Taste and Pain Response in Burning Mouth Syndrome With and Without Geographic Tongue

Aims: To assess the effect of geographic tongue (GT) on taste, salivary flow, and pain characteristics in burning mouth syndrome (BMS) to determine whether GT is a contributing factor to BMS and whether BMS and GT represent similar patient populations. Methods: A retrospective chart study was conducted. Patients with a diagnosis of BMS or BMS/GT were included. Data regarding smell testing, spatial taste-testing, salivary flow, oral pH, and subjective pain rating on a generalized labeled magnitude scale (gLMS) were collected. Results: No significant differences in age, gender, oral pH, smell, or pain were found between groups. Stimulated and unstimulated salivary flow were significantly lower in BMS/GT. Taste responses to all taste stimuli and to ethanol were significantly lower in BMS, with the exception of sour at the fungiform papillae. Conclusion: BMS and BMS/GT present with similar clinical pain phenotype and demographics; however, taste was more intact in BMS/GT, suggesting that GT may be a contributing factor in the development of BMS through a mechanism that does not involve taste.

burning mouth syndrome; geographic tongue; pain intensity; taste

1. Coculescu EC, Tovaru S, Coculescu BI. Epidemiological and etiological aspects of burning mouth syndrome. J Med Life 2014;7:305–309.

2. Klasser GD, Grushka M, Su N. Burning mouth syndrome. Oral Maxillofac Surg Clin North Am 2016;28:381–396.

3. Jimson S, Rajesh E, Krupaa RJ, Kasthuri M. Burning mouth syndrome. J Pharm Bioallied Sci 2015;7(suppl 1):s194–s196.

4. Steele JC. The practical evaluation and management of patients with symptoms of a sore burning mouth. Clin Dermatol 2016;34:449–457.

5. Ship JA, Grushka M, Lipton JA, Mott AE, Sessle BJ, Dionne RA. Burning mouth syndrome: An update. J Am Dent Assoc 1995;126:842–853.

6. Braud A, Descroix V, Ungeheuer MN, Rougeot C, Boucher Y. Taste function assessed by electrogustometry in burning mouth syndrome: A case-control study. Oral Dis 2017;23:395–402.

7. Bartoshuk LM, Snyder DJ, Grushka M, Berger AM, Duffy VB, Kveton JF. Taste damage: Previously unsuspected consequences. Chem Senses 2005;30(suppl 1):i218–i219.

8. Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Benign migratory glossitis or geographic tongue: An enigmatic oral lesion. Am J Med 2002;113:751–755.

9. Kullaa-Mikkonen A. Geographic tongue: An SEM study. J Cutan Pathol 1986;13:154–162.

10. González-Álvarez L, García-Pola MJ, Garcia-Martin JM. Geographic tongue: Predisposing factors, diagnosis and treatment. A systematic review. Rev Clin Esp 2018;218:481–488.

11. Darling MR, Su N, Masen S, et al. Geographic tongue: Assessment of peripheral nerve status, Langerhans cell, and HLA-DR expression. Oral Surg Oral Med Oral Pathol Oral Radiol 2017;124:371–377.e1.

12. Picciani BL, Domingos TA, Teixeira-Souza T, et al. Geographic tongue and psoriasis: Clinical, histopathological, immunohistochemical and genetic correlation—A literature review. An Bras Dermatol 2016;91:410–421.

13. Picciani B, Santos VC, Teixeira-Souza T, et al. Investigation of the clinical features of geographic tongue: Unveiling its relationship with oral psoriasis. Int JDermatol 2017;56:421–427.

14. Ching V, Grushka M, Darling M, Su N. Increased prevalence of geographic tongue in burning mouth complaints: A retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:444–448.

15. Grushka M. Clinical features of burning mouth syndrome. Oral Surg Oral Med Oral Pathol 1987;63:30–36.

16. Hummel T, Kobal G, Gudziol H, Mackay-Sim A. Normative data for the “Sniffin’ Sticks” including tests of odor identification, odor discrimination, and olfactory thresholds: An upgrade based on a group of more than 3,000 subjects. Eur Arch Otorhinolaryngol 2007;264:237–243.

17. Bartoshuk LM, Duffy VB, Green BG, et al. Valid across-group comparisons with labeled scales: The gLMS versus magnitude matching. Physiol Behav 2004;82:109–114.

18. Bartoshuk LM, Catalanotto F, Hoffman H, Logan H, Snyder DJ. Taste damage (otitis media, tonsillectomy and head and neck cancer), oral sensations and BMI. Physiol Behav 2012;107:516–526.

