Nothing but the Tooth column: A real bad taste in your mouth
Columns share an author’s personal perspective.
Q: I am plagued with dysgeusia(a) taste disorder emanating from tongue and gums, not acid reflux or GERD, and the taste is 24/7 and pervasive - horrid, rather sour - and I have had it for decades. I am also having issues with very dry mouth due to meds (beta blocker, warfarin, potassium citrate) which are constant and not pleasant. My other issue is the lower gums and teeth feel as though they are “fenced in” with sensation which never ends. I have had that for decades and perhaps with pandemic stress and other issues, being older, 77, it is just worse and permanent.
An ENT suggested I have GERD/acid reflux but my tummy/other areas are fine; it is primarily the tongue/mouth and gums which bother me. Might you suggest something I could try/do to alleviate or remove this? Someone suggested it may be from certain toothpaste products? I have tried spearmint Orbit but that is also temporary. I am relieved when I eat but the symptoms reappear when I am finished.
Any suggestions you have would be deeply appreciated. I am a Wisconsin native so more northern and perhaps inquisitive than others!
- C.S., Peoria, Illinois
A: One of the reasons, I am very happy practicing dentistry rather than medicine is that in dentistry, we dentists can pretty much solve most problems with a predictable outcome. In medicine, many issues have to be dealt with trial and error. Yours may be one of those issues.
I am familiar with this group of uncomfortable symptoms that you suffer from. Before I make a recommendation, I think the first thing that you need to have is a complete dental examination. This exam should be clinical (dentist examines each tooth carefully as well as other oral structures) and with a complete set of radiographs. Tooth decay and gum disease can give patients some of the strange taste problems that you describe. It is unlikely that this is the case because you report this problem for decades. However, the possibility needs to be eliminated. I do not believe that G.I. upset would present in this way nor would it be caused by a particular toothpaste. It is very interesting that the symptoms of this horrid and sour taste are relieved when you eat but then return quickly.
The medications that you take should not be altered unless the medical prescriber has a definite reason. You have the sensation of a dry mouth and that needs to be thoroughly evaluated to eliminate any direct salivary gland problem. Is it just a sense of dry mouth or is it a definite salivary flow issue? There are disease entities that can cause these salivary problems and these also need to be eliminated from the causal reasons for your discomfort. I would suggest that if your general dentist who does your complete evaluation can not comfortably evaluate the salivary problems that he/she refer you to an oral medicine specialist. This could be an oral surgeon who has more experience with these problems or a physician who has ample experience with head and neck issues, usually an oral medicine specialist or possibly a neurologist.
I will say to you that whenever I have seen these problems, I personally have referred the patient to an oral medicine specialist. These specialists will usually determine that these problems are caused by aberrant neurogenic issues that they usually refer to as Burning Mouth Syndrome. All of the symptoms you report have been previously reported in this syndrome and are termed idiopathic. This means they are real symptoms but have no known direct cause. The approach taken to help with this syndrome (group of symptoms) is almost always pharmacologic. This approach is taken when all other disease possibilities are eliminated and with deductive reasoning the decision is made to treat these as problems with a nerve origin. There are different combinations of drugs or singular drug therapies that may be tried and many clinicians report a reasonable outcome. We often do not hear of a reversal to absolute comfort, but usually find that with the drug therapy, your day-to-day quality of life will be much more tolerable.
I will advise you to be patient in seeking out the oral medicine specialist, be they dental or medical. You need to find one that responds to your issues with genuine knowledge and caring - one that has seen these problems before and has a treatment regimen in mind. Also, you have to be patient in going along with different drug therapies as a first, second, third or more may be needed to achieve positive results.
I wish you the best of luck as this is a difficult problem to endure and to treat, but the outcome can be good. Please keep me up to date as you hopefully proceed with my recommendations.
Dr. Richard Greenberg of Ipswich, Massachusetts practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at firstname.lastname@example.org.