[Clinical aspects of diagnosis and treatment of glossodynia in elderly and senile people.]

Glossodynia is a disease that is difficult to diagnose and treat. Persons of older age groups are in the most risk of its occurrence. This is due to the fact that its etiological factors are: age-related changes, general somatic diseases, usage of some pharmacological drugs, changes in the psycho-emotional background. Due to the similarity of the clinical picture of glossodynia with other diseases of the oral cavity, the doctor is required to be thoughtful when diagnosing and differentiating glossodynia. Clinical methods of examination are used, paying most attention to the anamnesis of life and disease, assessment of the personal and emotional sphere of the patient. Clinico-functional, clinico-instrumental, and laboratory methods of examination are also used. In the treatment of glossodynia, attention should be paid not only to the elimination of symptoms, but also to its prevention. The main efforts should be aimed at combating the main links of pathogenesis. Treatment should be comprehensive, differentiated and personalized. As a result of many researchers work, certain principles of diagnostics and treatment of glossodynia have been developed, which will be considered in our work.

A 78-year-old female with severe tongue pain: benefit of modern ultrasound.

BACKGROUND: Giant cell arteritis (GCA) is the most common form of systemic vasculitis in persons aged 50 years and older. Medium and large vessels, like the temporal and axillary arteries, are commonly affected. Typical symptoms are headache, scalp tenderness, jaw claudication and ophthalmological symptoms as loss of visual field, diplopia or amaurosis due to optic nerve ischemia. Tongue pain due to vasculitic affection of the deep lingual artery can occur and has so far not been visualized and followed up by modern ultrasound. CASE PRESENTATION: We report the case of a 78-year-old woman with typical symptoms of GCA, such as scalp tenderness, jaw claudication and loss of visual field, as well as severe tongue pain. Broad vasculitic affection of the extracranial arteries, vasculitis of the central retinal artery and the deep lingual artery could be visualized by ultrasound. Further did we observe a relevant decrease of intima-media thickness (IMT) values of all arteries assessed by ultrasound during follow-up. Especially the left common superficial temporal artery showed a relevant decrease of IMT from 0.49 mm at time of diagnosis to 0.23 mm on 6-months follow-up. This is the first GCA case described in literature, in which vasculitis of the central retinal artery and the lingual artery could be visualized at diagnosis and during follow-up using high-resolution ultrasound. CONCLUSION: High-resolution ultrasound can be a useful diagnostic imaging modality in diagnosis and follow-up of GCA, even in small arteries like the lingual artery or central retinal artery. Ultrasound of the central retinal artery could be an important imaging tool in identifying suspected vasculitic affection of the central retinal artery.

[GLOSSALGIA SYNDROME AS SUPRAESOPHAGEAL MANIFESTATION OF GASTROESOPHAGEAL REFLUX DISEASE].

The case of clinical supervision of the patient having polimorbid pathology is presented. One of extraesophageal manifestations of a gastroesophageal reflux disease is the glossalgia. Glossalgia is the polyetiological disease. Treatment needs to be carried out taking into account the factors causing emergence of a glossalgia. In this regard normalization of functions of organs and systems of an organism is provided.

Effectiveness of low-dose milnacipran for a patient suffering from pain disorder with delusional disorder (somatic type) in the orofacial region.

Glossodynia is chronic pain localized around the tongue, with no perceivable organic abnormalities. In the fields of oral and maxillofacial surgery, it is categorized as an oral psychosomatic disease. In contrast, psychiatric nosology classifies glossodynia as a pain disorder among somatoform disorders, per the DSM-IV. The patient was a 71-year-old woman who developed symptoms of glossodynia, specifically a sore tongue. In the decade before she presented to us, she had had bizarre symptoms of oral cenesthopathy such as the sensation that her teeth had become 'limp and floppy' and that she needles in her mouth. Treatment was attempted using several psychotropic drugs, but no satisfactory response was noted. Because the patient was referred to our outpatient clinic, we tried psychotropic therapy again. Additionally, valproic acid, tandospirone and sertraline were administered (in this order), but the patient still showed no response. However, when sertraline was changed to milnacipran, all symptoms disappeared in a short period. We suggest that a small dose of milnacipran can be effective for controlling oral cenesthopathy as well as glossodynia.

Glossodynia and coeliac disease.

Coeliac disease is an immune-mediated chronic inflammatory disorder of the small bowel caused by irritant gluten and, possibly, other environmental cofactors, in genetically prone people. Coeliac disease is characterized by no (or elusive or varied) symptoms. Oral clinical settings include aphthous stomatitis and dental enamel defects. Association with other signs in the oral mucosa (such as, for example, soreness, a burning sensation, erythema or atrophy) is much less common and, often, not considered by clinicians. We report on a 72-year-old woman with a four months history of oral burning sensation as a single clinical manifestation of coeliac disease. Clinical presentation and symptomatology are discussed in relation to the differential diagnosis of oral glossodynia. This case history highlights the importance of considering coeliac disease in managing cases of idiopathic glossodynia.

Hemifacial spasm, glossodynia, and dolichoectasia of the basilar artery.

