7 Signs of Caviar Tongue & What To Do

First things first, no we are NOT talking about the caviar you eat, AKA the delicacy food item served at all the fanciest restaurants. We’re talking about “caviar tongue,” also known as “sublingual varicosities” or "sublingual varices!" If you’ve never heard of caviar tongue, we’ll review a touch of the history of where it got its name, signs to look out for, and the potential systemic conditions that have been associated with caviar tongue occurrence. 

What is Caviar Tongue?

Caviar tongue is a sublingual varicosity on the bottom-side (ventral) portion of your tongue. What does that even mean? It’s classified as a benign, asymptomatic venous lesion. In other words, it’s veins that appear to be purple or dark in color and pretty swollen. 

A purple under tongue or caviar tongue is considered a natural/physiological change rather than a pathological one, so it’s not necessarily bad. In most cases, it’s usually associated with the ageing process. While it’s normal to see veins on the undersurface of your tongue (mostly due to thin tissues,) caviar tongue can look like a bulging dark purple and nodule. The appearance is distinctive and very different from the normal appearance of veins on your tongue. This nodule appearance is due to the dilation of veins, causing it to resemble caviar! 

History of Caviar Tongue

Caviar tongue got its name from a doctor named William Bennet Bean in 1952. Dr. Bean made observations of patients with this bulging appearance to the underside of the tongue. His findings included the appearance of the pooling of blood. He even went on to note that when applying pressure to the veins they would drain to surrounding veins, then when released would pool immediately back to their original shape.  

What Causes Caviar Tongue?

While there is still some debate regarding the origin of “caviar tongue,” many agree that the main risk factor is the aging process. As we age, it becomes more difficult for our blood vessels to continuously repair themselves. The smooth muscle fibers within our blood vessels don’t work quite as well, and the connective tissues within our vessels weaken and degrade as we age, making it hard to maintain their usual shape. Because of this process, our veins can collapse, causing blood to get stuck and pool in small pockets. These weakened blood vessel walls can open and close at random, thus causing a changing shape to caviar tongue. 

Depending on who you ask, some researchers suggests correlation to:

• Cardiovascular diseases
• Vitamin deficiencies
• Denture wearing
• Smoking or using tobacco
• Certain medications
• Malnutrition
• Chronic liver disease and alcohol abuse

Smoking has been known to worsen the appearance of caviar tongue. And people with cardiovascular disease and high blood pressure are the most likely to experience caviar tongue than their peers. 

Visible Signs of Caviar Tongue 

While caviar tongue is painless it does come with many visible attributes that can help confirm its diagnosis. However, it usually isn’t a major concern for patients; but it’s important to be able to rule out other potentially serious differential diagnosis. Below are several symptoms to look out for when diagnosing caviar tongue.

1. Visible Bulging Veins Under the Tongue

This is where caviar tongue gets its name. It's commonly seen at the underside of the tongue along the sublingual glands where the mucosal surface is thin. Veins appear often dark purple, blue, black, or tan with a bulging irregular appearance. This irregular texture and color come from the collapsing of the veins inner wall. Because tissues on the underside of our tongues are so thin, we can easily see the bulging pools of blood this is causing. It’s important to know this is not an inflammatory response in the body, rather a weakening of connective tissue within blood capillaries. 

2. Firm or Palpable

Veins can feel easily compressible or can have a firmer feeling when you press down on them due to constriction of blood flow. If there is a hardened mass within the area as you press down, it’s important to rule out other possibilities such as a granuloma, blocked salivary gland, or tumor. This is important to document clinically to ensure we are keeping track of any changes in appearance and texture and one reason why it’s important to schedule regular oral cancer screenings at your dentist’s office. 

3. Location

While the most common site for caviar tongue is the underside of your tongue, it can appear on other surfaces. The inside of your lips and cheeks, buccal mucosa, sides of your tongue, and even in the floor of your mouth can be prone to these “varicosities”. It’s extremely important that dentists or your dental hygienist take intraoral photos of to track changes between your routine dental appointments. 

