We are used to the fact that we need to go to the dentist if we have problems with our teeth or gums. What to do if you have inflammation of the tongue or glossitis? Dentists identify more than 10 types and subtypes of infection. The infection can be caused by both fungus and bacteria. Viral infection is less common. Inflammation can be caused by a lack of certain vitamins and minerals, or hormonal changes. There are many reasons for the disease, so it is important to identify what exactly caused the inflammatory process.
Stomatitis: features of the disease
Stomatitis is a disease related to dental pathologies in which inflammation of the oral mucosa occurs. Infection of the tongue with stomatitis in adults is also called “glossitis.”
The inflammatory process affects the mucous membrane and causes severe symptoms:
- redness and swelling of the tongue;
- formation of white plaque;
- severe pain;
- the formation of many small blisters and ulcers.
Due to severe sensitivity and soreness of the tongue, the patient cannot eat food, fever, insomnia and irritability are possible.
Stomatitis under the tongue in adults, as in other parts of the oral cavity, is classified into two types.
- Aphthous. A form of inflammation in which the tongue becomes covered with papules and ulcers that turn into erosions (aphthae).
- Herpetic. The inflammatory process is manifested by swelling and redness of the tongue. Small bubbles are localized in groups.
Prosthetic stomatitis and ulcerative-necrotic form of pathology are extremely rare.
Without treatment, the signs of stomatitis completely disappear, but this does not mean that the patient is cured of the pathology. The inflammatory process becomes chronic and when the immune system is weakened or exposed to an irritant, a relapse occurs.
Stomatitis: what kind of disease is it, the mechanism of appearance of stomatitis ulcers
Scientists have not yet fully studied the mechanism by which stomatitis occurs on the mucous membrane in a person’s mouth. The manifestation of symptoms of the disease is associated with the specific reaction of a person’s immune system, which he exhibits in relation to irritants present on the mucous membrane of the mouth.
Bacteria, fungi, viruses and other microorganisms act as irritants. Normally, they are always present on human mucous membranes in one quantity or another. But when a person’s immunity is weakened, or other reasons provoke an increase in the number of microorganisms and the development of infectious diseases in the mouth (staphylococcal, streptococcal, candidal, etc.), this fact can trigger a stomatitis reaction.
Ulcers on the human mucosa, which are stomatitis in nature, are formed as a result of the fact that lymphocytes (white blood cells of the human immune system) begin to attack molecules that they cannot recognize. This reaction of the body is similar to that which occurs in the case of organ transplantation. As a result of such a lymphatic attack, stomatitis ulcers are formed on the oral mucosa, which usually go away on their own in one to two weeks without scarring.
Causes of stomatitis
Stomatitis under the tongue in adults is a reaction of the immune system to certain types of irritants, which are any substances. The causes of stomatitis have not been clearly identified; presumably, the body exhibits an individual reaction to certain substances or microorganisms.
Possible causes of stomatitis on the tongue in adults:
- bacteria and infections of the oral cavity (caries, gingivitis, periodontitis, etc.);
- diseases of the gastrointestinal tract of an infectious or viral type;
- respiratory diseases (ARVI, influenza, etc.);
- frequent injury to the tongue by orthopedic or orthodontic structures;
- damage to the tongue due to a chipped tooth;
- fungal infection;
- bad habits (smoking or alcoholism);
- burning the tongue or eating “spicy” foods.
In addition to the listed causes of stomatitis on the tongue in adults, inflammation of the mucous membrane can be caused by the herpes virus (herpetic stomatitis).
Structure of the area under the tongue
Everything that is located under the tongue is called the floor of the mouth. This:
- nerve endings;
- hyoid bone;
- hypoglossal muscles;
- salivary gland;
- connecting folds called frenulums;
- vessels.
Each element of the floor of the mouth serves its own purpose and is irreplaceable. Only if all muscles, tissues, glands and nerves are healthy does the tongue function normally. If there is pain under the tongue, then we are talking about pathology.
Treatment Basics
If an adult has a swollen tongue, the surface is covered with plaque, or has severe hypothermia, you should consult a dentist. Even in the absence of neoplasms in the oral cavity in the form of papules, ulcers or erosions, a specialist will be able to determine the development of the inflammatory process. With timely treatment, the risk of pathology becoming chronic is minimal.
Treatment of stomatitis on the tongue in adults is carried out exclusively conservatively. Depending on the causes of the disease and the clinical picture, the doctor will determine a treatment regimen and prescribe effective drugs of systemic and local action.
