(Message in Diabetes) #: 748228 S16/Ask the Doc (CIS:DIABETES) 13-Aug-97 09:27:22 Sb: burning mouth/tongue Fm: Robert Arm 76164,344 To: all Replies: 0 TID: 106109 Par: 0 Chd: 0 Sib: 0 This was sent to me on another forum. Though it might of interest to some on this forum.Note special considerations/ problems have to be done with all patients , especially in diabetes Hello, Sorry I didn't response sooner. One great thing about Tapcis, I can mark items fast, pick up the messages.... saves a lot of time ..... but then to read them and ANSWER them ..... no fast way for that. First the disclaimer.... it is impossible to diagnosis and treat over the computer. A complete history, examination and needed lab tests and x-rays must be available/done to start with clinical impressions. Note most medications have side effects and interactions, any medication/treatment most be review for patient safety. Diabetic patients in special considerations due to sugar in many medicines and other complications. NOTE: AT WORK BY SECRETARIES DUE THE TYPING.... I'M NOT CHECKING THIS FOR TYPO'S OF SPELLING ERRORS .... READER BEWARE. I treat many patients with Burning Mouth/Tongue Syndrome as do many of my friends. Most of us are located in major teaching hospitals and in dental schools generally in the dept. of Oral Medicine / Oral Diagnosis. This thread might be best reviewed on the Medsig forum, dental section. In fact some prior messages might have been saved in the library, possibly one of the conferences I have given. NOW ABOUT BURNING MOUTH / TONGUE : The two most common causes of a burning sensation in or about the mouth are xerostomia (dry mouth) and yeast infections. These should be evaluated first and possible trials of medication/ treatment before looking for other possible etiology. Xerostomia is often caused by taking medications such as for blood pressure, antidepressants and other medicine for psych problems, decongestants and sinus medications, medicine for increase "stomach acid", just to name a few. Other causes are radiation therapy for cancer (to the head and neck), diseases ... like SjogrenĘs, surgical removal of glands, endocrine disorders, etc. There are to many to review now. Treatment is to treat the disease, stimulate saliva flow with medicine (like pilocarpine - Salagen) or sugarless candy, replace moisture ( like sprays or gels). Since saliva acts a lubricant and a buffer (just some of the properties) the patient may get a burning sensation from spicy or acid food/drinks or is the mucosa is very dry ... burning from anything placed in the mouth including saliva. The ph of the saliva may also cause problems. Yeast infections (generally candidiasis) can also cause burning. Yeast infection often occur in a patient with xerostomia so both should be treated. Antibiotics, steroids, and other drugs may make a patient prone to yeast infections. Systemic diseases like diabetes, HIV, transplant patients, oncology patients (just to name a few) make also make the patients prone. Often the clinical picture is not classic. Cultures generally show mixed flora (anyway we all have yeast as part of the normal flora). So a test trial of treatment /medications may be done for 2 - 4 weeks. You have to treat the entire mouth and items that go into it (like dentures). You have to restore the flora with bacteria ( it is decreased ... this allows the yeast to grow) with "bacteria tablets"( lactobacillus, etc) found in health food stores or with products with ACTIVE cultures such as yogurt. Medication has to be taken as directed, topicals must stay in the mouth long enough to work and be dissolved (note: some of the trochees won't dissolve if the mouth is very dry). Other causes include neuropathies as seen in diabetes, lupus, herpetic diseases, vascular problems and neurogenic problems. Here a large workup may be needed with scans and lab tests. Treatment is headed to treat the disease. In some neuropathies, meds may be needed to treat nerve transmission like substance p depleters ( many of these are also antidepressants but are used at a lower dose like elavil or others, other may increase the burning for a short period before working like capsaicin). Also psychogenic problems have to be looked for. If all other causes are rule out then you have true burning mouth/ tongue syndrome. Thus we have two types of burning mouths .... with a known cause and with no known cause. In these cases we try to keep the mouth extra moist, and use the substance P depleters or Klonopin. Klonopin has been shown to work in many studies for burning sensation. A major paper is out of Canada. Thus a short review. Hopefully it will be of some help. The Clinician's Guide by the Academy of Oral Medicine covers a lot of these topics. I have the current 4th copy on my office computer and draft of the fifth. I also have some handouts I give to patients on many of above problems. If you let me know where you are, I might be able to refer you to someone in an academic setting who may be able to help. Or if you have more questions or info ... this might best be done by E-Mail or a call to the office. I'm located at the Christiana Care Health Center (formally Medical Center of Delaware) in the dept. of dentistry 302- 428- 6468. I will try to also post this in Medsig forum so other doctors may see it... but may foul up (Know how to do multi addresses but not multi forums) Robert Arm, DMD, Chairman, Dept. of Dentistry, Christiana Care (formally Medical Center of Delaware) Clinical Professor, Oral Medicine, Temple University Past President, American Academy of Oral Medicine etc