4. Asymptomatic

Great news! Caviar tongue rarely causes any type of pain or discomfort. However, traumatic injuries caused by accidentally biting or eating hard foods can cause pain and swelling. This happens most often in denture wearers. Thankfully, it’s rare to experience pain due to the varicosities.  In fact, most people are unaware that they have caviar tongue until their dental provider brings it up it during a clinical exam.

5. Bleeding

Most of the time, bleeding is uncommon if you have caviar tongue veins. If bleeding is occurring it should be brought to your dentist’s attention ASAP, as this could mean a potential misdiagnosis of hemangioma, lymphangioma, Kaposi’s sarcoma and even melanoma that needs to be ruled out. That being said, bleeding can follow any traumatic injury. If bleeding is a recurring problem, definitely ask your dentist for a referral to an oral surgeon to properly evaluate what’s going on. 

6. Microscopic Appearance

When biopsied tissues appear collapsed or lack elasticity, it contributes to the pooling of blood within the collapsed vein. If there are concerns about sores under your tongue, specialists like oral surgeons will often biopsy the tissues to ensure there are no major concerns occurring at a microscopic level. Such as oral cancer. 

7. Chronic Venous Insufficiency

While often rare, caviar tongue can be a sign of a chronic condition known as venous insufficiency. What does that even mean?! It’s a condition that can cause inefficient draining of veins and can result in swelling in your legs. If you experience swollen legs as well as caviar tongue, you might want to see your primary care physician to rule out complications underlying systemic disease.

Is Caviar Tongue Painful?

Like I mentioned earlier, caviar tongue is very rarely painful. Most people have no idea they have this under their tongues, or they come into their dental appointment asking why their tongue appears bumpy and purple. If pain is present, a biopsy may be necessary to rule out a differential diagnosis. Because caviar tongue is not painful there is often no concern for these types of lesions.

Who gets caviar tongue and is it contagious? 

Caviar tongue occurs in about 10% of the world’s population. It’s most common sites often found in adults aged 60 and over. However there have been reports of individuals as young as 40 presenting with caviar tongue.

Caviar tongue is NOT contagious, meaning it can not be passed from person to person. You can kiss, share food, or drink after other people without worrying about spreading or catching caviar tongue. 

Caviar tongue is considered a physiological change in the structure of connective tissue and muscle fibers that make up your veins. You cannot pass on caviar tongue to another individual. However, some research supports a potential genetic component to caviar tongue occurrence, so there’s a higher risk that it might run in your family. 

Treatment for Caviar Tongue

Since most cases of caviar tongue are asymptomatic and don’t present concern, there’s not usually any need for treatment interventions. However, there are cases when the bulging veins appear on the inside of your lips or cheeks and can interfere with chewing and smiling. In these cases, some patients choose to have the veins removed via sclerotherapy. Sclerotherapy is a technique commonly used to remove varicose veins on the legs. This therapeutic intervention involves injecting a solution directly into the vein that essentially causes the vein to shrink and dissolve in appearance. Lasers are also a treatment of choice to ensure an aesthetically pleasing result!

Overcoming Sublingual Varices

Caviar tongue is a benign, asymptomatic, lesion in your veins that usually doesn’t cause problems for dental patients. Monitoring the area at your routine dental appointments is important to ensure no major changes are occurring. If you have high blood pressure, diabetes, vitamin deficiencies, or swelling of the lower legs, it’s best to ensure you’re following up with your primary care provider.

Monitoring caviar tongue may seem not all that important without many symptoms, however, systemic health conditions can often cause symptoms inside of your mouth. That means your dental team may catch them before your primary care physician does. Regular exams are done at every hygiene visit to properly monitor and evaluate the entire area inside of your mouth. 

Now that you know more about caviar tongue and what it involves, you can know whether or not it’s something you need to talk about with your dentist!