The dentist’s task is not only to eliminate symptoms and inflammation, but also to identify the cause. If the provoking factor has a constant impact, then stomatitis under the tongue will constantly recur.
Treatment of stomatitis on the tongue in adults begins with the relief of concomitant diseases - the root causes.
Symptoms of glossitis
- increased salivation;
- swelling and redness;
- pain and burning when eating;
- plaque on the tongue in the form of spots;
- bad breath;
- papillomas or warts on the tongue;
- speech disorder;
- foreign body sensation.
Prevention of glossitis - high-quality oral hygiene and no bad habits. It is important to undergo timely preventive examinations and also eat well. All these factors actively contribute to the development of the disease and bring a number of problems.
How is the treatment carried out?
Treatment for stomatitis is comprehensive.
- Anesthesia. To eliminate pain, the dentist may prescribe topical medications containing lidocaine or analgesics.
- Antiviral therapy. If the disease is caused by a herpes virus, the doctor prescribes antiviral drugs of the appropriate group of effects.
- Antibacterial therapy. In case of bacterial stomatitis, local treatment of the oral cavity with antiseptic solutions and dental ointments with antibacterial action is mandatory.
- Antifungal therapy. Stomatitis can be the result of fungal activity in the mouth. This form is more common in children, but is not excluded in adults. The specialist prescribes the patient a strict regimen of antifungal drugs.
- Anti-inflammatory therapy. It is carried out in cases of severe inflammation. The dentist recommends taking anti-inflammatory systemic drugs that have a targeted effect depending on the pathogen or cause of tongue stomatitis.
- Diet. Patients with stomatitis are prescribed a diet that excludes foods that can aggravate irritation of the mucous membrane and tongue. So dentists recommend avoiding hot, spicy, sour and salty foods. Smoking and drinking alcohol should be avoided.
Together with the treatment of stomatitis, treatment of diseases of the respiratory system, gastrointestinal tract, inflammation of the gums, caries, etc. can be carried out.
Diagnostics
An in-person examination by a dentist is enough to detect the problem. Sometimes a doctor can immediately diagnose and prescribe treatment. But if the disease is not of a dental nature, additional examination will be required.
For diagnostic purposes the following is carried out:
- general blood test to identify an infectious process;
- FGDS for detection of peptic ulcer;
- biochemical blood test for glucose content and determination of hormone levels if endocrine disorders are suspected;
- examination by a neurologist and conducting tests to diagnose damage to the nervous system;
- blood test for HIV and hepatitis B, C to find the cause of immunodeficiency;
- examination by an otolaryngologist to detect acute tonsillitis (tonsillitis).
Carrying out all types of diagnostic procedures is not necessary; often the cause is determined at the initial stage. Based on the results of the examination, a treatment regimen is selected.
General recommendations
For stomatitis in adults, treatment is carried out on an outpatient basis. The dentist can perform initial treatment of the oral cavity, then the patient will need to perform all the manipulations independently at home.
Antiseptic treatment of the entire oral cavity is a prerequisite for the successful treatment of stomatitis and the rapid recovery of the affected mucosa. For “disinfection”, solutions containing chlorhexidine, furatsilin or metronidazole are used. Dentists also recommend rinsing with a soda solution every 2-3 hours.
Locally in the affected areas, it is necessary to remove heavy plaque using gauze and apply anti-inflammatory and regenerating gels or ointments to the areas where ulcers accumulate. The procedure is unpleasant, but significantly speeds up recovery.
Treatment of stomatitis on the tongue in adults, subject to all prescriptions and recommendations of the dentist, takes no more than 10 days. Symptoms of the disease disappear after 3–5 days; a few more days are required to restore the affected tissues.
Classification
It is easy to understand why stomatitis develops by its classification. So, doctors distinguish the following types of pathology:
- viral;
- fungal;
- bacterial;
- allergic;
- autoimmune;
- traumatic.
When determining how to treat a disease, the doctor must take into account the provoking factor. Otherwise, it will not be possible to get positive dynamics quickly.
When to see a doctor
Visit your dentist if the spots don't go away within a week. White spots, cracks, ulcers and leukoplakia can cause oral cancer. In this case, the sooner a dangerous disease is recognized, the more favorable the outcome awaits the patient [6].
“According to WHO, in the Russian Federation alone in 2015, 589,341 cases of malignant neoplasms were identified (including 270,046 and 319,335 in male and female patients, respectively).
