Q: FOR months I’ve had a sore tongue, and can’t eat hot food, citrus fruit or spices. My GP prescribed drops, followed by a mouth gel, for thrush, but neither helped. At a walk-in centre I was told I have a dehydrated and cracked tongue, given a mouthwash and told to see a dentist.
Name and address supplied.
A: THIS sort of complaint can have a number of possible causes, so the diagnosis involves some medical sleuthing. Presented with a patient with a sore tongue, most doctors I know first prescribe antifungal treatments, such as the nystatin drops or fungicidal gel you were given on the assumption that the problem is oral thrush.
But I think sometimes they prescribe antifungal medication more out of hope than logical thought, as thrush has such a characteristic appearance – white, curdy flecks that leave an area of bleeding when displaced – that without seeing this, antifungals don’t make sense.
People who develop oral thrush tend to have had a history of antibiotic use or other trigger factors such as the regular use of a corticosteroid inhaler (for asthma, for instance).
Both of these can reduce levels of healthy bacteria, which gives fungi – in this case the candida strain – the opportunity to take hold.
In your case, given the symptoms you have listed, I see no real reason to suspect thrush is the culprit.
The more likely possibilities include a condition called burning mouth syndrome. The soreness may involve just the tongue or the entire mouth. It can also affect taste, and the mouth may feel dry.
It is rare, and mysterious in that there is no proper understanding of what causes it.
Most of those who develop it are postmenopausal women.
A second possibility is fissured tongue, although this isn’t usually associated with soreness. Here the fissures or cracks that appear, and the changes in the surface of the tongue, are permanent and don’t respond to any treatment.
Its causes are unclear, though it is associated with underlying nutritional deficiencies, and syndromes such as Down’s syndrome.
Another possible cause is atrophic glossitis, where the papillae – the tiny lumps and bumps found on the top and side of the tongue – become so thin and wasted that the whole surface of the tongue appears red and shiny.
The common causes are nutritional deficiencies, with a lack of iron, vitamin B12, and folic acid at the top of the list.
Coeliac disease, where the immune system reacts to the protein gluten – which can remain undetected until well into adult life – can also cause atrophic glossitis, as this can lead to serious difficulties when it comes to absorbing nutrients from food, especially iron.
Personally, I think it is atrophic glossitis that fits the description of your symptoms best.
I’d suggest consulting your doctor again in the expectation that a simple blood test might be carried out to check your blood cell count, iron levels, and inflammatory markers. This may shed some light on the exact diagnosis.
If the tests are all normal then I recommend asking your pharmacist to advise you of the best liquid probiotic, though there’s only anecdotal evidence that this helps with a sore tongue.
It is possible that a change in the bacterial balance of the mouth and tongue is the cause of the problem.
A liquid probiotic, made up of ‘friendly’ essential bacteria, will coat the tongue. The bacteria it contains may alter the balance of bacteria in your gastrointestinal tract and mouth enough to bring about relief of your symptoms.
Take this for at least a month, as it can do no harm and it might resolve the soreness.
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