Common causes for pus on the tongue include Ludwig’s angina, periodontal disease, sialolithiasis, and throat infections. All these conditions involve the forming of one or more abscesses filled with infectious pus, which includes live malicious bacteria, dead tissue, and white blood cells that the body has generated to fight the bacteria. The pus-filled sacks can originate on the surface of the tongue or beneath it. Medical professionals suggest that pus from initial infection of the actual tongue is rare since the tongue has a fortified outer layer and constant blood flow, both of which make it highly resistant to harmful bacteria. Often, however, abscesses form on gums, the throat, the roof of the mouth or the cheeks, resulting in pus after an abscess bursts and drains.
Ludwig’s angina is a type of submandibular swelling, which results in abscesses on the oral floor and a collection of pus on the tongue’s underside. On occasion, the pus is so great that it elevates the tongue and makes it difficult for an infected person to swallow or breathe. This condition is most likely after a severe tooth infection. It occurs primarily in children, teens and adults under 30 years of age. Medical professionals often prescribe antibiotics to kill the bacteria; a surgeon may also drain the pus using a needle during a minor hospital surgery.
With periodontal disease, a condition characterized by dental decay and infection, oral bacteria festers in pockets around the gum line and at the roots of teeth, often generating inflammation and odiferous pus between the teeth and, consequently, on the tongue. Pus is greatest when the inflammation of decaying teeth is so severe that a tooth abscess forms and then leaks or bursts. Such an abscess may need to be alleviated through a root canal or full removal of the infected teeth.
Sialolithiasis is a viral infection that results in lumps under the tongue, on the inside of the cheeks or on the roof of the mouth. These lumps can leak pus on the tongue, worsening the infection and possibly resulting in a fever or body aches. In some cases of sialolithiasis, pus-filled lumps or tumors can emerge directly on the top of the tongue. Other viral and bacterial infections, such as streptococcal infections, can cause inflammation, redness and pus on the tonsils or rear of the throat that can eventually expand and spread to the tongue. In some cases, a cold sore caused by the herpes virus can result in sores on the roof of the mouth that drain downward; this is rare, however, since most cold sores affect the lips and outer perimeter of the mouth.