The increase in this indicator compared to 2014 was 4.0%, and these numbers are growing” Mikhalchenko D.V., Associate Professor, Head of the Department of Volgograd State Medical University [6]
Pain and burning of the tongue: how to treat?
Probably every gastroenterologist in his practice has encountered a patient with complaints of pain or burning of the tongue. Turning to this specialist in the first place is probably due to the following logical chain: the tongue is in the oral cavity, where the digestion process begins, which means that if a problem arises, you should visit a gastroenterologist. Old publications also come to the aid of patients and doctors of other specialties, in which chronic diseases of the digestive organs were considered as the causes of burning tongue.
But is it really that simple? Is pain and burning of the tongue a separate disease and who should treat it?
A little history and terminology.
Pain/burning in the tongue has many synonyms: glossalgia, glossodynia, stomatodynia, glossopyrosis, oral paresthesia, neurogenic glossitis, tongue neurosis, glossalgic syndrome. This condition is traditionally part of the so-called burning mouth syndrome or “burnt mouth syndrome,” in which pain/burning sensations are localized in various areas: tongue, upper palate, gums, lower lip, pharynx.
Burnt mouth syndrome (SMS) was first described back in 1880; in the 20th century, the term glossodynia, i.e., appeared. pain in the tongue, since unpleasant symptoms from the tongue were most common. This syndrome was first identified as a separate disease in 2004.
Almost all existing review articles and recommendations consider glossodynia within the framework of the SOP. General recommendations for the diagnosis and treatment of ROP may be applicable to the special case of glossodynia.
Definition
The International Association for the Study of Pain has designated glossodynia and oral burning as chronic pain, specifically “burning pain of the tongue or other mucous membranes of the mouth.”
Later, a detailed definition was given for ORS: “a burning sensation or sensation of altered sensitivity in the oral cavity, repeated daily for more than 2 hours a day for more than 3 months, without obvious causative lesions on clinical examination and examination.”
Epidemiology
Data on the prevalence of ROP and tongue pain/burning separately still vary from study to study. The average incidence of all cases of oral burning (including but not limited to tongue burning) is 0.1-3.7% of the population. Women suffer from this syndrome 2.5-7 times more often than men, especially often over the age of 60 and after menopause.
Common causes of pain and burning in the mouth.
There are two groups of reasons why patients notice a burning sensation in the mouth:
1) Primary (idiopathic), when there are no diseases of the oral cavity and other organs and systems, this will be the true SOR.
2) Secondary, caused by local (localized in the oral cavity) and systemic causes (autoimmune diseases, deficiency conditions, etc.)
Causes of secondary burning sensation in the mouth/burning tongue.
Possible causes of secondary burning sensation in the oral cavity are diverse and, oddly enough, are rarely associated with pathology of the digestive organs. A review published in 2022 on this problem identified the following conditions and diseases responsible for the occurrence of burning sensation in the mouth:
Local factors:
A. Diseases, conditions and damage to the oral cavity:
- fungal infection (eg candidiasis)
- lichen planus
- pemphigoid
- pemphigus
B. Trauma
1) Mechanical
2) Chemical
A. From the patient's side:
- toothpastes with abrasives
- use of mouth rinses with ethyl alcohol
- medications such as aspirin (applied to the sore tooth); over-the-counter medications containing phenols, peroxide, sulfuric acid
- vitamin C (citrus fruits)
- sour drinks
- lozenges and cough suppressants with high menthol content
b. From the dentist:
- Irrigation of the oral cavity with solutions containing methyl methacrylate, formaldehyde, formocresol, sodium hypochloride
- acrylic resin
- eugenol
3) Thermal: spicy or hot food or drink
C. Parafunctional habits
- Tongue sticking out, cheek biting, excessive tongue brushing
- mouth breathing
D. Xerostomia or impaired quality/quantity of saliva
- consequences of radiation or chemotherapy, Sjogren's syndrome, pathology of the salivary glands
- side effects of medications (antihistamines, antidepressants, diuretics, steroid hormones, non-steroidal anti-inflammatory drugs, amphetamines)
- smoking
E. Allergic reaction/contact hypersensitivity
- products, additives, flavors
- colorings and flavors from oral care products
- dental materials (nickel sulfate, cobalt, zinc)
System factors
A. Deficiency conditions: decreased levels of iron, zinc, folic acid, vitamins B1, B2, B6, B12
B. Endocrine pathology
- diabetes
- hypothyroidism
- hormonal disorders (changes in cortisol/sex hormone levels)
C. Autoimmune diseases
- Sjögren's syndrome
- lichenoid reactions
- systemic lupus erythematosus
D. Other diseases
- gastroesophageal reflux disease
- celiac disease
- multiple sclerosis
- Parkinson's disease
- Fabry disease
E. Medicines
- angiotensin-converting factor inhibitors
- antiretroviral therapy
F. Peripheral and central neuropathies
- diabetic polyneuropathy, neuropathy due to renal failure, neuropathy due to systemic connective tissue diseases, neuropathy due to HIV infection, postherpetic neuropathy, neuropathy due to chemotherapy
As can be seen from this huge list, most cases of burning of the tongue and in the oral cavity in general are caused by a dental problem/pathology, neurological, endocrine and autoimmune diseases. Gastroenterological causes (for example, gastroesophageal reflux disease) are rather the exception to the rule.
