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:

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:

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:

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:

Treatment of oral dysaesthesia

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

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