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Dental and Oral Health (Adults)

Teeth irritating tongue

07/05/2007

Question:

I have had burning of tip and sides of tongue which gets wocrse with talking in particular and as the day progresses. I been to dentists, gum disease specialist, ENT and dermatologist to name a few to figure out but of no help. It started few years ago after dental clean for tartar and using whitening strips and then I developed tongue ulcers. I don`t know if it was coincidental or had anything to do with it. I saw my dentist and she tried to smooth my teeth which helped some and the ENT thought I may have tongue larger for my mouth. I have corrected autoimmune thyroid dz. I have tried all sort of supplements. I have tried to stop various foods which are spicy and irritating and it helps some but the burning has never gone away. I have no other sxs and stress doesn`t seem to be the causative agent, neither teeth grinding. I have tried changing toothpastes and gone onto baking soda. Also I feel a strange sensation where teeth touch tongue, as if teeth are raw or metallic. My lips do get dry a lot.

I have spoken to dentists and they cannot figure out or said anything when I asked if there are any tests or cultures they can do further ti=o diagnose. Please`suggest what may help, its quiet frustrating.

Answer:

By the sounds of your description of signs and symptoms, you may have a variant of "burning mouth syndrome". You really need to be evaluated by either an oral medicine specialist or a neurologist.

Burning mouth or Burning mouth Syndrome is a very complex and poorly understood problem.

There are many theories on the cause of this disorder that range from trauma or chemical insult to the lingual or trigeminal nerve to hormonal imbalances, viral infections and finally psychologically based causes.

In your case, the possible culprit may be your response to tooth whitening and the irritants that are in the strips (carbamide peroxide). Thus "smoothing your teeth" probably was of little if any help for this problem.

Your tongue being too large for your mouth (macroglossia) is questionable, as the tongue can enlarge laterally if you are missing teeth in the posterior mandibular arch, but I would be very suspect of someone wanting to cut on my tongue unless I had a serious lesion (Squamous cell CA).

The problem has been described to generally affect post menopausal women, but there are other studies that describe male subjects with BMS. Because of the prevalence of females that are post menopausal, hormonal variances have been implicated, but results are only anecdotal.

There are positive associations with the syndrome such as decrease or loss of saliva and changes in taste perception. Certain medications have been associated with BMS such as the ACE class of drugs (Angiotension converting enzyme inhibitors). Fungal infections or increased yeast carriage has been theorized to be responsible, but the increase in fungal carriage may be related to the decrease in salivary flow and not the causative agent.

As mentioned, certain drugs can cause oral dryness as can certain autoimmune disease, and thus may be causally associated with BMS.

To answer you concerns, she should see a dentist trained on oral medicine and BMS patients. An oral surgeon would be another option for evaluating your problem. If that is not a possibility, a neurologist would be in order to evaluate the possibility of nerve involvement to the tongue (cranial nerves 5, 7, and 9).

For more information:

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Response by:

Richard J Jurevic, DDS, PhD Richard J Jurevic, DDS, PhD
Formerly, Assistant Professor of Biological Sciences
School of Dental Medicine
Case Western Reserve University