Glossary K14.6

Chronic sensations of discomfort in the oral cavity and/or tongue (chronic oro-lingual dysesthesia), which manifest themselves as extremely unpleasant burning, stinging, tingling, itching as well as a feeling of soreness and other sensations. These symptoms may be associated with disturbed or bad taste (and smell) sensation.

The prevalence is between 80-120/100,000, with the highest age-adjusted prevalence being found among women between 70 and 80 years of age, at around 500/100,000.

Mostly there are psychological causes, e.g. in the context of a larvated depression or involution depression in carcinophobia. Contact sensitization can be detected in about 70% of patients (see below). Secondary occurrence as an accompanying symptom in:

Local factors:

• Exfoliatio areata linguae
• Hairy tongue
• diabetes mellitus
• lingua plicata
• Lichen planus mucosae
• Contact allergies(nickel, palladium, perubalsam, peppermint oil, methacrylates; benzoyl peroxide)
• temporomandibular joint syndrome (Cowden syndrome)
• Glossitis electrogalvanica (with fillings or dentures made of vesch. Metals between which a voltage element is created)

Systemic factors:

• Vitamin B12 deficiency
• Folic acid deficiency
• Glossitis Möller-Hunter
• Iron deficiency anemia (see below trace elements, deficiency symptoms)
• Plummer-Vinson syndrome
• Sjögren's syndrome
• Side effect of beta-blockers.
• Diabetes mellitus (undiagnosed or poorly controlled)
• Vitamin deficiency states of vitamin B1, B2, B6
• Sjögren's syndrome
• Acoustic neuroma
• Xerostomia causing drugs

Occurs mainly in women between 45 and 70 years of age, often during and after the menopause. In children this symptom practically does not occur. w:m=4:1.

Except for tongue burning and/or tongue pain no clinical local findings; only very rarely slight inflammatory redness of the tongue. Typical complaints are a constant feeling of a burned tongue (hot tongue syndrome) and burning or stabbing pain (burning mouth syndrome).

Associated disorders:

Dry mouth (66%)

Flavour disorders (11%)

Often signs of mild depression, insomnia and general listlessness are evident.

The glossodyniae can be classified as follows:

• Type I: Complaints usually begin in the morning and increase during the day. Complaints become unbearable in the evening when fatigue sets in.
• Type II: Continuous symptoms (often combined with contact allergies)
• Type III (most common type): Intermittent pain symptoms.

Many patients have a history of a causal relationship with a previous dental treatment.

Normal mucosa, no signs of inflammation. Signs of small fibre neuropathy.

A difficult clinical picture to treat, as often no organic substrate is detectable. An epicutaneous test should be carried out for the relatively high number of contact allergies.

Psychotherapy often does not lead to freedom from symptoms, but should still be discussed.

Important: Continuous care by an experienced, patient doctor is necessary. If necessary therapy of an underlying disease.

Mild rinsing with stomatological products such as camomile extracts (Kamillosan solution) and

anaesthetic solutions such as benzocaine before meals (e.g. Dolo-Dobendan solution).

Occasionally, artificial saliva products can help, especially in cases of additional dry mouth.

Success has also been achieved with the topical application of clonazepam (Liu YF et al. 2018), 3-minute sucking of a clonazepam 1 mg, tablet, then spit it out, 3 times daily for 14 days (The authors (Gremeau-Richard C et al. 2004) assume a local effect of clonazepam on the benzodiazepine-GABA-A receptor complex in the nerve endings of the tongue mucous membrane which goes beyond the placebo effect).

Initial successes on various drugs such as carbamazepine (e.g. Tegretal) 400-800 mg/day in 3-4 ED (slow dose build-up) or tricyclic antidepressants (e.g. Sarotene) 25 mg p.o. 3 times/day, max. 150 mg/day In the chronic, often years-long course, which dominates both private and professional life, an additional drug abuse may occur.

In the case of complete therapeutic failure, the ultima ratio is mutual blocking of the cervical superius ganglion or the stellate ganglion.

The glossodynia is a diagnosis of exclusion.

Psychogenic, chronic, oro-lingual dysesthesias are often the somatized expression of a severe, emotionally unprocessed experience of loss (family conflict, loss of partner, climacteric, family disintegration, etc.).

If in such a crisis situation the loss of teeth (prosthesis) is added to the awareness of age, patients who are disposed accordingly react, usually unconsciously, with an oral dysaesthesia symptom.

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