually reoccur over time, including new lesions. If and when you undergo complete surgical removal of the cyst, you can expect no more recurrence of the problem. This is especially true if followed up with proper home care and preventive measures (good dental hygiene and avoiding lip or cheek biting). However, if adjacent salivary glands haven't been transected or excised, there is some possibility of recurrence.
Seeing a clear bubble under tongue isn't the worst thing that can happen. More often than not, it will resolve on its own. All you need is time - and to not touch or aggravate the affected area. It might also appear in other locations in the oral cavity - the lips, inner side of the cheeks, and the palate. If in doubt or in the presence of an unusual symptom (like pain or inflammation), the best move is to consult a doctor. After diagnostic testing, treatment may be ordered. For the most severe cases, it is possible to undergo further testing and even surgical removal of the cyst.
To prevent the occurrence of the clear bubble under tongue in the first place, always practice good dental hygiene and avoid hurtful habits such as lip and cheek biting. Good dental health is key in avoiding more serious problems.