Burning tongue or burning mouth?

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Burning tongue or burning mouth?
APRIL 2003
Ken Landow, MD
POSTGRADUATE MEDICINE
Q: What are the differential diagnostic considerations in burning tongue? Do they differ from those in burning mouth?
Primary care physician, Iran
A: Glossodynia, a burning sensation that usually occurs at multiple sites in the oral cavity, is also known as burning mouth syndrome, sore mouth syndrome, stomatodynia, glossalgia, and orodynia. Typically, it affects middle-aged women, manifesting bilaterally on the tip and sides of the tongue. However, it also often involves the hard palate, gums, and lower lip. Glossodynia is commonly accompanied by xerostomia and may include abnormal sensations of smell and taste. Symptoms generally are mild or moderate and often follow a circadian pattern, with a nadir in the morning and a plateau in the late afternoon or evening. Vinegar and acidic fruit juices are known to exacerbate symptoms.
Diagnosis of glossodynia requires an absence of abnormal findings, such as active herpes simplex, lichen planus, obviously ill-fitting dentures, white plaques of Candida albicans, bruxism, and allergic reactions to dentifrices or foods.
The cause of glossodynia is unclear. Some "authorities" incorrectly blame a wide variety of nutritional deficits for the condition, which often is the case with chronic conditions of uncertain origin. However, little evidence suggests a role for pernicious anemia or deficiencies of iron, folic acid, zinc, or vitamin B1 or B2. Similarly, neither dental amalgam nor poorly fitted dentures provide a rational explanation. Glossodynia has been associated with diabetes, estrogen deficiency, subclinical yeast infection, and adverse reactions to drugs, although no link has been proved.
Because healthcare professionals often look askance at patients with a long history of distressing symptoms but no abnormal physical findings, patients who complain of glossodynia generally perceive their interactions with physicians and dentists as unhelpful.
Typically, patients with glossodynia have anxiety, depression, or somatization. Unfortunately, neither topical agents (eg, lidocaine hydrochloride solutions, gargles containing alcohol, antihistamine liquids) nor vitamin, mineral, or nutritional supplements consistently provide relief. A wide array of psychotropic agents--from benzodiazepines to selective serotonin reuptake inhibitors and tricyclic antidepressants--may be effective treatment.
Ken Landow, MD
Clinical Professor of Dermatology
University of Southern California, School of Medicine
Los Angeles