This chapter, written for undergraduate medical students and post-graduate doctors in training, presents information on how to manage painful tongue — a case which they are likely to encounter in the future in a general practice setting. It presents the case of a 24-year-old man who sees his general practitioner, complaining that his tongue stings when he eats spicy food. The discomfort has developed over the last 3 weeks. At first, he thought that he had eaten too much spicy food and 'burned' his tongue. He looked at his tongue and found red areas. Much to his concern the red areas have moved. The chapter provides details of the patients' medical history and the key findings of clinical examination, together with initial investigation results data for evaluation, and helps them develop their skills of clinical reasoning. Key questions then prompt the student to evaluate the patient, and reach a decision regarding their condition and the possible treatment plan.