Look for Organic, Treatable Causes of Glossodynia.
Some studies have suggested that the majority of cases of this often unbearably painful condition--also known as burning tongue syndrome--are psychosomatic, but in Dr. Rogers's experience most cases have one or more treatable, organic causes.
"The key here [to successful diagnosis and treatment] is that this is often a multifactorial [problem]. Seek more than one cause," advised Dr. Rogers, professor of dermatology at the Mayo Medical School in Rochester, Minn.
Patients with the condition complain of severe burning, stinging, or soreness of the mouth and tongue; there are no obvious lesions. The condition may be persistent or intermittent, and in some cases, disturbances in taste sensations are described.
It occurs most commonly in menopausal patients, with about one in four menopausal women complaining of such symptoms.
About 1 in 10 diabetic patients are affected, and about 1 in 20 patients in a general dental practice may complain of glossodynia symptoms.
Among the potential causes other than menopause and diabetes are candidiasis, nutritional deficiencies (especially B-vitamin deficiencies), drugs, xerostomia, dry mouth, and trauma (particularly from dentures). Assessment should include evaluation for all of these.
During menopause, estrogen deficiencies, low follicle-stimulating hormone levels, and bone loss--which can lead to poorly fitting dentures--all can cause glossodynia symptoms. In diabetics, medications and abnormal plasma glucose levels can contribute to the condition.
Another clue as to what is causing burning tongue symptoms may be found in the patient's description of the pain. Those who complain of soreness are more likely to have denture-related problems or B-vitamin deficiencies. Those who complain of burning are more likely to have iron deficiencies, Dr. Rogers noted.
In a study of 70 patients treated for glossodynia at the Mayo Clinic, it was found that 80% were menopausal women. Half of the patients had an abnormal physical examination, 30% had xerostomia, and 25% had dentures that were found to be associated with the pain.
About two-thirds of the patients had inflammation associated with trauma, about three-quarters had inflammation associated with candida, and many menopausal women had rapid alveolar bone loss that contributed to the pain. Other causes included inadequate oral cleansing, contact allergy stress-induced muscle activity, heat accumulation, dry mouth, geographic tongue, furred tongue, and various psychological factors.
The Minnesota Multiphasic Personality Inventory is a clinically useful tool for identifying psychological disorders associated with the condition, Dr. Rogers noted.
One major problem affecting many glossodynia patients is fear of cancer. "If I find nothing suggestive of cancer, then I say 'I find nothing for cancer in the exam.' Occasionally I'm greeted with an audible sigh of relief," said Dr. Rogers.