Primary burning sensation in the oral cavity (BOR) and its causes.
If there are no indications of secondary causes of burning in the oral cavity, most likely there is a true SOR. This is an independent disease, the cause of which is still unclear. In its development, the role of psychological factors and mental disorders, changes in the nerve endings and conductive nerve fibers of the oral cavity, as well as the central nervous system is assumed.
Clinical manifestations of ROP.
Symptoms that may bother patients with ROP are:
1) Pain and/or burning in the mouth of varying intensity. Some patients describe these sensations as tingling or irritation, as well as impaired sensitivity. The pain often occurs spontaneously, is often symmetrical and does not necessarily affect only one area. In the case of glossodynia, pain/burning is most often localized in the anterior 2/3 of the tongue, on its back, and lateral surfaces. The pain is minimal in the morning immediately after waking up, increasing in intensity throughout the day. Eating spicy, hot foods and drinks, as well as stress and fatigue increase the pain/burning sensation.
2) More than 70% of patients, in addition to pain/burning, note changes in taste, a decrease in its intensity, as well as the appearance of a foreign taste (bitter, metallic, or a combination of both). Most often, the sensation of sweet and salty tastes is reduced, and sour tastes are perceived more intensely.
3) Dry mouth (xerostomia) is noted by 46-67% of patients with SOP, while according to research data, an objective decrease in the amount of saliva is not observed in them.
4) Association with burning/pain from other mucous membranes has also been described in patients suffering from ROP. Most often this is a burning sensation in the rectum and genital tract. An alternative may be a feeling of dry mucous membranes (eyes, genital tract in women)
5) Night sleep disturbances are common (in 80% of cases) in people with SRS
6) Anxiety and depression are frequent companions of SOR and glossodynia separately. A meta-analysis of clinical studies showed that anxiety conditions increase the risk of developing RAS by 2.6 times, and depression by 3.2 times. Cancerophobia, social phobia, neuroticism, etc. are also often noted.
7) ODS is characterized by an association with other diseases that manifest as chronic pain: fibromyalgia, chronic back pain, chronic pelvic pain, irritable bowel syndrome, etc.
Treatment of SOR.
1) Patient information and support
Many patients with chronic oral burning and pain do not understand why their symptoms persist for so long. An important task of the doctor is to explain to patients with SRS the possible mechanisms of the formation of unpleasant sensations. Patients should be reassured that their symptoms are not imaginary or related to any form of cancer. This support will reduce anxiety, depression, fear and frustration, especially in individuals who have had previous unsuccessful treatment experiences.
2) Local therapy
Local use of clonazepam in the form of mouth rinses showed good results in reducing the severity of pain/burning in the mouth. There is encouraging evidence for the topical use of capsaicin (a chili pepper alkaloid) in low concentrations.
3) Systemic therapy
Tricyclic antidepressants, antidepressants from the group of serotonin and serotonin/norepinephrine reuptake inhibitors, clonazepam, and antiepileptic drugs (pregabalin and gabapentin) are actively used as drugs for the treatment of ORA. The use of alpha-lipoic acid has shown little effectiveness.
4) Non-drug psychotherapy
Given the frequent association of ODS with anxiety disorders, phobias and depression, non-pharmacological psychotherapy is an integral part of the treatment of this problem. Cognitive behavioral therapy, individual and group psychotherapy should be considered as methods of choice.
5) Physiotherapy and alternative treatments
Low-level laser therapy and acupuncture have been studied as methods for reducing pain. These methods were effective in some people with cerebral obstruction, but are not widely used.
Conclusion.
Identifying the causes of pain/burning in the oral cavity is a challenge for doctors of different specialties, but their friendly work allows us to solve the problem and improve the quality of life of patients.
