Clinical study of tongue pain: Serum zinc, vitamin B12, folic acid, and copper concentrations, and systemic disease

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Abstract

The aim of this retrospective study of patients with tongue pain who showed no improvement after initial treatment and examination was to find out if their lack of response correlated with serum concentrations of zinc, vitamin B12, folic acid, and copper, and if it was associated with coexisting systemic diseases. We studied 311 patients for whom we had data about serum concentrations of these elements, and recorded whether they had any systemic diseases and were taking medicines regularly. One patient (0.3%) had a copper concentration outside the reference range; 2 patients (0.6%) had folic acid concentrations outside the reference range. The corresponding number for vitamin B12 was 5 (2%), and for zinc 30 (10%). The systemic diseases with the highest rates were: hyperlipidaemia (n = 53, 17%), gastritis or gastric ulcer (n = 51, 16%), angina pectoris (n = 39, 13%), diabetes mellitus (n = 31, 10%), thyroid disease (n = 31, 10%), mild mental disorder (n = 27, 9%), hypertension (n = 18, 6%), cerebral infarction (n = 17, 6%), leiomyoma (n = 15, 5%) and anaemia (n = 15, 5%).

Roughly 10% of the patients were deficient in zinc. This study suggested that the serum concentration of zinc was most important to the patients with tongue pain. Many patients had more than one systemic condition, and all were taking various drugs.

Introduction

Tongue pain is both complex and controversial because of its multifactorial aetiology.1 The cause may be local (xerostomia, stomatitis, candidiasis, tooth disease, or periodontitis), systemic (pernicious anaemia, iron-deficiency anaemia, pellagra, arteriosclerosis, or diabetic neuropathy), or psychological (hypochondriasis, depression, or cancerphobia).

Many studies have emphasised the involvement of psychological factors, but the mechanisms of pain when there are no macroscopic abnormalities on the tongue are not known,2 though it is usually easy to treat patients who have macroscopic abnormalities (atrophy, erosion, or ulcer).

The treatment becomes more complex when the symptoms do not improve after initial treatment (adjustment of a prothesis, or treatment of dental caries, stomatitis and tartar) and first-line examinations (microbiological examination for Candida, and haematological assessments of red blood cell count, packed cell volume, and haemoglobin concentration). The relation between the incidence and treatment of dysgeusia in patients with glossodynia and serum concentrations of zinc, copper and other substances have been reported.3, 4, 5

The aim of this retrospective study was to assess the part played by the serum concentrations of zinc, vitamin B12, folic acid and copper in the patients with tongue pain who did not improve after initial treatment and examination. We also considered the effect of systemic disease.

Section snippets

Patients and methods

This study took place at the First Department of Oral and Maxillofacial Surgery, Osaka Dental University and Department of Oral and Maxillofacial Surgery, Fukui Prefectural Hospital, Japan, between April 1999 and December 2003 among patients whose chief complaint was tongue pain.

Before treatment was started, all patients were interviewed and examined extraorally and intraorally. Next, we adjusted prostheses; treated dental caries or tartar, or both; and prescribed gargle or ointment, or both;

Results

Age distribution and male:female ratio are shown in Table 1.

Results of serum concentrations of zinc, vitamin B12, folic acid, and copper are shown in Table 2.

Previous or present systemic diseases are shown in Table 3.

Discussion

The mechanisms of tongue pain when there are no macroscopic abnormalities are not known. In general, these cases are often described as glossodynia, which is also known as glossalgia, glossopyrosis, stomatodynia, or burning mouth syndrome. It is characterised by a burning sensation in the tongue, often in the absence of clinical and laboratory findings.6

However, the definition and criteria of glossodynia is ambiguous. Nagai et al. defined it as “superficial and spontaneous pain or abnormal

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