The case of a 77-year-old hypertensive man presenting with hemifacial spasm and glossodynia is reported. Imaging studies revealed gross dolichoectasia of the vertebrobasilar arterial system with pontine compression. It is suggested that the neurologic symptoms most likely resulted from pontine compression, rather than from any compression of the cranial nerves.

Glossodynia from Candida-associated lesions, burning mouth syndrome, or mixed causes.

OBJECTIVE: Candida-associated lesions (CALs) and burning mouth syndrome (BMS) may induce glossodynia without objective manifestations. We investigated patients with glossodynia to examine the relationship between CAL and BMS. PATIENTS AND METHODS: A visual analog scale was used to divide 95 patients with glossodynia into three groups according to intensity of pain at rest and when eating. Group A was the functional pain group; group B was the nonfunctional pain group; and group C was a mixed pain group. Antifungal treatment was scheduled for patients with suspected Candida infection by clinical, mycological, or cytological criteria. RESULTS: Culture tests and direct examination results indicated that group A had high Candida positivity (73.0% by culture and 59.5% by direct examination), and showed a good response to antifungal treatment (75.7%). Antifungal treatment was not useful in group B. This was supported by a low Candida infection rate, as determined by direct examination (3.1%). For group C, Candida positivity and antifungal treatment effectiveness were between groups A and B. Furthermore, six patients in group C showed complete remission of functional pain by antifungal treatment only. Favorable outcomes were obtained for 23 patients (10 in group B and 13 in group C), who received antidepressant treatment. CONCLUSION: These results suggested that glossodynia was Candida-associated in group A, and BMS-induced in group B, while group C contained patients with both CAL and BMS.

[Functional somatic syndrome in dental practice].

Functional somatic syndromes (FSSs) are common in dental as well as medical practice. Many patients with unexplained symptoms in oro-maxillo-facial areas visit dentists, but they are not diagnosed and treated properly. Temporomandibular disorder, atypical facial pain, and glossodynia (burning mouth syndrome) are included in dental FSSs. These diseases overlap with each other and with FSSs in other organs, such as myofacial pain syndrome, tension-type headache, fibromyalgia, and chronic fatigue syndrome. They coexist with mental disorders, such as anxiety disorder, mood disorder, and somatoform disorder. Multidisciplinary and holistic approaches should be applied to dental FSSs; pharmacological therapy (antidepressants), physical therapy, and cognitive-behavioral therapy. Clinicians have to support a patient in"enjoying his/her life with symptoms". Dental specialists in "oral medicine" with psychosomatic viewpoints are now required.

Atrophic glossitis from vitamin B12 deficiency: a case misdiagnosed as burning mouth disorder.

BACKGROUND: Glossodynia, or painful sensation of the tongue, can have a spectrum of etiologies, such as local infection, trauma, nerve damage, glossitis, or the enigmatic neuropathic pain syndrome, burning mouth disorder (BMD; also known as burning mouth syndrome). Careful history-taking, physical examination, and appropriate laboratory screening can differentiate these causes of glossodynia and direct further therapy. METHODS: A 73-year-old woman presented with several months of glossodynia having previously been diagnosed by her primary care physician with primary BMD. Subsequently, she consulted an otolaryngologist, who pursued further diagnostic evaluation. RESULTS: Examination revealed the presence of a beefy, red, smooth tongue, and further laboratory evaluation yielded a low serum vitamin B(12) level and macrocytosis. Three months of oral vitamin B(12) supplementation led to partial restoration of serum vitamin B(12) levels and a modest improvement in symptoms. Her final diagnoses were atrophic glossitis and glossodynia secondary to vitamin B(12) deficiency, most likely due to pernicious anemia. CONCLUSIONS: The results of this case have important clinical implications for the diagnostic evaluation and management of patients with glossodynia and apparent BMD. Pathogenic mechanisms of nutrient deficiency in atrophic glossitis are discussed.

[The effectiveness of a benzydamine rinse in the management of stomato-glossopyrosis]. / Benzidamin-tartalmú szájöblítovel szerzett klinikai tapasztalatok a stomato- glossopyrosis kezelésében.

Burning mouth syndrome (BMS) is a frequent source of oral discomfort and sensation mainly at middle-aged or elderly women without identifiable local pathology. Forty-two patients with stomato-glossopyrosis were registered at the Department of Periodontology, Dental School, University Pécs, between August 2002 and January 2003. Oral clinical examination failed to identify physical explanation for the complaint of painful or burning mouth. After complete examination (blood test included), scaling, root planning and oral hygiene instructions were given. Six patients reported decreasing mucosal pain or burning. Two patients had iron-deficiency and Sjögren's syndrome was suspected and verified at another two patients. Thirty-two patients completed the benzydamine-study. They were divided into two groups. The study group (16 patients) rinsed with benzydamine containing solution, the control group (16 patients) received placebo solution for rinsing the same way for ten days. Differences were found between the two groups favouring the benzydamine containing solution. Pain reduction, mouth dryness and diminution of burning sensation were detected by means of visual analog scale (VAS). Benzydamine rinses could be effective in the management of BMS, but clinicians need to monitor patients for possible side effects in the case of long-term use.

