Caviar Tongue | Symptoms, Causes, Treatments, and Prevention

Today’s article from Healthsoothe will talk about the caviar tongue. Yeah, you heard me. I said “caviar”. But trust me, it isn’t what you are thinking. You know caviar as a type of food, but the caviar we are talking about here isn’t food related.

Ever seen someone’s tongue being purplish or bluish, and bulging with veins? Yeah, it happens, and this is known as the caviar tongue. Some of you must have already known about it, and are here to confirm something or get the answer to questions like; is caviar tongue dangerous? Can caviar tongue kill? What causes Caviar tongue and how can I prevent it?

This article will answer these questions and give critical information on what you need to know about the caviar tongue.

So, we move!

Caviar Tongue – What is it?

Caviar tongue is a disease characterized by purple nodular enlargement of veins on the tongue's undersurface.¹https://en.wikipedia.org/wiki/Caviar_tongue

It is usual for veins to be seen behind the tongue, partially due to the thin and transparent mucous membrane in this area, but when these vessels get dilated and convoluted, they may seem spherical and black resembling caviar.

With a caviar tongue, however, the blood vessels become dilated and convoluted, appearing spherical and dark (like caviar). Caviar tongue, also known as sublingual varices and varix, resembles veins that varicose in the tongue. It is a venous lesion that is asymptomatic and benign.

What Does Caviar Tongue Look like? – Symptoms of caviar Tongue

Caviar tongue is a condition recognized by purplish veins located on the ventral side of the tongue.²Viswanath, V; Nair, S; Chavan, N; Torsekar, R (Jan–Feb 2011). "Caviar tongue". Indian Journal of Dermatology, Venereology and Leprology. 77 (1): 78–9. doi:10.4103/0378-6323.75002. PMID 21220892. Veins are normally visible underneath (ventrally) the tongue since the mucous membrane is so thin and translucent. However, with a caviar tongue, the blood vessels become dilated and tortuous and appear round and black (resembling caviar).

To know more on what this type of tongue looks like, watch the video below:

Caviar Tongue Location

Caviar tongue occurs in a few different sites. It is commonly noticed under the tongue along the sublingual vein, the floor of the mouth at the opening of the sublingual glands, and along the lateral, ventral (underside) of the tongue. It’s rarely seen on the lips and buccal mucosa.

It originates as a small outpouching of the veins and gradually elevates the overlying thin mucosa varying from red to purple, resembling buckshot or caviar with an iridescent surface. They originate bilaterally from the posterior of the tongue and end at the apex of the tongue. Histologically, a sublingual varix is a dilated vein with no inflammatory changes. The endothelium is hypoplastic, and the wall is thick and cellular.

Due to the dilated blood vessels, the flow of blood will slow down, causing a higher risk for thrombosis. A regular varix will blanch on compression. A varix with a thrombosis will not blanch under compression due to the thrombus being unable to be pressed into the adjacent vasculature.

A varix will feel firmer, similar to a BB pellet, beneath the mucosal surface. Although this sounds serious, it poses very minimal risks of embolism.

The Etiology of the Caviar Tongue

As to what else causes the larger, prominent blood vessels underside of the tongue is not fully concrete. Other conditions have been studied and researched with a variety of studies including sublingual varices associated with smoking, diabetes mellitus, hypertension, chronic cough, venous insufficiency, vitamin C deficiency, denture wearing, and cardiovascular and cardiopulmonary disease.

All have been suggested as predisposing factors, but researchers are unable to solidly prove it. A Saudi Medical Journal study focused on correlations or predisposing factors of sublingual varices with smoking, cardiovascular conditions, hypertension, denture wearing, and vitamin C deficiency.

According to this study, a patient 40 years of age and older with sublingual varices has a 50% risk of being hypertensive. If smoking is involved, the risk increases to 58%. In this group of people studied, the prevalence of sublingual varices associated with age, smoking, and hypertension was higher (64.7% of smokers compared to 44.7% of nonsmokers).

