DIFFERENTIAL DIAGNOSIS AND MANAGEMENT OF

GLOSSODYNIA
By K.Naren babu IVth Year B.D.S

DEFINITION OF GLOSSODYNIA

Glossodynia or Stomatodynia is a condition characterized by a burning or tingling sensation on lips,tongue,or entire mouth

The condition is less commonly known as Orodynia. Some times it is known as burning tongue. It shows discoloration ,ulcers or other visual anomalies in the oral cavity.

GLOSSODYNIA

CAUSES OF GLOSSODYNIA
The main causes of glossodynia are. Local causes

Trauma to oral mucosa eg;-poorly fitting dentures Gastroesophageal reflux disease Oral submucous fibrosis Oral candidiasis Xerostomia (Dry mouth) Trigeminal Neuralgia Mucosal disorders-geographic tongue,lichen planus,etc. Chronic tongue thrust habit Chronic mouth breathing

SYSTEMIC CAUSES

Vitamin B12 ,Iron deficiencies Diabetes mellitus Estrogen deficiency Anxiety,Stress,Depression Hypothyroidism Chronic gastritis Immunologically-mediated diseases (eg:-sjogrens syndrome) AIDS

EXPECTED DURATION OF GLOSSODYNIA

Glossodynia can be acute sometimes it is chronic the length of time often depends on the cause

SIGNS AND SYMPTOMS OF GLOSSODYNIA The main signs and symptoms of glossodynia are

Burning sensation of tongues lips gums and oral mucosa Sensation of dry mouth Tingling sensation of mouth or tongue Mouth pain increased at the end of the day Loss of taste Difficulty of chewing and swallowing Increased thirst Tongue swelling Sore mouth

DIAGNOSIS OF GLOSSODYNIA
The various procedures for diagnosis of glossodynia are Clinical features that are helpful in diagnosis of BMS : Complains of dry mouth in presence of normal flows Presence of abnormal or dysgeusic tastes usually metallic ,bitter or sour Unilateral or Bilateral burning pain localized to tongue,palate,lips and gingiva

CLINICAL TESTS THAT MAY BE HELPFUL IN DIAGNOSING GLOSSODYNIA

Hematological tests:-such as complete blood count Glucose tests Oral cultures for fungal,viral and bacterial infections if suspected Saliva test should be done in case if salivary flow is low than Sjogrens syndrome is suspected

DIFFERENTIAL DIAGNOSIS OF GLOSSODYNIA

BURNING MOUTH SYNDROME

Is a common dysaesthesia (distortion of taste) typically described by the patient as a burning sensation of the oral mucosa in the absence of clinically apparent mucosal alterations.

Aetiology:
Various local and systemic factors have been postulated to cause this condition It has been associated with: Post-menopausal women: estrogen and progesterone deficit. Depression and anxiety states

Clinical features:

Age : 30years (40 years men) and the onset in women, within 3 to 12 years after the menopause. Onset: typically spontaneous, it may be gradual The dorsum of the tongue develops a burning sensation in the anterior two thirds. Patient may describe irritability or raw feeling. Diminished number and size of filiform papillae Erythematous and edematous papillae on the tip of the tongue: due to constant rubbing of the tongue against the teeth

Additional oral sites are affected in a similar manner, especially the anterior hard palate and the lips. There is a seldom decrease in stimulated salivary output tests, despite complain of xerostomia. Condition does not interfere with sleep. Persistent altered or diminished taste may accompnay the burning sensation. Contact with hot food or liquids intensifies the symptoms. Chronic discomforts: demonstrate psychologic dysfunction, usually depression, anxiety or irritability.

Oral Submucous Fibrosis

Defined as an insidious, chronic disease affecting any part of the oral cavity and sometimes even the pharynx. Characterized by fibroelastic change of the lamina propria with epithelial atrophy This causes: - stiffness of oral mucosa - trismus - difficulty in eating Disease may be due to hypersensitivity to betel nut.

Clinical features Most common initial symptom: - Burning sensation in the mouth , on eating spicy food. Other frequent early symptoms: - Blisters, ulcerations, recurrent stomatitis Striking clinical feature: blanching of the oral mucosa On palpation: presence of fibrous bands in palate, facial pillars, buccal mucosa and lips.