Oral Burning With Dysphagia and Weight Loss.

Fibromyalgia is a disorder characterized by an abnormal pain regulation. Widespread pain, fatigue, and sleep disturbance are the prevalent symptoms. When unusual symptoms are overbearingly predominant at clinical presentation, the diagnosis becomes challenging.We report on the case of a patient with fibromyalgia, who presented with dysphagia, odynophagia, and glossodynia as prevalent symptoms. Difficulty in swallowing gradually developed over a month prior hospitalization, and worsened progressively so that nourishment and fluid intake were impeded.Because anemia with mild iron deficiency was found, esophagogastroduodenoscopy was performed, but no lesions were seen in the upper digestive tract. Levels of zinc and vitamin B12 were normal. Intense pain at pelvis and the inferior limbs, which was at a first glance referred to as osteoarthrosis, associated with oral symptoms and feeling of being in the clouds allowed us to diagnose fibromyalgia. Amitriptyline was used, with relief of symptoms.Although oropharyngeal symptoms were occasionally reported in fibromyalgia, they are often overlooked. The present case, therefore, testifies the need to consider the diagnosis of fibromyalgia when the patient presents with such symptoms that cannot be readily explained on other grounds.

Treatment of glossodynia with olanzapine.

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.

Glossodynia--psychodynamic basis and results of psychopathometric investigations.

Between 1985 and 1988, 131 patients suffering from glossodynia were submitted to a careful examination that included a neurological work-up, a detailed psychiatric interview and a number of psychological tests. Particular attention was paid to psychosomatic and psychopathologic disorders. The average age of the patients was 55 yr, and 73% of them were female. In 40% of patients, the psychiatric interview revealed no psychopathological findings, while in most of them, a psychiatrically relevant disorder, usually depression, was found. All patients had an unremarkable neurological status, and the EEG's showed no pathological changes. Psychodynamic considerations in conjunction with the elevated scores for depressive mood, anxiety and tension suggest that glossodynia is an expression of a psychosomatic disorder.

Glossodynia and other disorders of the tongue.

This article discusses the approach to diagnosis and management of disorders of the tongue. These disorders include glossodynia, geographic tongue and smooth tongue, fissured tongue, and black hairy tongue and furred tongue. A brief review of the examination of the tongue is also included.

Pernicious anemia with associated glossodynia.

Glossitis and glossodynia are commonly seen by the dental practitioner. The awareness that these symptoms in conjunction with other oral signs indicate pernicious anemia is important for the clinician. Correct diagnosis can be made, and neurological complications avoided. Two case reports are presented and typical oral and systemic features of pernicious anemia are discussed.

Diabetic neuropathy masquerading as glossodynia.

BACKGROUND: Diabetic neuropathy, or DN, occurs in approximately 50 percent of patients who have type 2 diabetes mellitus, or DM. Oral burning and symptoms consistent with glossodynia (burning mouth syndrome) may occur secondary to DN. CASE DESCRIPTION: A 54-year-old woman reported to a university dental clinic with a chief complaint of oral burning. No clinical signs were evident. Her medical history was positive for type 2 DM. The initial diagnosis was glossodynia, and she was evaluated with relevant blood studies, which indicated that her diabetes was not well-controlled. The patient was referred back to her physician, and her symptoms abated once her diabetic condition was under control. CLINICAL IMPLICATIONS: It is important to consider DN within the differential diagnoses of patients who have symptoms consistent with glossodynia but have no clinical signs. Dentists are invaluable in ascertaining underlying systemic disease considerations in patients with oral symptomatology. Cooperation between dentists and physicians often is helpful and necessary in caring for patients who have uncontrolled type 2 DM and oral symptoms.

Glossodynia as an oral manifestation of diabetes mellitus.

The oral signs and symptoms of glossodynia and xerostomia present a diagnostic problem for the clinician. One of the etiologic considerations in the differential diagnosis should be diabetes mellitus. When diabetes mellitus is suspected, appropriate blood tests should be ordered. If diabetes mellitus is the cause, proper control of the disease will minimize these and other complications and improve the patient's quality of life.

Glossodynia as an oral manifestation of sex hormone alterations.

Oral inflammation occurs during puberty, pregnancy, menses, and therapy with hormones (especially oral contraceptive agents), and other medications such as phenytoin. Alterations of the oral environment result from fluctuations of plasma and salivary sex steroids. The ratio of the sex steroids to one another, and their absolute concentration, determine the amount of prostanoid and peroxidase production and salivary flow. These relationships are complex and are not readily predictable; however, they are reproducible in both humans and animals. The sex steroids exert profound effects on the function of many nonsexual organs; particularly the skin, bone, liver, salivary glands, and oral tissues. We reviewed the currently available information concerning sex steroid action on salivary glands and oral epithelium. In light of the dramatic drop in sex steroid levels at menopause, the purely psychogenic nature of glossodynia or burning mouth (stomatopyrosis), first manifested at menopause, requires further consideration and study.