Posted by Paul De Smedt
on July 28, 2000 at 16:15:22:
In Reply to: Re: Burning tongue posted by Kaye on February 19, 2000 at 15:20:09:
: : I have a problem with the end of my tongue burns and sometimes my lips. Could this be an allergie of somekind?? Has anyone else had this problem??
: I had a burning tongue and cracked lips for a year which escalated as time went on. After another year I learned that I was allergic to FD&C dyes as well as many food preservatives. Have eliminated these symptoms as well as others by taking these out of my diet.
2BURNING TONGUE SYNDROME ( B.T.S. ) May 3. 2000
While surfing on Internet in order to get the latest treatment of the Burning Tongue Syndrome (B.T.S) nothing has been found for those mostly desperate patients. Since the year 1986 more than fifty patients were treated in our department. All recorded patients have been seen between 1986 and 1990.It was like an Epidemic. Since 1990 cases were very rare... less than ten patients were examined. All except three were females ageing from 40 to 92 years. Before treatment one should make sure that no confusion could be made with a Yeast Candida Albicans infection,pernicious anemia,geographic tongue etc.... Look also for diabetes. All biopsies showed an infiltration of polynuclear and lymphocytes cells under the base of the mucosa, infiltration that disappeared in the biopsy of patients after treatment. In one biopsy the anatomopathologist mentioned possible virus infection.(?)
Patients were all treated by surface cauterisation of the painful spots. The first patient which was treated with electrocoagulation could locate a precise tiny spot ,the pain seemed very superficial and so came the idea of destroying that spot,the result was very good.She had suffered during 14 years. Those spots may be located at the tip, at the left and right border, at the middle of the tongue. Lips and soft oral mucosa have been taken care of but very cautiously because of the thinness of the epithelium. The first three patients had electrocoagulation,this procedure was later abandonned due to the severe pain,results were good. Surface anaesthesia could not be used because it would not be possible for the patient to indicate the exact area to be treated. An aqueous solution at 2%or 5%of phenolic acid was used for the other cases. This solution was applied on the sore spots till a superficial necrosis of the tongue surface appeared (whitish surface).
During the first minutes this is painfull but subsides very quickly. Patients said it bearable. Phenol is also considered having some anaesthetic properties. After a few days the necrotized mucosa is discarded and there are no signs of scar tissue. Several treatments may be necessary after the complete healing of one site, another may be started in the following session. . Patients over the age of seventy need several treatments in one year on the same spot. A few cases got complete relief of pain after one session, other needed more treatments, sometimes at different spots Recurrence of B.T.S is not frequent and may be treated again. This occurs with elderly patients. In treated patients the success rate was 70%. Success means: satisfied or completely healed patients. Some patients reported good results during a follow up of thirteen years. One patient has given a twenty year testimony. Other methods of necrotisation have not been tried: cryotherapy, laser cauterisation, trichloracetic acid, even straight hydrogen peroxide as one patient reported with some success, etc... This treatment should be reserved to M.D and Dentists since a correct diagnosis should be made first. Phenolic acid is not easy to handle. Medical follow up is a necessity A lot of research need to be done with proper scientific procedures and good statistical methods. Any comment and results obtained by other practitioners will be welcome.
Dr.P.J.De Smedt. MD ,LDS,(Univ.Louvain,Belgium)
DDS, (Northwestern Univ.,Chicago)
5 Clos du Taillis,1150 Brussels,Belgium
Case report made by the patient:Dr.John D. born in 1925.
August 1980:acute glossitis,tip of tongue depappileted,reddish and very painfull. Chewing of fresh pineapple gives some relief;the taste was disturbed and speech impaired by pain.
April 1981:analysis showed the presence of a candida albicans infection.Treatment by nystatine, Miconazol,amphoterizine B.
January 1983:Lipiodol scialography:normal
January 1988:Acute recurrence of B.T.S:Cauterisation of sore spots with 2%phenol by Dr.P.D.S.
October 1988:second treatment with 2%phenol by Dr.P.D.S.there after I treated myself,whenever necessary with a 1%solution of pnenol during a period of four months.The situation improved a lot and the pain was reduced to a very small area at the tip of the tongue .
1990:the improvement is stable and once in a while a cauterisation is necessary with a 2%solution
April 5th.2000: almost complete healing,a few and rare recurrencies but very slight pain.
Diet:rich in fibers,low fat and salt content,vitamins.
Beverages:beer,wine at meals.
Alcohol:genever,vodka,white concentrated alcoholic beverages are not tolerated.
Commentary:Dr.John.D. is head of the department of chest surgery.Therfore he conducted, after the two first sessions, the treatment by himself.It showed that a weaker solution of phenol could be succesfull but takes more time.A timespan of twenty years gives also a great value to this testimony.