DIFFERENTIAL DIAGNOSIS AND MANAGEMENT OF

GLOSSODYNIA
By K.Naren babu IVth Year B.D.S

It shows discoloration .tongue.DEFINITION OF GLOSSODYNIA  Glossodynia or Stomatodynia is a condition characterized by a burning or tingling sensation on lips. Some times it is known as burning tongue.or entire mouth   The condition is less commonly known as Orodynia. .ulcers or other visual anomalies in the oral cavity.

GLOSSODYNIA .

Local causes          Trauma to oral mucosa eg.etc.CAUSES OF GLOSSODYNIA The main causes of glossodynia are.lichen planus.-poorly fitting dentures Gastroesophageal reflux disease Oral submucous fibrosis Oral candidiasis Xerostomia (Dry mouth) Trigeminal Neuralgia Mucosal disorders-geographic tongue. Chronic tongue thrust habit Chronic mouth breathing .

Stress.SYSTEMIC CAUSES         Vitamin B12 .Depression Hypothyroidism Chronic gastritis Immunologically-mediated diseases (eg:-sjogren’s syndrome) AIDS .Iron deficiencies Diabetes mellitus Estrogen deficiency Anxiety.

EXPECTED DURATION OF GLOSSODYNIA  Glossodynia can be acute sometimes it is chronic the length of time often depends on the cause .

SIGNS AND SYMPTOMS OF GLOSSODYNIA The main signs and symptoms of glossodynia are          Burning sensation of tongues lips gums and oral mucosa Sensation of dry mouth Tingling sensation of mouth or tongue Mouth pain increased at the end of the day Loss of taste Difficulty of chewing and swallowing Increased thirst Tongue swelling Sore mouth .

DIAGNOSIS OF GLOSSODYNIA The various procedures for diagnosis of glossodynia are  Clinical features that are helpful in diagnosis of BMS : Complains of dry mouth in presence of normal flows  Presence of abnormal or dysgeusic tastes usually metallic .lips and gingiva .bitter or sour  Unilateral or Bilateral burning pain localized to tongue.palate.

CLINICAL TESTS THAT MAY BE HELPFUL IN DIAGNOSING GLOSSODYNIA Hematological tests:-such as complete blood count  Glucose tests  Oral cultures for fungal.viral and bacterial infections if suspected  Saliva test should be done in case if salivary flow is low than Sjogren’s syndrome is suspected  .

.DIFFERENTIAL DIAGNOSIS OF GLOSSODYNIA BURNING MOUTH SYNDROME  Is a common dysaesthesia (distortion of taste) typically described by the patient as a burning sensation of the oral mucosa in the absence of clinically apparent mucosal alterations.

Aetiology: Various local and systemic factors have been postulated to cause this condition It has been associated with:  Post-menopausal women: estrogen and progesterone deficit.  Depression and anxiety states Clinical features:       Age : 30years (40 years men) and the onset in women. Patient may describe irritability or raw feeling. within 3 to 12 years after the menopause. Onset: typically spontaneous. it may be gradual The dorsum of the tongue develops a burning sensation in the anterior two thirds. Diminished number and size of filiform papillae Erythematous and edematous papillae on the tip of the tongue: due to constant rubbing of the tongue against the teeth .

There is a seldom decrease in stimulated salivary output tests. especially the anterior hard palate and the lips. despite complain of xerostomia. Condition does not interfere with sleep.      Additional oral sites are affected in a similar manner. Contact with hot food or liquids intensifies the symptoms. Chronic discomforts: demonstrate psychologic dysfunction. . anxiety or irritability. Persistent altered or diminished taste may accompnay the burning sensation. usually depression.

difficulty in eating Disease may be due to hypersensitivity to betel nut. chronic disease affecting any part of the oral cavity and sometimes even the pharynx.trismus . Characterized by fibroelastic change of the lamina propria with epithelial atrophy This causes: . .Oral Submucous Fibrosis     Defined as an insidious.stiffness of oral mucosa .

Clinical features  Most common initial symptom: . facial pillars. . recurrent stomatitis  Striking clinical feature: blanching of the oral mucosa  On palpation: presence of fibrous bands in palate. ulcerations. buccal mucosa and lips.Burning sensation in the mouth .  Other frequent early symptoms: .Blisters. on eating spicy food.

