Since you have paid Dr. Attili, there is no need or obligation to pay again for this supplemental answer. Dr. Attili has recommended a dental organization to you. I agree that it would be prudent to be sure you do not have a dental problem before proceeding further. However, if your problem is not dental, then I feel a dermatologist specializing in oral medical problems would be a good approach. If the dentist cannot find anything wrong with your mouth, you may have what is referred to as the BURNING MOUTH SYNDROME. This is a burning of the mouth with or without dryness, or dysgeusia ( disordered taste). With BMS there is no obvious lesion, laboratory abnormalities, or systemic ( internal) disease. Some medical conditions and medications can cause this and this is secondary BMS. For some reason BMS is much more frequently found in women. The typical patient is a postmenopausal woman with a dry mouth, altered taste sensation ( metallic or bitter). The tongue is most commonly involved. BMS seems to come on out of the blue without a preceding precipitating event. If yours is typical it seems to worsen as the day progresses. The cause is basically unknown. Hypotheses include neurologic disorders, salivary gland problems, taste disturbances, atrophy of the mucous lining of the mouth, an psychological problems.
In an evaluation, as Dr. Attili suggests, you should see a dentist first to rule out such problems as denture problems or neglected dental issues. After that other possibilities should be addressed: these would include patch testing to rule out a 1) contact dermatitis
to metals, acrylates, flavorings and preservatives 2) Infectious causes such as Candida, bacterial overgrowth or viral problems 3) Inflammatory diseases that occur in the mouth such as lichen plants, pemphigus, bullous pemphigoid
, apthosis ( canker sores) , or geographic tongue...these are all conditions in which dermatologists would have far more experience in treating than dentists.
Nutritional deficiency such as Iron, B vitamins, folate and zinc
Neurologic: trigeminal neuralgia, glossopharyngeal neuralgia ( nerve problems involving the nerves that innervate the mouth).
Pharmacologic: as mentioned above an number of medications can cause this problem
Gastro-Intestinal problems: Crohn's Disease, Reflux
Endocrine: Diabetes, estrogen deficiency, thyroid problems
Autoimmune: Sjogren's Syndrome, lupus, fibromyalgia
Psychological factors: Depression, anxiety.
If all the above have been adequately ruled out you have primary BMS. Secondary BMS can be treated by addressing the above.
First, realize that this is not serious. Not cancer.
Topical medications thought to be of benefit include clonazepam, lidocaine, capsaicin, and doxepin.
The problem with Capsaicin is that it can cause GI distress. Doxepin has actually not been studied but works in patients with oral cancer pain.
Pills which benefit include: Neurontin, pregablin, amitriptyline, paroxetine, sertraline,clonazepam, pramipexole. If you want to go a bit holoistic: alpha-lipoic acid may help.
Psychologic intervention may also help,
Most patients with this problem have sought care from multiple providers including dentists and oral surgeons, internists, primary care providers and ENT specialists. Many patients are not aware of the expertise of dermatologists in this field and seek treatment from them after all else has failed. I would advice you to find a dermatologist who has special expertise in this field.
As I have already offered, I would be happy to provide you with the name of a dermatologist who limits his practice to this area of our specialty. Just let me know!