For most people, tongue chewing is a habit that the hands-off part of the brain runs on its own, usually switched on by stress, boredom or intense focus. A smaller group chew or bite without any awareness at all, during sleep or because of involuntary muscle movements, and that kind points to a different set of causes.1PubMed Central. Tongue Biting Event in Patients with Sleep-Related Facial Mandibular Myoclonus: A Case Series Study Whether you catch yourself doing it while awake or only find the damage afterward is the most useful first clue.
Tongue Chewing Is Usually a Stress Habit
Chewing the edges of the tongue is a recognized habit.2The Korean Journal of Pathology. Morsicatio Labiorum/Linguarum – Three Cases Report and a Review of the Literature – The same habit can target the cheeks or lips, and many people do more than one.3IntechOpen. Oral Mucosal Trauma and Injuries It is grouped with nail biting and skin picking as a body-focused repetitive behavior, or BFRB.4The TLC Foundation. Effective Treatment Options for Tongue Chewing
Chewing often targets one spot on the side of the tongue, and hours later you feel a rough or sore patch there. Many people only realize they do it when someone points it out.
Boredom5The TLC Foundation. Effective Treatment Options for Tongue Chewing, tension, intense focus and a craving for a physical sensation can set it off too.6Advanced Behavioral health. Why Do I Keep Biting My Lip, Cheek, or Tongue? Understanding Body-Focused Repetitive Behaviors (BFRBs) The sensation brings brief relief, which teaches the brain to repeat it.7Advanced Behavioral health. Why Do I Keep Biting My Lip, Cheek, or Tongue? Understanding Body-Focused Repetitive Behaviors (BFRBs) The more often it calms you, the more automatic it becomes.
Because it runs on autopilot, the chewing can go on for minutes before you notice. Noticing is usually the first real step toward changing it.
A repetitive body habit is common and is not a sign of serious mental illness. These habits tend to rise and fall with stress levels.
If you can feel yourself doing it while awake, and it eases when you are busy or relaxed, that fits a habit, though it is one clue and not proof. A habit chewer usually has no other new symptoms, such as blackouts or muscle jerks, and that absence is reassuring. If the chewing feels forced, you can’t stop it by deciding to, or it comes with other unwanted movements, the causes later in this article are more likely.
How Your Teeth and Bite Can Play a Part
A large overjet, where the upper front teeth sit far ahead of the lower ones, can lead to frequent tongue or cheek biting.8Fredericksburg Orthodontics. Common Orthodontic Issues and How They’re Fixed – Dr. Almy With open bites, missing teeth or misaligned teeth, the tongue may push or rub against the teeth to compensate.9Acta Medica Mediterranea. IS THERE A RELATIONSHIP BETWEEN BODY POSTURE AND TONGUE POSTURE? GLOSSO-POSTURAL SYNDROME BETWEEN MYTH AND REALITY That constant pressure leaves wavy tooth marks along the tongue edges.10Acta Medica Mediterranea. IS THERE A RELATIONSHIP BETWEEN BODY POSTURE AND TONGUE POSTURE? GLOSSO-POSTURAL SYNDROME BETWEEN MYTH AND REALITY
You can check your own mouth. Look in a mirror for a scalloped tongue edge, and for a sharp or broken tooth near the sore spot. Think about whether the chewing started after dental work or a new filling. A dentist can smooth sharp edges or assess a bite problem. Fixing the tooth may not end the habit on its own, because the urge can continue once it has been learned.
Accidental biting feels different from habit chewing. An accidental bite hurts suddenly, often while eating. Habit chewing is gentle and repeated and rarely hurts at the time. A swollen spot from one bite is easy to bite again, which starts a cycle.
How to Stop the Habit
Habit reversal has the strongest evidence. It teaches you to notice the urge and swap in a harmless competing action.11PubMed. The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: a meta-analytic review Across 18 studies it worked well for a range of repetitive habits, including mixed mouth habits and nail biting.12PubMed. The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: a meta-analytic review In a small trial of people who bit lips, cheeks or tongue, one session cut the habit by about 99% over almost two years.13PubMed. Habit reversal vs negative practice treatment of self-destructive oral habits (biting, chewing or licking of the lips, cheeks, tongue or palate) Simply repeating the habit on purpose, an older approach, cut it by only about 65%.14PubMed. Habit reversal vs negative practice treatment of self-destructive oral habits (biting, chewing or licking of the lips, cheeks, tongue or palate) The 99% comes from a small trial, so it shows promise and is not a guarantee.