There is evidence that the largest tactile fibers are not involved. Although aberrant blood vessels or neoplasm's may impinge on the trigeminal nerve. g.Neuralgias Trigeminal neuralgia  Trigeminal neuralgia (tic douloureux) is characterized by brief paroxysms of pain limited to the facial distribution of the trigeminal nerve and is precipitated by stimuli to sensory endings in the trigeminal receptive area. touching the face..32  The etiology of trigeminal neuralgia remains an enigma. as in shaving or washing) or by stimuli such as talking and mastication. they do not explain the nature of this pain syndrome. which increase the proprioceptive inflow. .  It is common knowledge that the attacks of pain are precipitated by tactile stimulation of the trigger zone (e.

Glossopharyngeal neuralgia  The glosophayrngeal neuralgia is characterized by unilateral paroxysmal stabbing pain followed by a burning sensation.  Among 217 patients with glossopharyngeal neuralgia. 155 times: tonsil. 69 times. If the patient is relieved for one or two hours afterward. 147 times. but it is a rare condition when compared with the occurrence of trigeminal neuralgia and the pain is less severe. The treatment is similar to that for trigeminal neuralgia. the test is considered positive for glossopharyngeal neuralgia52  The etiology of glossopharyngeal neuralgia is obscure. the pain was localized to one or more of the following regions: ear. . larynx. and tongue 43 times52  Glossopharyngeal neuralgia bears a striking similarity to trigeminal neuralgia.  The application of a 10% solution of cocaine to the region of the tonsil and pharynx may assist in the correct diagnosis.

Reddening become intense. At this stage:Tongue becomes swollen that indentations from the teeth are found along the borders of the tongue. Filiform  most sensitive and disappear first. . Tongue :.first manifestations of pellagra and dermatitis Tongue becomes Fiery red. In early stages :Only and margins of the tongue are swollen and red.NIACIN DEFICIENCY                Oral changes :.extremely sensitive. Devoid of papillae. Ulcerations' :. In advanced cases: Tongue loses all the papillae. Fungi form  become enlarged.dorsum of tongue.

Immature WBC in circulating blood. Small cracks on the dorsum.FOLIC ACID DEFICIENCY AETIOLOGY :            Inadequate intake (alcoholics) Deficient absorption (tropical sprue) Excessive demand by tissue of the body (rapidly growing tumors). deficiency (pernicious anemia) except for absence of nemologic disturbances in folic acid deficiency. Leukemia :Leukemia is a malignant systemic disease characterized by a progressive overproduction of any of the WBCs. O/M:Marked glossitis Tongue is fiery red and the seat of atrophy of both filiform and fungi form papillae. Symptoms and signs of folic acid closely resemble those of vitamin B12. Tongue is swollen. .

hormone replacement or topical estrogen applied to oral mucosa . spicy and acidic foods Drink more fluids Analgesic sprays or mouthwashes such as Benzydamine hydrochloride In post –menopausal female patients .TREATMENT AND MANAGEMENT OF GLOSSODYNIA The main treatment involves management and drug therapy for glossodynia Management       Good oral hygiene Stop smoking Avoid alcohol .

75mg Low doses of tricyclic antidepressants like amitriptyline 1040mg Topical medications like clonidine and capsaicin may be considered for application to local site Low doses of anticonvulsants like barbiturates is to be given in conditions like CNS depressions Alpha-Lipoic acid 600-800mg is given      . The drugs mainly used in glossodynia are Low doses of benzodiazepines like clonazepam 0.250.DRUG THERAPY FOR GLOSSODYNIA There is no cure for glossodynia but the treatment helps to reduce the signs and symptoms of glossodynia.

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DRUGS CAUSING GLOSSODYNIA There are some classes of drugs which cause glossodynia they are  Drugs using for hyper tension such as ACE inhibitors  Estrogen replacement therapy but only in some cases  Diuretics  Salivary gland hypo function (dryness) .

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REFERENCE BURKET’S ELEVENTH EDITION  SHAFER’S ORAL PATHOLOGY SIXTH EDITION  NEVILLE ORAL PATHOLOGY  .