Glossodynia (burning mouth syndrome, stomatopyrosis, orodynia) is mostly
considered to be a psychosomatic disorder characterised by painful
sensations within the oral cavity, particularly the tongue, without
detectable abnormalities of the mucous membranes or underlying medical
disorder. Frequently, patients also complain of xerostomia and
dysgeusia. Based on the similar characteristics of glossodynia and
neuropathic pain, comparable therapeutic approaches are recommended.
Antidepressants have been the therapy of choice to date.
Typically, patients awaken without pain but note increasing symptoms through the day and into the evening. Conditions that have been reported in association with burning mouth syndrome include chronic anxiety or depression, various nutritional deficiencies, type 2 diabetes (formerly known as noninsulin-dependent diabetes) and changes in salivary function. However, these conditions have not been consistently linked with the syndrome, and their treatment has had little impact on burning mouth symptoms
Causes
Possible causes include nutritional deficiencies, chronic anxiety or depression, type 2 diabetes, menopause, oral disorders such as thrush or dry mouth, or damaged nerves (specifically, cranial nerves associated with taste).
One cause of burning mouth syndrome and associated disorders is the foaming agent in many toothpastes, sodium lauryl sulfate, a surfactant commonly used in household products. There are now several toothpastes on the market specifically without this additive.
Most of the many causes of glossodynia proposed in the literature either lack evidence of causation or don't fit with his definition of glossodynia, which is pain on the tip and sides of the tongue with no inflammation, masses, or atrophy. These proposed causes include drugs, postmenopausal hormone levels, vitamin or mineral deficiencies, diet, infection,
Typically, patients awaken without pain but note increasing symptoms through the day and into the evening. Conditions that have been reported in association with burning mouth syndrome include chronic anxiety or depression, various nutritional deficiencies, type 2 diabetes (formerly known as noninsulin-dependent diabetes) and changes in salivary function. However, these conditions have not been consistently linked with the syndrome, and their treatment has had little impact on burning mouth symptoms
Causes
Possible causes include nutritional deficiencies, chronic anxiety or depression, type 2 diabetes, menopause, oral disorders such as thrush or dry mouth, or damaged nerves (specifically, cranial nerves associated with taste).
One cause of burning mouth syndrome and associated disorders is the foaming agent in many toothpastes, sodium lauryl sulfate, a surfactant commonly used in household products. There are now several toothpastes on the market specifically without this additive.
Most of the many causes of glossodynia proposed in the literature either lack evidence of causation or don't fit with his definition of glossodynia, which is pain on the tip and sides of the tongue with no inflammation, masses, or atrophy. These proposed causes include drugs, postmenopausal hormone levels, vitamin or mineral deficiencies, diet, infection,
Psychological factors: Emotional disorders, such as anxiety and
depression, are often associated with burning mouth syndrome, as is an
extreme fear of cancer. Although these problems can cause a burning
mouth, they may also result from it.
Symptoms
Symptoms consistent with a psychiatric disorder. A detailed free amnestic assessment by a board certified Geriatric Psychiatrist (John S. Kennedy, MD) found that the patient was oppressed by the pain. He did not meet the criteria for major depression nor did he have any anxiety disorder or delusions. Because of the presence of dysphoria and anticipatory anxiety secondary to glossodynia, the patient was started on olanzapine.
Treatment
Treatment of burning mouth syndrome is highly individualized and depends on your particular signs and symptoms and on the underlying cause or causes, if they can be identified. Most people with burning mouth syndrome can control their symptoms through tailored treatment plans.
Glossodynia, or burning tongue syndrome, may be associated with fungal disorders, B-12 deficiency, dentures, and spicy foods. Olanzapine, Zyprexa[R], is an anti-psychotic and anti-manic medication that has never been documented to be used in glossodynia. It is not by any means a first-line therapy for this condition but we should consider it after all other etiologies, fungal and other, are ruled out. The medication belongs to the thienobenzodiazepine class of anti-psychotics that work on dopaminergic.
In order to check for severe dry mouth, which can cause pain, the salivary glands can be examined for proper quality and quantity of saliva. Persistent areas of pain or burning that are associated with long-lasting mouth sores (lesions) should have a biopsy to rule out oral cancer or pre-cancer. Your dentist can order blood tests to evaluate changes in the blood count, glucose (sugar) and vitamins.
Symptoms
Symptoms consistent with a psychiatric disorder. A detailed free amnestic assessment by a board certified Geriatric Psychiatrist (John S. Kennedy, MD) found that the patient was oppressed by the pain. He did not meet the criteria for major depression nor did he have any anxiety disorder or delusions. Because of the presence of dysphoria and anticipatory anxiety secondary to glossodynia, the patient was started on olanzapine.
Treatment
Treatment of burning mouth syndrome is highly individualized and depends on your particular signs and symptoms and on the underlying cause or causes, if they can be identified. Most people with burning mouth syndrome can control their symptoms through tailored treatment plans.
Glossodynia, or burning tongue syndrome, may be associated with fungal disorders, B-12 deficiency, dentures, and spicy foods. Olanzapine, Zyprexa[R], is an anti-psychotic and anti-manic medication that has never been documented to be used in glossodynia. It is not by any means a first-line therapy for this condition but we should consider it after all other etiologies, fungal and other, are ruled out. The medication belongs to the thienobenzodiazepine class of anti-psychotics that work on dopaminergic.
In order to check for severe dry mouth, which can cause pain, the salivary glands can be examined for proper quality and quantity of saliva. Persistent areas of pain or burning that are associated with long-lasting mouth sores (lesions) should have a biopsy to rule out oral cancer or pre-cancer. Your dentist can order blood tests to evaluate changes in the blood count, glucose (sugar) and vitamins.
By: Peter Hutch
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