You can try habit reversal yourself. Keep a log of when and where chewing happens for a week. Learn your early signal, like the tongue moving to the side. Then use a competing response: rest the tongue on the roof of your mouth, lips closed and teeth slightly apart, for a minute. Reward yourself and practise daily. If you get stuck, ask a therapist trained in BFRBs.
The competing action has to be something you can’t do while chewing and discreet enough for a meeting or the car. Hold it until the urge fades.
When the urge strikes during a stressful task, use the competing action as soon as you notice the early signal, even if you only caught it halfway through a chew. Don’t scold yourself for slips, because frustration adds the very tension that feeds the habit. Progress is gradual, with fewer episodes first and then longer gaps between them.
Because the habit tracks stress, stress management is a useful add-on.15The TLC Foundation. Effective Treatment Options for Tongue Chewing Breathing exercises or short breaks lower the tension behind it. A safe chewing alternative can also satisfy the urge, as one person found with a chewable necklace.16PubMed Central. Compulsive Biting and Chewing with Mixed Amphetamine Salts: A Case Report Sugar-free gum gives the jaw something to do, and notes or phone reminders during known triggers help awareness.
Biting Your Tongue in Your Sleep
Some people have very brief jaw jerks in sleep that can injure the tongue.17PubMed Central. Tongue Biting Event in Patients with Sleep-Related Facial Mandibular Myoclonus: A Case Series Study Grinding during sleep usually wears down teeth and only rarely bites the tongue.18PubMed Central. Tongue Biting Event in Patients with Sleep-Related Facial Mandibular Myoclonus: A Case Series Study Some people are first told they grind their teeth before the jerks are recognized.19PubMed Central. Tongue Biting Event in Patients with Sleep-Related Facial Mandibular Myoclonus: A Case Series Study Overnight testing with video can show jaw jerks without seizure activity.20PubMed. Nocturnal tongue biting beyond epilepsy: sleep-related facio-mandibular myoclonus -a diagnostic and therapeutic challenge
Biting in sleep can also come from sleepwalking-type disorders, acting out dreams, or rhythmic movement disorders.21PubMed Central. Violent Parasomnia With Recurrent Biting and Surgical Interventions: Case Report and Differential Diagnosis In one case, severe sleep apnea fuelled the episodes, and treating it with a breathing machine plus medicine stopped them.22PubMed Central. Violent Parasomnia With Recurrent Biting and Surgical Interventions: Case Report and Differential Diagnosis Sedatives sometimes used for these sleep disorders can worsen low oxygen in people with sleep apnea, so doctors use it cautiously.23PubMed Central. Tongue Biting Event in Patients with Sleep-Related Facial Mandibular Myoclonus: A Case Series Study
You are asleep during the event, so the first sign is often a sore tongue or a bloodstain on waking and not any memory of biting. Because the clues are indirect, a bed partner’s observations can help a lot. A single bitten tongue after a bad night is not alarming, but a repeated pattern deserves attention.
When you see a doctor, ask a bed partner about jerks, sounds, snoring or breathing pauses. Note blood on the pillow and how often it happens. Mention tiredness during the day, a sign of sleep apnea. A sleep study can sort out the cause.
The treatment depends on the cause: a guard won’t fix sleep apnea, and a breathing machine won’t fix jaw jerks. Meanwhile, a dentist can make a soft mouth guard. It protects the tongue but doesn’t treat the underlying cause.
When Tongue Biting Points to a Seizure
Among people who black out, a bitten tongue makes a seizure about eight times more likely than a faint.24PubMed. Value of tongue biting in the differential diagnosis between epileptic seizures and syncope Only about a third of seizures cause a tongue bite, so no bite doesn’t rule one out.25PubMed. Value of tongue biting in the differential diagnosis between epileptic seizures and syncope A bite on the side of the tongue in particular points to a true seizure rather than a stress-related episode.26PubMed. Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective In a hospital epilepsy unit, nearly all biting injuries came from seizures, mostly whole-body ones.27PubMed. Ictal biting injuries in the epilepsy monitoring unit, a cohort study of incidence and semiological significance
That side-of-the-tongue pattern happens because the jaw clamps shut in a strong muscle contraction. The injury can be deep, and it is usually noticed afterward. It is very different from the gentle, repeated nibbling of a habit.