Neuralgias
Trigeminal neuralgia Trigeminal neuralgia (tic douloureux) is characterized by brief paroxysms of pain limited to the facial distribution of the trigeminal nerve and is precipitated by stimuli to sensory endings in the trigeminal receptive area. It is common knowledge that the attacks of pain are precipitated by tactile stimulation of the trigger zone (e. g., touching the face, as in shaving or washing) or by stimuli such as talking and mastication, which increase the proprioceptive inflow. There is evidence that the largest tactile fibers are not involved.32 The etiology of trigeminal neuralgia remains an enigma. Although aberrant blood vessels or neoplasm's may impinge on the trigeminal nerve, they do not explain the nature of this pain syndrome.

Glossopharyngeal neuralgia The glosophayrngeal neuralgia is characterized by unilateral paroxysmal stabbing pain followed by a burning sensation. Among 217 patients with glossopharyngeal neuralgia, the pain was localized to one or more of the following regions: ear, 155 times: tonsil, 147 times; larynx, 69 times; and tongue 43 times52 Glossopharyngeal neuralgia bears a striking similarity to trigeminal neuralgia, but it is a rare condition when compared with the occurrence of trigeminal neuralgia and the pain is less severe. The application of a 10% solution of cocaine to the region of the tonsil and pharynx may assist in the correct diagnosis. If the patient is relieved for one or two hours afterward, the test is considered positive for glossopharyngeal neuralgia52 The etiology of glossopharyngeal neuralgia is obscure. The treatment is similar to that for trigeminal neuralgia.

NIACIN DEFICIENCY

Oral changes :- first manifestations of pellagra and dermatitis Tongue becomes Fiery red. Devoid of papillae. Filiform most sensitive and disappear first. Fungi form become enlarged. In early stages :Only and margins of the tongue are swollen and red. In advanced cases: Tongue loses all the papillae. Reddening become intense. At this stage:Tongue becomes swollen that indentations from the teeth are found along the borders of the tongue. Tongue :- extremely sensitive. Ulcerations' :- dorsum of tongue.

FOLIC ACID DEFICIENCY AETIOLOGY :

Inadequate intake (alcoholics) Deficient absorption (tropical sprue) Excessive demand by tissue of the body (rapidly growing tumors). Symptoms and signs of folic acid closely resemble those of vitamin B12. deficiency (pernicious anemia) except for absence of nemologic disturbances in folic acid deficiency. O/M:Marked glossitis Tongue is fiery red and the seat of atrophy of both filiform and fungi form papillae. Tongue is swollen. Small cracks on the dorsum. Leukemia :Leukemia is a malignant systemic disease characterized by a progressive overproduction of any of the WBCs. Immature WBC in circulating blood.

TREATMENT AND MANAGEMENT OF GLOSSODYNIA The main treatment involves management and drug therapy for glossodynia Management

Good oral hygiene Stop smoking Avoid alcohol , spicy and acidic foods Drink more fluids Analgesic sprays or mouthwashes such as Benzydamine hydrochloride In post menopausal female patients ,hormone replacement or topical estrogen applied to oral mucosa

DRUG THERAPY FOR GLOSSODYNIA

There is no cure for glossodynia but the treatment helps to reduce the signs and symptoms of glossodynia. The drugs mainly used in glossodynia are Low doses of benzodiazepines like clonazepam 0.250.75mg Low doses of tricyclic antidepressants like amitriptyline 1040mg Topical medications like clonidine and capsaicin may be considered for application to local site Low doses of anticonvulsants like barbiturates is to be given in conditions like CNS depressions Alpha-Lipoic acid 600-800mg is given

DRUGS CAUSING GLOSSODYNIA

There are some classes of drugs which cause glossodynia they are Drugs using for hyper tension such as ACE inhibitors Estrogen replacement therapy but only in some cases Diuretics Salivary gland hypo function (dryness)

REFERENCE
BURKETS ELEVENTH EDITION SHAFERS ORAL PATHOLOGY SIXTH EDITION NEVILLE ORAL PATHOLOGY