Burning Mouth / Swallowing Difficulties

Burning Mouth

What is burning mouth?

Burning mouth is a sensation of burning in the tongue and often of the palate (the roof of the mouth); however, it may also occur anywhere in the mouth or throat. It starts " out of the blue" for no apparent reason and persists for months or even years. The sensation is commonly described as the discomfort felt when the tongue is burned with hot coffee. Most people find that the burning sensation gets worse through the day. The mouth may feel fine in the morning only to develop burning in the evening. Once asleep the pain seems to lessen. The next morning the cycle recurs.

A metallic taste or bitter taste often occurs at the same time as the burning sensation. The feeling of a dry mouth sensation is commonly reported; however, an exam of the lining of the mouth almost always reveals normal saliva flow. At times, the burning pain may be very severe and lead to depression and anxiety from the chronic pain.

What causes burning mouth?

Research has revealed that there is a relationship between burning mouth and taste (gustatory) changes. Research has shown that many people with burning mouth have a loss of bitter taste buds at the tip of the tongue. So someone with normal taste for sweet, sour and salty has a reduced sensitivity for bitter taste. Here is the interesting part. The theory is that taste inhibits pain but when the ability to taste bitter is lost, pain fibres begin to "fire" spontaneously. This pain is felt as a burning sensation in the mouth.

An infection in the mouth, a deficiency of vitamin B 12, folate or iron can mimic the sensation of burning mouth.

How is burning mouth diagnosed?

Burning mouth is diagnosed by clinical symptoms and by excluding other problems such as oral yeast infection, diabetes or vitamin deficiency. If none of those problems were found, the diagnosis of burning mouth is given. A careful and through examination by an ENT surgeon is recommended to exclude other conditions.

Is burning mouth more common in certain people?

Burning mouth is more common in postmenopausal women. It is likely related to reduced oestrogen levels, which causes the decline in the sensitivity of the taste buds. Occasionally, men or young people develop this problem; usually they have another condition called geographic tongue. This is a benign (mild, of no danger to health) condition in which red patches appear on the tongue surface and move from site to site.

Another factor seems to complicate the issue. There is an apparent difference in people’s ability to taste based on genetic factors. Some people are "nontasters," some medium "tasters," and some are super "tasters." For the supertasters, flavors are much more intense compared with other types of "tasters." Women are much more likely then men to be super tasters; but even so, few women are super tasters. In summary, most burning tongue sufferers are women who were once super tasters and have now lost taste sensation. Strangely, it has been notice that many of these women are also teeth clenchers. It is thought that pressure on the teeth worsens the burning sensation.

Certain medical problems are also associated with burning mouth. Occasionally, people with Sjögren’s Syndrome (rheumatoid arthritis, dry mouth, and dry eyes), diabetes, thyroid disease, and liver problems have burning mouth. Sometimes patients treated for hypertension with ACE inhibitors develop burning tongue. Even after stopping the medication, the pain may continue if it is not treated.

How is burning mouth treated?

Some patients report that melting ice chips in the mouth or chewing gum helps improve or reduce the discomfort. Some medications seem to help but they are not currently or specifically approved for burning mouth. These medications include certain antidepressants, an anti-seizure medication, and gabapentin (a drug used to treat seizures and the pain associated with herpes). Discuss treatment options with your doctor. About one third of those with burning tongue will improve over 3 to 5 years without any treatment at all.

Swallowing Difficulties / Dysphagia

Dysphagia is defined as difficulty in swallowing. It is usually associated with either difficulties caused by problems with the mouth or throat (oropharyngeal dysphagia) or problems with the gullet (oesophageal dysphagia).

Some signs and symptoms of oropharyngeal dysphagia include difficulty controlling food in the mouth, coughing, choking, aspiration pneumonia, unexplained weight loss, gurgling after swallowing, food getting stuck in the throat and regurgitation of food.

Dysphagia can prevent people from enjoying meals or social occasions; it can even lead to malnutrition or dehydration.

There is a spectrum of possible causes of dysphagia, which would be explored by the consultant.

Treatment depends on the underlying problem causing the dysphagia. These treatments can include:

• Medication

• Surgery

• Speech and language therapy

• Management of the consistency of food

• Alternative forms of feeding

Mr Repanos has considerable expertise in the assessment and diagnosis of dysphagia and the underlying condition, together with the ability to treat a wide variety of causes of swallowing difficulties.