Certain signs call for prompt action: waking confused, sore all over, or having wet the bed with a bitten tongue, or a witnessed episode of stiffening or jerking. See a doctor promptly, because a first possible seizure needs assessment.
At an assessment, the doctor will ask what happened before, during and after the episode, and will ask witnesses what they saw. Tests such as a brain-wave recording or imaging may be arranged, depending on the story. Bringing a witness, or a phone video if there is one, helps considerably.
Medicines, Stimulants and Movement Disorders
Long-term antipsychotic use can cause tardive dyskinesia, with repetitive movements such as chewing, lip smacking and tongue pushing.28PubMed Central. Antipsychotic-Related Movement Disorders: Drug-Induced Parkinsonism vs. Tardive Dyskinesia—Key Differences in Pathophysiology and Clinical Management Some anti-nausea drugs and calcium-channel blockers have also been linked to it.29PubMed Central. Interdisciplinary recognizing and managing of drug‐induced tardive oromandibular dystonia: two case reports
Stimulants can do something similar. Amphetamines can bring constant chewing, grinding and rubbing the tongue on the lip.30Journal of Orofacial Pain. Drugs and Bruxism: A Critical Review About 3 in 10 people taking MDMA in one group reported grinding.31Journal of Orofacial Pain. Drugs and Bruxism: A Critical Review One woman on ADHD amphetamine salts developed an uncontrollable urge to chew.32PubMed Central. Compulsive Biting and Chewing with Mixed Amphetamine Salts: A Case Report
Oromandibular dystonia causes painful, involuntary spasms of the jaw, face and tongue muscles.33PubMed Central. Management of Oromandibular Dystonia: A Case Report and Literature Update Some forms force the tongue out repeatedly.34PubMed. Severe tongue protrusion dystonia: clinical syndromes and possible treatment Botox injections into the tongue muscle improved symptoms by roughly 70 to 80% in a large group.35PubMed Central. Botulinum Neurotoxin Therapy for Lingual Dystonia Using an Individualized Injection Method Based on Clinical Features For dystonia, a neurologist is the usual specialist.
A medicine-related movement problem tends to feel like something that happens to you, not something that comforts you. It often continues when you are calm and not only when you are stressed. Others may notice the movements before you do.
The most useful clue is timing: when the chewing started relative to a new medicine or a dose change. Some of these movements appear only after long-term use, so a medicine taken for years can still be responsible. Bring a full list of your medicines and any over-the-counter products or stimulants to the appointment.
Never stop a prescribed medicine suddenly; talk to the prescriber. A doctor can examine your movements, review your medicines and decide whether a change or a different treatment makes sense.
Caring for a Chewed Tongue
Start by rinsing gently and looking at the injury to see whether it is a small nick or a deeper cut. Press a clean cloth on a bleeding bite and use a wrapped ice pack for swelling.36Colgate. I Bit My Tongue. What Now? Warm salt-water rinses keep the area clean and ease pain after meals.37Colgate. I Bit My Tongue. What Now? Mouth gels form a protective coat and reduce soreness.38Pennsylvania Center for Dental Excellence. I Bit My Tongue Really Bad: Remedies and Prevention
For a few days, choose soft, cool, bland foods and avoid sharp, spicy or very hot food that irritates the wound. Brush carefully around the area so food debris does not sit in the sore.
Small cuts usually heal in three to four days, and bad bites can take two weeks or more.39Pennsylvania Center for Dental Excellence. I Bit My Tongue Really Bad: Remedies and Prevention A small sore becomes less painful each day and shrinks steadily. One that stays the same or worsens after a couple of weeks is not following the normal pattern. Mouth tissue heals quickly, but if you keep chewing the same spot, you reopen it and restart the clock. Stopping the habit is therefore part of the treatment.
Repeated chewing leaves white, shredded or rough patches.40IntechOpen. Oral Mucosal Trauma and Injuries Years of chewing can form a firm smooth bump called a fibroma, which a dentist can remove simply and send to be checked under a microscope.41PubMed Central. Diseases of the tongue: a review of etiologies and treatments A sore, burning or smooth tongue can instead come from low vitamin B12.42PubMed Central. Oral manifestations of vitamin B12 deficiency associated with pernicious anemia: A case report
Get help for bleeding that won’t stop after 15 minutes of pressure, a cut that gapes, or signs of infection like fever or pus. A sore or lump lasting over two weeks should be checked by a dentist. People with severe chewing and developmental disabilities can be helped by custom guards.