Glossodynia is a neurogenic disease that develops against the background of chronic pathology of internal organs, manifested by paresthesia, changes in taste sensitivity and saliva secretion. Patients indicate the appearance of burning, tingling on the oral mucosa, tongue, palate, facial skin. There are no paresthetic symptoms during meals. Diagnosis includes clinical examination, saliva examination, identification of characteristic neurological reflexes. Therapy is aimed at eliminating causal factors, triggers and local paresthetic manifestations. The task of pathogenetic treatment is to normalize the work of the central nervous system.
ICD 10
K14.6 Glossodynia
Meaning
Glossodynia (paresthetic phenomenon, stomatodynia) is a viscero–reflex stem syndrome accompanied by a violation of the sensitivity of the tongue, paresthesia, a change in the secretory function of the salivary glands. Among diseases of the oral mucosa, the frequency of glossodynia is 15-18%. Pathology is more often diagnosed in young and middle-aged women. In the vast majority of patients diagnosed with glossodynia, unpleasant sensations are concentrated on the tongue. In 2/3 of patients, there is a change in the rate of salivation: 80% of them have hyposalivation, 20% have increased salivation. Psychosomatic disorders contribute to the development of the disease.
Causes
Etiological factors are not fully understood. The pathogenetic relationship of glossodynia with general somatic pathology has been established. The causes of glossodynia are chronic diseases of internal organs and neurogenic disorders:
- Disorders of the digestive system. With gastritis, colitis, cholecystitis, characteristic paresthesia symptoms occur at the time of exacerbation of the underlying disease and are absent during remission. Manifestations of glossodynia may also be associated with pancreatitis, gastric ulcer.
- Diseases of the endocrine system. Changes in the hormonal background contribute to the launch of the paresthetic phenomenon. Signs of glossodynia occur in patients with diabetes mellitus, with a violation of the functioning of the thyroid gland.
- Diseases of the heart and blood vessels. The causes of glossodynia are the initial form of atherosclerosis, hypertension, ischemic disease. Diseases characterized by cerebral vascular lesions also occur with pronounced paresthetic symptoms.
- Dysfunction of the nervous system. This group includes vegetative-vascular dystonia, as well as functional disorders of the nervous system, accompanied by insomnia, decreased performance, rapid fatigue.
Risk factors
The manifestation of pathology against the background of chronic diseases is facilitated by the influence of local or general provoking factors. Triggers:
- local conditions: dysfunction of the temporomandibular joint, supracontacts due to irrational prosthetics;
- the effect of mechanical, chemical or thermal stimuli on the oral mucosa;
- stressful situations;
- psychogenic disorders: patients with anxiety and depressive states are prone to glossodynia.
Pathogenesis
In diseases of the digestive system accompanied by functional disorders, a constant stream of nerve impulses enters the segmental apparatus of the brain stem and suprasegmental structures of the autonomic nervous system. As a result, stagnant foci of excitation develop in the new cortex, limbic-reticular complex and hypothalamus.
There is a violation of the connection of cortical-subcortical-stem structures with the involvement of the immune system, opioidergic neurons, hypothalamic-pituitary regulation. This causes even more pronounced irritation of the nuclei of the segmental apparatus. Paresthesia occurs on the oral mucosa, tongue, palate, secretory and gustatory bulbar disorders develop.
Patients have increased activity of the sympatho-adrenal system with simultaneous suppression of kallikrein-kinin. Due to hypertension, hypoxia and tissue ischemia occur in target organs with excessive accumulation of metabolic products, which leads to changes in the sensitive structures of the vegetative nuclei.
Classification
A characteristic feature of glossodynia is the concentration of paresthesias in one zone with a gradual spread of symptoms to adjacent areas. Based on this principle, the neurostomatologist E.S. Yavorskaya identifies 6 forms of pathology:
- Lingual-mandibular. Unpleasant sensations are focused on the tongue and spread to the mucous membrane of the alveolar process of the lower jaw.
- Mandible-maxillary. The pathological focus involves the lips, the mucosa covering the alveolar processes, and the palate.
- Maxillary. Paresthesia is localized in the area of the upper jaw.
- Glossopharyngeal. The paresthetic focus spreads from the root of the tongue to the pharynx and esophagus.
- Frontoparietal. Unpleasant sensations occur on the skin of the frontal zone with the gradual involvement of the parietal area.
- Occipital. Burning sensations, tingling correspond to the occipital region.
In clinical dentistry, there is another alternative classification, where the principle of localization of pathological manifestations is also taken as a basis. Includes 2 forms:
- Flour. Glossodynia spreads to the mucous membrane of the oral cavity, tongue, palate, alveolar processes, pharynx.
- Dermatomucous. Paresthetic symptoms, in addition to the oral mucosa, alveolar processes, are also manifested on the skin of the central parts of the face.
Symptoms
The disease is characterized by the appearance of paresthetic sensations on the oral mucosa. Characteristic complaints: tingling, itching, “crawling goosebumps”, the presence of hair. Glossodynia is characterized by the concentration of local symptoms in the tip area or over the entire surface of the tongue, less often in the root area. Over time, the lesion expands according to the type of “oil stain”. The oral mucosa, pharynx, and facial skin are involved in the pathological process.
