Incidence and Treatment of Dysgeusia in Patients with Glossodynia
Nihon University, Edo, Tōkyō, JapanActa oto-laryngologica. Supplementum 02/2002; 122(546):142-5. DOI: 10.1080/00016480260046535
In 96 patients who visited our hospital with glossodynia, we conducted gustatory tests, measured serum zinc and copper levels, examined lingual papillae using biomicroscopy, conducted psychological tests and investigated the effectiveness of treatments directed at the cause of dysgeusia. Gustatory test results showed that 43 (44.8%) of the patients had dysgeusia, which was mild in 62.8%, moderate in 30.2% and severe in 7.0%. By giving higher priority to treatment of dysgeusia than to glossodynia, pain disappeared or was relieved and gustatory sensation improved in 27 (62.8%) of these 43 patients. Overall, pain disappeared or was improved in 65 (67.7%) cases. When treating glossodynia, it is important to diagnose the cause of pain and to give higher priority to treating that cause. The clinical efficacy of treatment for glossodynia will be improved when the presence or absence of dysgeusia is diagnosed early in the course of treatment.
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ABSTRACT: Introduction: 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. These often lead to dry mouth and aggravation of symptoms due to their anticholinergic side-effect profile, and thus to patient incompliance. Gabapentin has been used in the treatment of neuropathic pain for some time now. Side effects and interactions are low. In particular, there are no anticholinergic mechanisms of side effects. Patients and Methods: We treated 4 female glossodynia patients with gabapentin. Results: The intensity of the typical glossodynia symptoms before start of therapy was 4.9 ± 1.1 on the Visual Analog Scale (VAS). Gabapentin therapy (900–2,400 mg/d) decreased the intensity of glossodynia symptoms in all patients to 1.3 ± 0.2. The time to the maximum and stable gabapentin effect ranged from 7 to 21 days. Discussion: Our results show a good gabapentin effect in all treated patients with glossodynia. Gabapentin is thus a very promising therapeutic approach in the treatment of glossodynia. Thanks to the rapid onset of action with only mild side effects and minimal interactions, gabapentin is probably superior to the antidepressants favoured thus far in therapy.
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ABSTRACT: A 73-year-old white male with a 6-month history of glossodynia, unresponsive to clotrimazole troches, cevimeline, triamcinolone dental paste, paroxetine, and lorazepam presented to the dermatology clinic for consultation. Work-up revealed no oral abnormalities and no underlying systemic disorder. He denied 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. Improvement of pain symptoms were noted within 3 days with full resolution of symptoms at 1- and 3-month follow-ups. Dysphoria and anticipatory anxiety remitted fully upon pain relief.
Article: Burning mouth syndrome: Etiology[Show abstract] [Hide abstract]
ABSTRACT: The Burning Mouth Syndrome (BMS) is an oral mucosa pain--with or without inflammatory signs--without any specific lesion. It is mostly observed in women aged 40-60 years. This pain feels like a moderate/severe burning, and it occurs more frequently on the tongue, but it may also be felt at the gingiva, lips and jugal mucosa. It may worsen during the day, during stress and fatigue, when the patient speaks too much, or through eating of spicy/hot foods. The burning can be diminished with cold food, work and leisure. The goal of this review article is to consider possible BMS etiologies and join them in 4 groups to be better studied: local, systemic, emotional and idiopathic causes of pain. Knowing the different diagnoses of this syndrome, we can establish a protocol to manage these patients. Within the local pain group, we must investigate dental, allergic and infectious causes. Concerning systemic causes we need to look for connective tissue diseases, endocrine disorders, neurological diseases, nutritional deficits and salivary glands alterations that result in xerostomia. BMS etiology may be of difficult diagnosis, many times showing more than one cause for oral pain. A detailed interview, general physical examination, oral cavity and oropharynx inspection, and lab exams are essential to avoid a try and error treatment for these patients.
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