STORY BYRetired police officer James Maddox noticed a metallic taste in his mouth in 1999 after extensive dental work. Soon, the metallic taste vanished, but he was left with a constant burning. Since then, he has seen dentists, neurosurgeons, even the dean of a dental school—an oral pathologist—to find a way to put out the fire.
Three percent of the population endures Burning Mouth Syndrome (BMS), a condition that is poorly understood but is exacerbated by certain diseases like Sjogren’s (pronounced “SHOW-grins”) Syndrome and other medical problems.
BMS is a chronic condition that may last for years. Of those sufferers, 25 percent have a taste disorder. Fourteen percent of post-menopausal women experience BMS. And although estrogen deficiency may trigger the problem, (which doesn’t improve with replacement hormones) men are not immune.
Almost everyone has experienced unusual feelings in the mouth: dryness, rough areas, heat sensation or a metallic taste—maybe from stress, fever, spicy foods, upset stomach or medication. This may be uncomfortable, but it usually goes away about the time you make a dental appointment for it. BMS does not disappear so quietly or quickly.
Dry mouth itself brings a slew of customers to a dentist’s or doctor’s office. “More than 200 medications actually cause dry mouth. It also can be caused by diseases, in particular, Sjogren’s Syndrome,” explains Catherine M. Flaitz, D.D.S, M.S., interim dean of the University of Texas Dental Branch at Houston.
Sjogren’s is an autoimmune disorder, in which white blood cells attack the moisture-producing glands. Signature symptoms are dry eyes and dry mouth, but it is a systemic disease that can affect multiple organs. Up to 4 million Americans have Sjogren’s. Often, but not always, says Flaitz, Sjogren’s is the trigger for BMS.
It may be occasional, but if you have ever
experienced that sudden flash of intense
pain—like a pin stabbing you under your
tongue—you'd remember it.
Flaitz says this is caused by a blockage or
rapid production of fluids from the salivary
glands under the tongue. Sour or acidic
foods and beverages are most likely to
trigger this response.
If you have discomfort with eating and the
floor of the mouth becomes swollen, most
likely you have a plugged duct that is not
allowing the thick saliva to escape.
No treatment is necessary in most cases
because the pain quickly goes away. If the
pain lingers, frequently recurs or the floor
of the mouth becomes enlarged, then your
dentist can help identify the problem.
If there is a blockage or stone in the duct of
the gland, you will usually need to be
treated by an oral and maxillofacial surgeon
or an otolaryngologist (ear, nose and throat
doctor.)
“ I have had patients in their 30s and 40s who have had it. Usually, it coincides with a recent severe cold or flu. The initiating factors seem to be different in the accelerating age groups. It can be associated with systemic diseases,” Flaitz points out. Low-functioning thyroid, diabetes, some forms of anemia, nutritional problems, autoimmune diseases, and yeast infection in the mouth can also play a part.
“Also, it can be associated with Parkinson’s and stomach
problems, such as reflux disease and chronic irritation from the
”she adds.
“My patients compare it to the feeling of scalding coffee in the mouth.” Flaitz says that the most confounding aspect of BMS is that it can continue indefinitely. Although it is not a serious problem in itself, it certainly can interfere with the quality of life.
Flaitz suggests that people who are experiencing this problem seek help first from a dentist to check out the obvious culprits. “Ordinarily, a healthcare professional would be able to look in your mouth and see that something isn’t right. There might be some shaggy white patches, or a little bit of redness,” Flaitz observes. BMS is the result of nerve damage that changes one’s perception of taste, temperature, touch and moisture, but it can’t be visually identified.
Local causes might include:
If BMS is not due to one of the local factors, Flaitz believes in the simple approach:
She mentions that simply the flavor of gum may be helpful to some patients, while others find the taste only increases bitterness. If these tactics fail, then antidepressant medications at low doses may be helpful to reduce the anxiety or preoccupation of the sensation. It usually takes a couple of months before these medications become effective.
Many people with BMS fear they have cancer. “Because they’ve heard that if you’re in constant pain that doesn’t go away, that’s a sign of serous illness, like cancer.”
Flaitz explains why BMS feels different: “With cancer, you don’t have pain in the entire mouth, as you do with BMS. You can have cancer metastasize and move to the mouth. The tumor cells can wrap around nerves in the beginning causing a more severe type of pain that is localized to one side. Then the mouth gets numb.”
Maddox reports that about a week ago for one day, the burning completely disappeared for the first time in more than four years. He thought he was over BMS. It returned the next day. His neurologist told him BMS showed up one day without warning, and it might just go away the same way. He says he hopes she’s right.
For more information: http://www.sjogrens.org/
UPDATED: 10-23-2003
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Dr. Catherine M. Flaitz is Dean of the UT Dental Branch.
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Food Irradiation
and Safety
On August 22, 2008, the Food and Drug Administration (FDA) published a final rule that allows the use of irradiation to make fresh iceberg lettuce and fresh spinach safer and last longer without spoiling.
Irradiating fresh iceberg lettuce and spinach will help protect consumers from disease-causing bacteria such as Salmonella and Escherichia coli O157:H7 (E. coli). Illnesses from these bacteria range from uncomfortable symptoms to life-threatening health problems.
The foods affected by the final rule are
Irradiation (also sometimes termed "ionizing radiation") is a process of treating products with a measured dose of radiation. Food irradiation is not new. FDA has conducted irradiation safety evaluations for more than 40 years and has determined the process to be safe for use on a variety of foods.
After studying the safety of irradiating fresh iceberg lettuce and fresh spinach, FDA has determined that these greens, when irradiated under the conditions specified in the final rule, retain their nutrient value and are safe to eat.
FDA considers irradiation a complement to, not a replacement for, proper food-handling by producers, processors, and consumers. Irradiation is just another tool to reduce the levels of disease-causing microorganisms on fresh iceberg lettuce and fresh pinach.
Irradiation does not take the place of washing. FDA continues to recommend that consumers wash fresh and bagged produce before eating unless the packaging specifically states that the product has been pre-washed.
For more information, go to: http://www.fda.gov)
