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The nutritional deficiencies which causes glossodynia are iron, vitamin B12 and folate deficiency. Glossodynia associated with iron deficiency occurs in 13% of cases. The iron deficiency is low in men (3%), as compared to non-pregnant women (10-30%), and pregnant women (10-60%). Because of glossitis and glossodynia in iron deficiency anemia, the patient may seek dental treatments. The dentist and patient must be aware of signs and symptoms to prevent serious neurological complications of this disease.
Iron deficiency is not a disease, but a sign of disease, which is also associated with glossodynia. The high incidence of iron deficiency anemia in pregnancy is due to the increased demand for iron in second half of pregnancy; thus it's more common in females than males. In postmenopausal women and adult males, the common cause of iron deficiency is gastrointestinal bleeding by non steroidal anti-inflammatory drugs and hookworm infection.
The oral mucous membrane is sensitive and its integrity is maintained by complex interacting factors superimposed on localized stabilizing mechanism. The patients suffering from deficiency states are particularly susceptible to candida albicans infection. There is atrophy of tongue epithelium with resulting disturbance of underlying nerve resulting in taste disturbance and painful tongue. This change in sensitivity of tongue can be a diagnostic value in deficiency states.
Iron deficiency anemia has an incidious onset with gradual fatigue, irritability, dizziness, palitation, breathlessness and headache. Glossodynia may be one of classic symptoms of iron deficiency anemia. These changes in metabolism of oral epithetial cells are due to minor variations in the quality of blood supply, which give rise to abnormalities of cell structure and kreatization pattern of oral epithelium resulting in the atrophy particularly of the filiform papillae of the tongue which may be almost completely lost. The atrophic changes in tongue may lead to ulceration and soreness, which, in many cases, affect the whole oral mucosa and lead to ulceration.
In a small group of patients, the atrophic changes in the oral and pharyngeal mucosa may lead to widespread soreness and dysphagia which is associated with achlorhydria and is known as plymmer-vinson syndrome. There is angular chelitis and thrush symptoms and the patient may complain of disturbance of taste sensation due to atrophy of the tongue epithelium, with resulting disturbance of underlying nerve endings.
The gastrointestinal complaints are anorexia, pyrosis, flatulence, nausea, belching and constipation which are commonly associated with iron deficiency anemia.
In addition to the clinical features of the iron deficiency anemia , the laboratory findings are most supportive. The laboratory values have low mean corpuscular volumes; mean corpuscular hemoglobin; and mean corpuscular Hb concentration.
Low-iron values would result in decrease serum iron, elevated total iron binding capacity and low ferritin. The oral examination of the patient shows atrophy of the tongue (anterior border) and paleness of the palate. which exclude neurotic glossodynia (in which no abnormality of tongue tissue can be seen.)
The recent data indicates that burning sensation may also result from deficiency of vitamin B1, B2, B6 and B12. The deficiency of vitamin B2 And B6 also produces greasy dermatitis of the face.
In pernicious anemia, there may be generalized atrophy of the oral mucosa with ulceration as in iron deficiency anemia. The soreness of tongue is due to atrophic changes in the lingual papillae termed as "beefy red tongue." The tongue often shows a shiny smooth appearance and may be painful and tender to hot or spicy foods. Glossodynia is a common symptom. The diagnosis can be made by RBC morphology and serum vitamin B12 level which can be resolved by vitamin B12 parenteral therapy.
Folic acid such as vitamin B12 is involved with RNA and DNA metabolism. A deficiency of folic acid may lead to burning mouth angular cheilitis. The tongue shows varying degrees of papillary atrophy which progresses until the surface of tongue is smooth and shiny. The diagnosis is done by RBC morphology and serum folate level. Likewise, niacin deficiency causes generalized erythma of the oral mucous along with papillary atrophy. There is glossodynia. Diagnosis can be made by measurement of niacin level. It is treated with niacin and vitamin B-complex vitamins.
