Oral dysaesthesia

Author: Dr Delwyn Dyall-Smith FACD, Dermatologist, 2010.


What is oral dysaesthesia?

Oral dysaesthesia describes a painful, usually burning feeling, in the mouth. It can be classified as:

  • ‘primary’ when no organic cause can be identified. This form is usually called ‘burning mouth syndrome’ although there are numerous other names used including orodynia and glosssodynia.
  • ‘secondary’ when a local or systemic cause can be found for the symptom.

Causes of secondary oral dysaesthesia

Oral dysaesthesia may result from local or systemic conditions.

Causes of a painful mouth
Local causes
Infection
Contact stomatitis Irritation or allergy due to contact with:
Dry mouth (xerostomia) Reduced parotid salivary gland output due to:
  • Duct obstruction
  • Duct or gland inflammation
  • Following surgery or radiotherapy
  • Mouth breathing/nasal obstruction.
Other local causes
Systemic causes
Anaemia
Autoimmune diseases
Connective tissue diseases
Dehydration  
Hormonal disorders
Lichen planus
Medications:
  • Causes of oral burning – ACE inhibitors, angiotensin receptor blockers, antiretroviral agents, chemotherapy, clonazepam
  • Causes of xerostomia – anticholinergics, psychotropic drugs, tricyclic antidepressants e.g. amitriptyline, antihistamines
Neurological disorders
  • Multiple sclerosis
  • Ciguartera neurotoxin
Nutritional deficiencies

Clinical features

When taking the history, the pattern of pain can be classified into three types:

  • Type 1 – pain absent on waking, gradually increasing during the day
  • Type 2 – pain can be present day and night
  • Type 3 – intermittent with pain-free days.

Further questioning will inquire about symptoms of associated disorders, general health, diet and medication use including prescribed, over-the-counter and alternative therapies.

A thorough clinical examination must be performed. This should include careful evaluation of the mouth, head and neck for local causes. A general examination including the skin and nails may provide evidence of nutritional deficiencies, autoimmune and connective tissue diseases, hormonal deficiencies or lichen planus. Neurological examination will assess for neurological deficits including the neuropathies of diabetes and vitamin B12 deficiency.

How is the diagnosis made?

The diagnosis of oral dysaesthesia is made on careful history and examination. Sometimes the pattern of pain may give a clue as to the cause:

  • Type 1 – nutritional deficiency, diabetes
  • Type 2 – chronic anxiety
  • Type 3 – food allergy

A list of possible causes can then be made.

The actual cause however may only be determined with further investigations. These will be determined by the clinical findings and may include:

  • Blood Tests
  • Full blood examination
  • ESR
  • Fasting blood sugar
  • Serum folate and vitamin B12 levels
  • Iron studies
  • FSH/LH
  • Thyroid hormone studies
  • Autoantibodies – antithyroperoxidase, antimicrosomal, antithyroglobulin
  • ANA, RF, anti-SS, -Ro, -SS-B, -SS-La antibodies
  • Imaging studies may include CT scan (head), MRI (head, spinal cord), thyroid scan
  • Lumbar puncture
  • Mucosal biopsy for histopathology and possibly immunofluorescence
  • Mucosal scraping or swabs for microbiological assessment
  • Patch tests with benzoic acid, benzoyl peroxide, chestnuts, cinnamon, cobalt chloride, mercury, methylmethacrylate, nicotinic acid, octyl gallate, peanuts, petrolatum cadmium sulfate, propylene glycol, sorbic acid
  • Schirmer’s test
  • Sialometry
  • Upper GIT endoscopy

Treatment of oral dysaesthesia

Treatment is of the underlying condition and therefore options will include, amongst others:

  • Ceasing/changing drugs that cause xerostomia or oral pain
  • Oral nystatin
  • Adjust thyroxine dose
  • Avoid potential irritants and allergens
  • Cease smoking or oral tobacco use
  • Chew sorbitol-containing gum to stimulate saliva
  • Supplements of folate, iron and B group vitamins
  • Dental care such as adjust dental prostheses

 

Related Information

References:

  • Bolognia JL, Jorizzo JL, Rapani RP. Dermatology: second edition 2008. Dysesthesias
  • Meddles KG, Eusterman VD. Burning Mouth Syndrome – eMedicine Otolaryngology and Facial Plastic Surgery
  • Savage NW, Boras VV, Barker K. Burning mouth syndrome: Clinical presentation, diagnosis and treatment. Australas J Dermatol 2006; 47: 77–83.
  • Torgerson RR, Davis MD, Bruce AJ, Farmer SA, Rogers RS 3rd. Contact Allergy in Oral Disease. J.Am Acad Dermatology 2007 Aug; 57(2):315-21

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