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Sunday, May 19, 2013
Dry and bitter mouth
Recently, I feel very dry and bitter in my mouth. It doesn`t help even after I drink a lot of water. Sometimes, it will relieve for a short period after eating the food. Could you tell me what causes this condition and how to treat it? Thanks.
This is a very complex problem, with multiple etiologies. I will first preface my comments with "I would recommend that you have this evaluated by your dentist or physician or both."
You complain of 2 problems, oral dryness or xerostomia, and a "bitter" taste in your mouth that is transiently relieved with eating, not drinking water.
Dry mouth can be due to many different things:
- autoimmune diseases (Sjogrens syndrome, diabetes, and systemic lupus erythematosis)
- radiation treatment
- and other systemic diseases (Cystic fibrosis, HIV/AIDS).
Thus, you need to have the dry mouth problem evaluated. The bitter taste problem may also be exacerbated by the dry mouth. Lack of saliva can be a bothersome condition and lead to dental caries, and oral infections (candidiasis) and altered taste such as you describe.
The taste problem or dygeusia (perception of altered taste), is much more complex and may be the result of recent infection, medications, or underlying systemic condition. Oral fungal infection (candidiasis) can be associated with increased bitter taste sensation as can periodontal infection or dental abscess. Neurologic disorders have also been implicated in dysgeusia (Bell's palsy, herpetic infection, migraine headaches).
Taste perception and associated problems is a "hot" topic in the basic oral science arena. Recent findings have discovered specific "G-protein coupled receptors" (GCPCs) known as T2R1 and T2R2 located on chromosome 5p15 that are associated with the responsiveness to bitter taste.
It is conceivable that certain medications may also affect the function of GPCRs and potentate the bitter taste response. I would ask your physician if anything you are currently taking may be associated with your tastecproblem. Bitter response is one mechanism for the body to detect or warn of "poisons," thus the aversion or avoidance to bitter foods like caffeine, nicotine, and strychnine and certain plant alkaloids that are toxic. So the ability to taste bitter is good, it is a protective mechanism, but your problem is that you experience it all the time, and that is a pain.
Currently, specialized oral medicine/taste disorder labs use a chemical (propylthiouracil or "Prope") to test for bitter taste receptors abnormalities. Not many general practice dental practices are set up to evaluate the complex constellation of taste disorders, and you may need to be evaluated at one of the major medical/dental institutions within the state (CWRU/UH, OSU, UC) if the condition persists or worsens. Your problem may be simple and related to current medications and or a recent infection. But, I would highly recommend that you have it evaluated so that the etiology of the problem can be determined and resolved.
Richard J Jurevic, DDS, PhD
Assistant Professor of Biological Sciences
School of Dental Medicine
Case Western Reserve University