19. Poon R, Su N, Ching V, Darling M, Grushka M. Reduction in unstimulated salivary flow rate in burning mouth syndrome. Br Dent J 2014;217:E14.

20. Liebgott B. The Anatomical Basis of Dentistry, ed 2. St Louis: Mosby, 2001.

21. Dafar A, Bankvall M, Garsjö V, Jontell M, Çevik-Aras H. Salivary levels of interleukin-8 and growth factors are modulated in patients with geographic tongue. Oral Dis 2017;23:757–762.

22. Purves D, Augustine GJ, Fitzpatrick D, et al. Neuroscience, ed 2. Sunderland, MA: Sinauer Associates, 2001.

23. Grushka M, Sessle B. Taste dysfunction in burning mouth syndrome. Gerodontics 1988;4:256–258.

24. Nasri-Heir C, Gomes J, Heir GM, et al. The role of sensory input of the chorda tympani nerve and the number of fungiform papillae in burning mouth syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:65–72.

25. Imura H, Shimada M, Yamazaki Y, Sugimoto K. Characteristic changes of saliva and taste in burning mouth syndrome patients. J Oral Pathol Med 2016;45:231–236.

26. Just T, Steiner S, Pau HW. Oral pain perception and taste in burning mouth syndrome. J Oral Pathol Med 2010;39:22–27.

27. Forssell H, Jääskeläinen S, List T, Svensson P, Baad-Hansen L. An update on pathophysiological mechanisms related to idiopathic orofacial pain conditions with implications for management. J Oral Rehabil 2015;42:300–322.

28. Eliav E, Kamran B, Schaham R, Czerninski R, Gracely RH, Benoliel R. Evidence of chorda tympani dysfunction in patients with burning mouth syndrome. J Am Dent Assoc 2007; 138:628–633.

29. Schöbel N, Kyereme J, Minovi A, Dazert S, Bartoshuk L, Hatt H. Sweet taste and chorda tympani transection alter capsaicin-induced lingual pain perception in adult human subjects. Physiol Behav 2012;107:368–373.

30. Naud JM, Benca L, Drangsholt MT, LeResche L, Coldwell SE. A case-control evaluation of fungiform papillae density in burn-ing mouth syndrome. Laryngoscope 2018;128:841–846.

31. Kaplan I, Levin T, Papoiu AD, et al. Thermal sensory and pain thresholds in the tongue and chin change with age, but are not altered in burning mouth syndrome. Skin Res Technol 2011;17:196–200.

32. Lauria G, Majorana A, Borgna M, et al. Trigeminal small-fiber sensory neuropathy causes burning mouth syndrome. Pain 2005;115:332–337.

33. Yilmaz Z, Egbuniwe O, Renton T. The detection of small-fiber neuropathies in burning mouth syndrome and iatrogenic lingual nerve injuries: Use of quantitative sensory testing. J Oral Facial Pain Headache 2016;30:87–98.

34. de Tommaso M, Lavolpe V, Di Venere D, et al. A case of unilateral burning mouth syndrome of neuropathic origin. Headache 2011;51:441–443.

35. Borsani E, Majorana A, Cocchi MA, et al. Epithelial expression of vanilloid and cannabinoid receptors: A potential role in burning mouth syndrome pathogenesis. Histol Histopathol 2014;29:523–533.

36. Yilmaz Z, Renton T, Yiangou Y, et al. Burning mouth syndrome as a trigeminal small fibre neuropathy: Increased heat and capsaicin receptor TRPV1 in nerve fibres correlates with pain score. J Clin Neurosci 2007;14:864–871.

37. Wang H, Zhou M, Brand J, Huang L. Inflammation activates the interferon signaling pathways in taste bud cells. J Neurosci2007;27:10703–10713.

38. Wang H, Zhou M, Brand J, Huang L. Inflammation and taste disorders: Mechanisms in taste buds. Ann N Y Acad Sci 2009; 1170:596–603.

39. Kumarhia D, He L, McCluskey LP. Inflammatory stimuli acutely modulate peripheral taste function. J Neurophysiol 2016; 115:2964–2975.

40. Levine N. Irregular papillae pattern on tongue. Patient notes discomfort following spicy meals. Geriatrics 2005;60:20.

41. Feng P, Jyotaki M, Kim A, et al. Regulation of bitter taste responses by tumor necrosis factor. Brain Behav Immun 2015; 49:32–42.

42. Grushka M, Epstein JB, Gorsky M. Burning mouth syndrome. Am Fam Physician 2002;65:615–620.