Glossodynia is a pathology characterized by chronic pain of the tongue apart from any lesion that can be seen on clinical examination. Glossodynia can be secondary, linked to an external cause, or primary: this is called stomatodynia. Stomatodynia refers to “burning tongue syndrome”, also called psychogenic oral paresthesia. The exact mechanism of this pathology remains controversial to this day and much research is still trying to determine it in order to find the appropriate treatment.

Definition of glossodynia

Glossodynia is a pathology characterized by chronic pain of the tongue apart from any lesion that can be seen on clinical examination.

Types of glossodynies

Glossodynia can be:

• Secondary, that is to say linked to a loco-regional or general cause: it then becomes synonymous with glossalgia;
• Primary or essential: this is called stomatodynia. This type of glossodynia refers to “burning tongue syndrome”, also called psychogenic oral paresthesia.

Causes of glossodynia

The causes of secondary glossodynia are various:

• Bruxism (teeth grinding), ill-fitting dental apparatus, bimetallism (electrolyte interaction between two metals and saliva), occlusion disorders (dental contact);
• Glossitis (inflammation of the tongue) of autoimmune, genetic origin;
• Oral yeast infection (parasitic infection such as thrush);
• Contact allergy: food, medication, make-up, toothpaste…;
• Gastroesophageal reflux…

Those of primary glossodynia, or “burning tongue syndrome”, remain controversial and the exact mechanism of this pathology has not yet been defined. Among the hypotheses, we find:

• Neuropathic origins with an alteration of peripheral and / or central sensory nerve fibers;
• Hormonal changes associated with menopause;
• Depression and anxiety;
• A possible neuronal inflammation …

Diagnosis of glossodynia

The diagnosis of glossodynia is the elimination of secondary glossodynia and / or confirmation of primary glossodynia with the following tests:

• A careful examination of the oral mucous membranes in order to detect any abnormal lesions of organic origin;
• An examination of the teeth;
• The search for glossitis;
• Saliva tests combined with a biopsy of the salivary glands as needed;
• A mycological sample;
• A neurological test to rule out central or peripheral neuropathy;
• A complete blood count (or blood count) in order to rule out the hypothesis of an anemic tongue;
• A sedimentation rate to eliminate organic disease;
• Measurement of serum iron, zinc, folate, vitamins B1, B6 and B12 levels;
• Blood sugar in order to rule out potential diabetes;
• Estrogen and progesterone levels (menopause-related disorders).

People affected by glossodynia

Primary glossodynias mainly affect women between the ages of 40 and 60 and are very often associated with menopause or psychological disorders.

Factors favoring glossodynia

Different factors can promote glossodynia:

• Dental occlusion disorders;
• Oral tics;
• Xerostomia (dry mouth);
• Contact allergies (food allergens, cosmetics, chlorhexidine, etc.);
• Bacterial, fungal or viral agents;
• Diabetes ;
• Thyroid dysfunction;
• Menopause ;
• Certain drugs;
• Nutritional deficits (vitamins B1, B2, B6, B12, folic acid, iron, zinc).

“Mouth on fire”

Glossodynia causes pain, mainly localized on the tongue, of the “burning” or “tingling” type. During primary glossodynia, these pains usually appear after waking up to reach a peak of maximum intensity in the late afternoon. On the other hand, they diminish during meals.

Salivary disorders

Glossodynia frequently causes a feeling of dry mouth, sticky saliva or, conversely, excess saliva.

Taste disorders

Primary glossodynia can be accompanied by an altered taste sensation – bitterness, acidity, metallic taste …

Anxiety disorders

Due to the anxiety-related somatization of a more serious disease, primary glossodynia often generates anxiety and / or depressive disorders.

Other symptoms

• Discomfort in the lips, palate, cheeks and sometimes in the throat;
• Ageusia (loss of taste);
• Swallowing problems.

The treatment for secondary glossodynia is that of the causative disease.

That of primary glossodynia remains complicated and much research is currently underway to establish the precise causes of this pathology in order to find the appropriate treatment. However, some options for relieving pain do exist:

• Clonazepam (benzodiazepine) reduces the burning sensation in 70% of patients;
• Capsaicin, a chemical compound of the alkaloid family, an active component of pepper, applied to the tongue 3 to 4 times a day allows partial or even total remission of pain;
• The practice of cognitive and behavioral therapies;
• Psychological support, in particular the recognition of the pathology, also allows a marked improvement in pain. It should be noted that the administration of anxiolytics and antidepressants proves to be insufficient.

In order to prevent or not worsen glossodynias, some precautions can be taken:

• No smoking ;
• Avoid spicy dishes, hot or acidic sauces and acidic drinks;
• Limit the consumption of alcohol and sparkling drinks;
• Do not use mouthwash containing alcohol;
• Practice regular physical activity;
• Good sleep ;
• Better manage your stress: phases of rest (reading, writing), meditation, yoga …