At first, the unpleasant sensations last for several minutes. With the progression of the disease, patients complain of constant discomfort. More often episodes occur in the evening. Sometimes the burning sensation in the tongue can last all night, after which patients feel exhausted. There is no paresthesia symptom complex during meals. In addition to tingling, burning, itching, patients may indicate that the tongue has become swollen, does not fit in the mouth. There is a feeling of pressure in the throat, swallowing and articulation are disturbed.
Complications
The duration of periods of paresthesia tends to increase over time. This leads to emotional depression. Patients feel pronounced physical fatigue, weakness, decreased performance. Patients often suffer from insomnia. Against the background of glossodynia, neurasthenia, neurosis, and carcinophobia may develop.
Diagnostics
Diagnosis of glossodynia is based on complaints, clinical examination data and auxiliary research methods. The patient is examined by a dentist-therapist, gastroenterologist, neurologist. Diagnostics include:
- Inspection. The mucous membrane of the mouth is pale pink in color without pathological changes. There is a slight plaque on the back of the tongue. When palpating the tongue, pathological formations are not detected, the shape and size are unchanged. During compression, soreness occurs.
- Saliva examination. Both hyper- and hyposalivation may be noted. The hydrogen index is determined using indicator strips, ph is within the normal range. With glossodynia, there are no galvanic currents during the measurement of the potential difference.
- Electromyography. With the help of an electromyograph, the initial localization, distribution zones, and duration of paresthesia symptoms are determined.
- Neurological research. Pharyngeal and curtain reflexes are absent, when examining the tongue, active contractions of muscle fibers, rhythmic trembling are diagnosed. During palpation of the projection areas of the upper cervical and submandibular vegetative nodes, soreness is present.
- Auxiliary research. To identify somatic pathology, a general and biochemical blood test, an electrocardiogram, and a determination of the acidity of gastric juice are prescribed.
Glossodynia is differentiated with glossalgia, galvanosis, glossitis, inflammatory diseases of the mucous membrane. Neuralgia of the lingual and lingual nerves, neuritis of the lingual nerve should also be excluded.
Treatment
Pharmacotherapy
Treatment of the disease requires an integrated approach. Local symptomatic measures are ineffective. Only a full-fledged interdisciplinary etiopathogenetic therapy aimed at relieving exacerbation and achieving stable remission of chronic somatic disease can stop the stagnant flow of pathological impulses.
- Etiotropic therapy. The goal is to normalize the work of the cardiovascular, endocrine system, and gastrointestinal organs. In addition to prescribing medication, it is recommended to follow a diet, eat small portions at intervals of 2-3 hours. This allows you to eliminate biliary dyskinesia, which is often observed with glossodynia.
- Pathogenetic therapy. The main task is to influence the vagosympathetic department, break the chain of pathological impulses. Vitamins B, PP are prescribed to improve the functioning of the nervous system. Since glossodynia is accompanied by hypertension and, as a consequence, ischemia of target organs, patients are shown antispasmodics, drugs that reduce blood pressure and dilate the lumen of blood vessels.
- Symptomatic treatment. The elimination of the parastetic symptom complex is achieved by taking sedatives, neuroleptics. To relieve unpleasant sensations from the mucous membrane, skin, tongue, blockades are performed, iron-based drugs are prescribed.
Dental stage
Patients are provided with professional oral hygiene, treatment of caries and its complications. To prevent injury to the mucous membrane, the sharp edges of the fillings are smoothed. In the presence of defects in the dentition, prosthetics using homogeneous metals is shown. Plastic crowns are only possible as temporary structures.
Physical therapy
With glossodynia, ozone therapy is widely used. Due to the pronounced effect of ozone on metabolic processes, along with the saturation of tissues with oxygen, the utilization of metabolic products occurs. The use of laser therapy reduces paresthetic symptoms, promotes the development of local immunity factors, and stops the inflammatory process.
Prognosis and prevention
The prognosis for glossidinia depends on the cause of the disease and on how accurately all etiological factors of somatic genesis will be established. Therefore, in prognostic terms, two indicators are important: cooperation on the part of the patient and qualitative collection of anamnesis with the participation of related specialists: dentist, therapist, endocrinologist, neurologist, cardiologist, psychiatrist.
The scheme of primary prevention of glossodynia has not been developed. Secondary preventive measures consist in the timely detection and treatment of general somatic pathology, maintaining a healthy lifestyle. It is also important to avoid stressful situations.
Literature
- Dombi C., Czeglédy A. Incidence of tongue diseases based on epidemiologic studies (review of the literature) // Fogorv Sz. — 1992; 85 (11): 335–341.link
- Picciani B. L. et al. Geographic tongue and psoriasis: clinical, histopathological, immunohistochemical and genetic correlation — a literature review // Anais brasileiros de dermatologia. — 2016; 91 (4): 410–421.link
- Methods of differential diagnosis of glossodynia and galvanosis in outpatient settings/ Borisova E.G., Nikitenko V.V., Khlebnikov D.A.// Medico-pharmaceutical journal “Pulse” – 2016. – No. 4.
- Pain and paresthetic syndromes in the maxillofacial region/ Yavorskaya E.S. – 2007.