The Tortured Tongue and The Teeter-Totter of
Taste: Burning Mouth Syndrome
Aim:
Recognize: The clinical symptomatology of burning mouth syndrome (BMS).
Understand: The pathophysiologic mechanisms of BMS.
Those with BMS suffer from both glossopyrosis and hypogeusia. While
burning pain worsens as the day progresses, there is a quotidian reduction in
the ability to taste sweet. A reciprocal fluctuation in these two diurnal cycles
in a single patient has not heretofore been described.
Methods:
Case report: A 60 year old female, six months prior to presentation, noted
burning of her mouth, which worsened as the day progressed. Coincident
with this, she lost her sweet taste. Her taste gradually improved, but was
subject to diurnal variation: On awakening, her ability to taste sweet was
95% of normal and by the evening, her ability to taste sweet was 5% of
normal. This contrasted with her burning pain: absent on awakening,
(0/10 in intensity), worsening to 9/10 by the evening. This inverse
relationship recurred on a daily basis.
Results:
Chemosensory testing:
Olfaction: Normosomia. Brief Smell Identification: 9, Quick Smell
Identification: 3, Alcohol Sniff: 23, Retronasal Smell Index: 7. Gustation:
Normogeusia: Propylthiouracil disk taste: 6, Threshold for NaCl, HCl,
urea, and phenothiocarbamol. Sucrose threshold: aguesia.
Conclusion:
Her reports of reciprocal cyclic diurnal worsening of burning pain and
reduction of sweet taste is consistent with Bartoshuk’s hypothesis, that
taste loss is the primary factor disinhibiting the pain of BMS. This case
suggests treatment modalities for BMS may be most effective if they
include not just pain reduction, but also taste enhancement.