SCALDED TONGUE: CAUSES, SYMPTOMS AND TREATMENTS - MEDICINE - 2025

The scalded tongue is a condition that causes pain, burning or stinging on the tongue, either wholly or the portion corresponding to the buccal mucosa. It is referred to by the patient as a "burning sensation."

It is part of what is known as burning mouth syndrome, glossodynia (painful tongue) or glossopyrosis (burning tongue), as well as stomatodynia, stomatopirosis or oral dysesthesia.

Fictitious representation of the main scalded tongue syndrome. Creative Commons Zero License - CC0

This syndrome is a clinical picture characterized by the sensations in the oral cavity described above, without other clinical or laboratory data to explain the symptoms.

It has also been defined as chronic pain or burning in the tongue or in the oral mucosa for at least a prolonged period of 4 to 6 months, without presenting other clinical or laboratory signs.

This pathology is more frequent in women at the time of menopause. The cause is not known and many factors of various origins have been implicated, which is why it is considered a multifactorial pathology.

Nutritional, hematological, rheumatological, hormonal, neurological, psychological, dietary and hygienic factors have been proposed.

This syndrome that affects the quality of life of people who suffer from it will be described below and, although of unknown origin, some related antecedents, diagnostic guidelines and therapeutic approach will be described.

Causes of scalded tongue

Burning mouth syndrome or burning mouth can be primary or idiopathic, that is, the cause of which is unknown, and secondary as it is related to systemic or local conditions that can predispose or cause this symptomatology.

Systemic or local causes

This sensation of stinging, burning, pain and / or burning of the tongue or oral cavity is not accompanied by lesions in the mucosa. It is more common in women after 50 years of age and, for this reason, some authors associate it with a decrease in estrogens.

In elderly patients it has commonly been linked to poorly fitting dentures, anxiety and depression, which can be treated. In other cases, it has also been linked to the habit of some elderly people of permanently pushing the tongue against the gums or teeth.

Symptoms sometimes lead to vitamin B12 deficiency, iron deficiency, diabetes mellitus (diabetic neuropathy), mild Candida infections, geographic tongue (or benign migratory glossitis), sensitivity to some foods such as cinnamon, mild xerostomia (dry tongue) and Vinson Plummer syndrome.

Vinson Plummer syndrome is a rare syndrome. It is related to iron deficiency, anemia, dysphagia and other esophageal problems and with an oral pathology characterized by glossitis, glossopyrosis, glossodynia and angular cheilitis (painful lesion in the corner of the mouth).

Other associated causes have been allergies to dental materials such as methyl methacrylate cobalt chloride, mercury and nickel sulfate.

Allergies to some substances included in food such as cinnamic aldehyde (food flavoring and toothpastes), propylene glycol, nicotinic acid (rubefacient in toothpastes) and sorbic acid (preservative in some foods). In these cases the symptoms are intermittent.

Drugs

Some drugs are related to the sensation of a scalded mouth or burning mouth, among these are some antihistamines and neuroleptics, some antihypertensives such as inhibitors of the renin-angiotensin system and benzodiazepines.

Symptoms

This syndrome can occur at any age, some authors even describe it as one of the first manifestations of HIV infection. It is rare in those under 30 years of age and its highest frequency is for women around 50-70 years of age, although it also occurs in men.

By visual examination, no lesions were observed on the oral mucosa or on the tongue, only some patients had chapped lips and dry mucosa.

Patients describe their bothersome oral sensations as burning sensations, tingling, stinging, numbness. These sensations can range from mild to moderate, to severe. They can be continuous or intermittent (fluctuating).

Some patients describe not having any symptoms when they get up and then these appear throughout the day, reaching their maximum intensity in the afternoon. These cases are frequently related to nutritional deficiencies.

Badly fitting dental prosthesis a cause of glossodynia (Source: Pilar Molés Julio via Wikimedia Commons)

Others report continuous discomfort that is exacerbated at night, being related to anxiety or depression. Others have intermittent discomfort with some days without symptoms, this form of presentation is frequently related to allergies.

The sensations can be located on the tongue or in any part of the oral cavity. The tip and the anterior two-thirds of the tongue are the most frequent locations. In the wearers of dentures or dental prostheses, the sensations are located in the alveolar ridge.

Patients may also report dry mouth (xerostomia) and strange tastes.

Treatments

The therapeutic approach is difficult and the use of some medications, sometimes, instead of improving, exacerbates the symptoms. First, it is advisable to make an accurate clinical diagnosis in order to determine the presence of local or systemic causal factors.

When the oral cavity is examined, the fit of the prostheses, occlusion problems, the presence of certain habits such as bruxism, an involuntary habit that causes the patient to clench the jaw strongly and grind the teeth, denoting emotional stress should be examined.

In the oral cavity, the presence of geographic tongue, mild candidiasis, and xerostomia should be evaluated.

If none of the aforementioned alterations are present, systemic causes should be evaluated, such as deficiencies in B vitamins, iron deficiency, hormonal problems and allergies. For this, the clinical examination and complementary tests will be used.

Local treatment

Local causes related to dental prostheses, occlusion, bruxism and local candidiasis must be corrected and treated and, many times, this solves the problem, thus the symptoms disappear.

If the problem is xerostomia, a benzydamine solution, which is a non-steroidal anti-inflammatory drug, can be used. It is used locally with “swish”, as a mouthwash. There are references that indicate that, in some patients, this procedure improves xerostomia, reduces pain and the burning sensation.

In the case of causes related to nutritional deficits, these must be treated and some local measures can be used simultaneously. These include the use of some topical swish solutions, such as swish made with warm water, diphenhydramine syrup (antihistamine medicine), sodium bicarbonate, and hydrogen peroxide.

Another therapeutic measure that has proven to be efficient for certain patients is the use of hypnosis, as it reduces anxiety and pain.

Pharmacotherapy

In patients in whom empirical procedures fail or a precise cause related to their symptoms cannot be detected, some pharmacological procedures may be indicated.

Anxiolytics and antidepressants should be used with care because, although they may initially produce improvement, the side effect of xerostomia related to their use may later worsen the clinical picture.

In some patients, good results have been obtained with gabapentin, an anticonvulsant drug that is indicated at low doses.

References

1. Arnáiz-Garcíaa, ME, Arnáiz-Garcíab, AM, Alonso-Peñac, D., García-Martínd, A., Campillo-Campañac, R., & Arnáize, J. (2017). general and family medicine.
2. Forssell, H., Jääskeläinen, S., Tenovuo, O., & Hinkka, S. (2002). Sensory dysfunction in burning mouth syndrome. Pain, 99 (1-2), 41-47.
3. Grushka, M., Epstein, JB, & Gorsky, M. (2002). Burning mouth syndrome. American family physician, 65 (4), 615.
4. Iorgulescu, G. (2009). Saliva between normal and pathological. Important factors in determining systemic and oral health. Journal of medicine and life, 2 (3), 303.
5. Perdomo Lovera, M., & Chimenos Klistner, E. (2003). Burning mouth syndrome: update. Advances in Odontostomatology, 19 (4), 193-202.
6. Ros Lluch, N., Chimenos Küstner, E., López López, J., & Rodríguez de Rivera Campillo, ME (2008). Burning Mouth Syndrome: Diagnostic and Therapeutic Update. Advances in Odontostomatology, 24 (5), 313-321.
7. Viglioglia, P. (2005). Stomatodynia-Glossodynia. Acta Terap Dermatol, 397.