I have been experiencing very painful sores on both the left and right sides of my tongue. They feel similar to canker sores I get a few times a year in my mouth. My throat is sore, too. Is it possible to get canker sores on my tongue? Can I get these from being under stress, too much salt, not enough of something, diet, what? It is painful to eat because my tongue feels swollen.

D.K.

The list of possible causes is very long. Unfortunately, the list includes cancer. Before we talk about what this could be, I want to emphasize that you MUST see a doctor about this as soon as possible. The most appropriate specialist for this problem would be an ear, nose and throat specialist (ENT) or an oral surgeon.

You state that these "feel similar to canker sores." Do they look like canker sores? Canker sores are usually smaller than 1cm (about 1/3 inch) and have a white or yellow center and a red border. They are sharply demarcated (meaning there is a clear boundary between the sore and healthy tissue). They may occur singly or in groups.

If you get canker sores a few times a year, then you may suffer from a condition called recurrent aphthous ulcerations. There are probably many different causes for this condition, including food allergy, genetic tendencies, hormonal effects, vitamin deficiency, stress and trauma. Recurrent aphthous ulcers are usually treated with topical corticosteroids; your ENT or oral surgeon would be able to prescribe an appropriate medication.

A variety of other medications have been used to treat this problem; the usual treatment goals are the prevention of recurrences and/or the treatment of stubborn (steroid-resistant) ulcers. Based on recently published studies, two particularly promising medications are colchicine and thalidomide (Thalomid). Both of these drugs cause severe birth defects and so should be used with extreme caution in any woman who has even the slightest chance of becoming pregnant.
What else could this be? Here are a few possibilities:

• If you do not really have ulcers on the borders of your tongue but do have pain in this region, then you may suffer from glossopyrosis, another mysterious condition.
  
• Behcet's disease consists of oral and genital ulcerations, along with chronic inflammation of the eye (uveitis and iridocyclitis). Some patients also suffer from arthritis.
  
• Wegener's granulomatosis (WG), like Behcet's disease, is an uncommon and unusual disease. WG involves inflammation and scarring of the upper and lower respiratory tract and kidney damage. Oral ulcers are not uncommonly seen in WG.
  
• Oral ulceration may be due to an allergic reaction to medication (stomatitis medicamentosa). You should ask yourself whether you began a new medication shortly before the onset of your current symptoms. Bear in mind that nonprescription drugs can cause this problem, too.
  
• Similarly, food allergy (allergic contact stomatitis) can cause ulceration of the mouth and throat. But don't limit your imagination to food: Chewing gum, toothpaste, mouthwash, denture adhesive, acrylic dentures, dental amalgam (filling material) and artificial cinnamon flavoring have all been linked to stomatitis. Anything foreign that goes into your mouth could provoke a stomatitis.
  

Unfortunately (for you and your doctor), this is just a partial list. Determining the cause of your tongue problem will require considerable patience, perseverance and detective work. Best of luck to you