Older studies show strong associations with cardiovascular disease, but some studies found no relation. Sublingual varices were found connected to vitamin C deficiency while the denture wearing and diabetes connection to sublingual varices have not been sufficiently proven.

If caviar tongue is present in younger people, it is suggested that it could be a sign of premature aging. It may be an underlying systemic disease. Another study found that healthy, non-medicated people ranging between 20 to 95 years of age had no oral changes with the tongue.

Although age-related sublingual varices may be associated with systemic diseases, malnutrition, medication, and ill-fitting dentures. While writing this, I did my own “clinical study” with patients. I found 100% of patients who had caviar tongues were also on high blood pressure medication.

It could be a coincidence. It could be substantial or faulty. Either way, it’s something to be aware of. While the study from above confirmed the prevalence of sublingual varices with hypertension. Mentioning this condition to a patient may be beneficial for the patient to be aware of their blood pressure and systemic health.

Treatment and Prevention of Caviar Tongue

Sublingual varices like the caviar tongue usually need no treatment but only reassurance regarding its benign nature. Sclerotherapy or surgery has been attempted in single lesions and unusual locations like lips or buccal mucosa.

To prevent caviar tongue from occurring to you, you may have to reduce discomfort associated with geographic tongue by avoiding or limiting substances that commonly aggravate sensitive oral tissues, such as spicy or acidic foods or beverages, as well as alcohol and tobacco.

Who is Mostly Affected by Caviar Tongue and Why?  - What Causes Caviar Tongue?

Caviar tongue is seen most commonly at 40 years of age and older, affecting 10% of the population with increased frequency into life, with the highest occurrence during the eighth decade. The aging process leads to a weakening of the venous wall from degeneration of elastic fibers.

The lesions are commonly seen as a physiological change in connection with age. During the aging process, the changes in the blood vessels and connective tissue in blood flow may change the arterial pressure at the arteriovenous shunts.

The process of the smooth muscle fibers encircles the capillaries³Mulliken, John B. (2013). "13. Capillary malformations, hyperkeratotic stains, telangiectasias, and miscellaneous vascular blots". In Mulliken, John B.; Burrows, Patricia E.; Fishman, Steven J. (eds.). Mulliken and Young's Vascular Anomalies: Hemangiomas and Malformations (2nd ed.). Oxford University Press. pp. 552–553. ISBN 978-0-19-972254-9. and arterioles at periodic locations, causing the opening and closure of vessels. This activity changes the distribution of blood in the tissues causing blood to pool from arterioles to the venules without passing the capillary bed.

Although bleeding is uncommon, bleeding from a tortuous vein may be found in association with conditions such as increased venous pressure (portal hypertension) or superior vena cava syndrome.

Portal hypertension is high blood pressure in the hepatic portal system. The portal vein is the vein that carries blood from the digestive organs to the liver. This increased pressure in the portal veins may lead to swollen veins throughout the body.

A possible connection of portal hypertension and varicose veins of the leg to sublingual varices has been suggested. Superior vena cava syndrome is multiple symptoms that result when blood flow through the superior vena cava − the large blood vessel that returns blood from the upper body back to the heart − is blocked.

When this occurs, swelling of the face, neck, and dilation of the veins on the skin surface occurs.

All right, guys, that is it for now for caviar tongue. I hope Healthsoothe answered any questions you had concerning the caviar tongue. 

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Additional resources and citations

• 1
  https://en.wikipedia.org/wiki/Caviar_tongue
• 2
  Viswanath, V; Nair, S; Chavan, N; Torsekar, R (Jan–Feb 2011). "Caviar tongue". Indian Journal of Dermatology, Venereology and Leprology. 77 (1): 78–9. doi:10.4103/0378-6323.75002. PMID 21220892.
• 3
  Mulliken, John B. (2013). "13. Capillary malformations, hyperkeratotic stains, telangiectasias, and miscellaneous vascular blots". In Mulliken, John B.; Burrows, Patricia E.; Fishman, Steven J. (eds.). Mulliken and Young's Vascular Anomalies: Hemangiomas and Malformations (2nd ed.). Oxford University Press. pp. 552–553. ISBN 978-0-19-972254-9.