Abstract
Physiologic examinations, candida culture test and psychosomatic approach were carried out on patients complaining glossal pain or abnormal taste sensation without no visible or pulpable findings. By the examination results and response to treatments, causes of glossal hyperesthesia and taste impairment were differentiated. Tongue pain was based on a psychosomatic condition, i. e. glossodynia in 39 cases (43.4% of the total), and on organic diseases such as candidosis (23.3%), Fe deficiency (18.9%) and mechanical irritation (4.4%). Both psychic and organic impairments were associated with tongue pain in 9 cases (10%). Abnormal taste sensation was defined as hypogeusia and dysgeusia in 17 and 4 cases, respectively. Impaired taste sensation was considered to be derived from Fe deficiency (28.6% of the total), candidosis (23.8%), xerostomia (14.3%) and complicated with glossodynia (19.0%) including unknown origin origin in 2 cases.
Salivary flow rate (SFR) lowered clearly in hypogeusia group, but slightly in glossodynia cases. Both stimulated and non-stimulated SFR increased with improvement of the disturbed sensation, however SFR in hypogeusia did not elevated sufficiently to healthy control level.
Tongue pain threshold exhibited clear difference among glossal hyperesthetic patients. In organic disease-associated cases, the threshold on the painful region was significantly lowered than that on the painless region, and the threshold difference disappeared with improvement of the symptom. On contrary, no threshold difference could be found in glossodynia between the “painful” and painless region, and also between before and after treatment.
Lowered taste threshold was detected in all of glossodynia, candidosis, Fe deficiency and of course most greatly in hypogeusia. In four fundamental tastes, threshold for sweet most clearly lowered. Elevation of mean thresholds for four tastes was seen in all groups corresponding with the clinical course. From these, it was clearified that unexpectively large number cases of glossal pain without manifesting any objective finding are caused by organic disorders such as Fe deficiency, candidosis or xerostomia. Besides, it was also clearified that abnormal taste sensation is associated with these organic factors. Therefore, it seems important for differential diagnosis of abnormal tongue sensation to examine patient's physical conditions regarding SFR, pain and taste threshold and candida culture test including psychosomatic approach.
