Glossodynia

Specialty: Otolaryngology.

• Burning mouth syndrome
• painful glossitis
• persistent burning tongue
• painful paresthesia of the tongue

Why it occurs

• Primary or idiopathic glossodynia linked to small fiber sensory neuropathy
• Severe nutritional deficiencies of vitamin B12, folates, iron or zinc
• Chronic non-exudative erythematous oral candidiasis
• Poorly controlled diabetes mellitus or diabetic peripheral neuropathy
• Severe xerostomia secondary to salivary gland dysfunction
• Chronic mechanical irritation due to misaligned dentures or sharp cusps

Initial workup

Complete blood analysis (hemogram, blood glucose, glycosylated hemoglobin, levels of iron, ferritin, vitamin B12 and folic acid), tongue smear for direct fungal culture, dental evaluation of the condition of the prostheses and teeth, and tongue biopsy if suspicious mucosal lesions (leukoplakia, erythroplakia) are detected.

Standard management

• Clonazepam in low doses — 0.25-0.5 mg orally at night, or mouthwash solution without swallowing 3 times a day to take advantage of its local anesthetic effect on peripheral GABA receptors
• Tricyclic antidepressants such as amitriptyline — 10-25 mg orally at night
• Gabapentin or pregabalin — for pain of purely neuropathic origin
• Diluted topical capsaicin solutions for progressive sensory desensitization.