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What is burning mouth syndrome?
Burning mouth syndrome is a relatively common condition that is characterized by a complaint of an abnormal sensation of the lining of the mouth that most patients describe as feeling like their mouth has been scalded. Usually this sensation develops in the front part of the mouth, typically affecting the inner surfaces of the lips, the roof of the mouth and the sides and tip of the tongue. In some patients, only the tongue will be affected, however, any combination of these sites may be seen. Some patients may have a decreased taste ability or altered taste sensation (bitter or salty). Other patients may feel that their mouths are dry or sticky. In all cases, however, the lining of the mouth clinically appears normal.

Who gets burning mouth?
Most patients who develop burning mouth syndrome are post-menopausal women. We usually see about ten women for every man who has burning mouth syndrome. This is a relatively common problem that is seen all over the world. For example, in Holland, patients with burning mouth syndrome have formed a support group. This seems to be a condition that affects people of all races and all socioeconomic backgrounds.

What causes burning mouth?
Nobody knows for sure. There are a few uncommon diseases that should be tested for, such as anemia, diabetes and oral yeast infections. For most patients with burning mouth syndrome, however, those tests turn out to be normal. Some investigators have suggested that burning mouth may be a problem related to the nerves in the mouth. We know that burning mouth is not related to anything serious, such as cancer or AIDS. Furthermore it is not contagious so it can’t be passed from one person to another.

How do doctors diagnose burning mouth syndrome?
Burning mouth syndrome is diagnosed by doing blood tests and cultures to make certain that one of the other problems mentioned previously is not present. If those tests are all negative, and if the lining of the mouth appears normal, then we can make a diagnosis of burning mouth syndrome.

How is burning mouth syndrome treated?
Unfortunately, no one has developed a medically proven treatment for burning mouth syndrome. The main problem is that we don’t know what causes burning mouth syndrome, therefore it is difficult to develop a treatment for the condition. A variety of medications (including anti-depressants, anti-seizure drugs, female hormone replacement therapy and vitamin therapy) have been tried, however, such treatments either have no effect or their effect is no greater than what we would expect to see with placebo (sugar pill) treatment.

How long will the burning sensation last?
Again, we cannot say for sure. We know that for about half of the affected patients, the condition will resolve after a period of time, but no one can predict how long that will be for a particular individual. For the most part, this problem is a nuisance, and it is a frustrating situation for both patients and doctors.

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What is cicatricial pemphigoid (sicuh-tri-shul pem-fuh-goyd)?
Cicatricial pemphigoid is a relatively uncommon blistering disease that mostly affects the mucous membranes, that is, the moist linings of the mouth, the eyes, the nose and throat, and the vagina. Sometimes only one or two of these areas are affected at first, and the condition may spread to other areas, including the skin, if it is not treated.

Who gets cicatricial pemphigoid?
Cicatricial pemphigoid is a condition that primarily affects middle-aged or older adults. Either sex can get the disease, but women are affected slightly more often than men.

Can I spread this disease to my family and friends?
No. Cicatricial pemphigoid is not a disease that can be passed from one person to another like the flu. Probably the best explanation as to what is happening in cicatricial pemphigoid is that it is a type of unusual allergic reaction. In the case of cicatricial pemphigoid, however, instead of being allergic to, say, strawberries or seafood, the body is sort of allergic to itself. In other words, the immune system, which normally protects the body by destroying invading organisms, gets confused and actually starts attacking the lining tissues of the body itself. Thus, cicatricial pemphigoid is in the group of diseases that we call autoimmune (literally “self” immune) diseases.

How do doctors diagnose pemphigoid?
The best way to diagnose pemphigoid is to take a tissue sample (biopsy) from the involved area of the mouth. This is a minor surgical procedure, performed using local anesthesia (numbing) in the office. The tissue is then examined in the laboratory under a microscope and special tests are performed to detect the abnormal immune reaction.

Why is it important to diagnose pemphigoid?
The most serious problem associated with untreated cicatricial pemphigoid is possible blindness if the lining of the eye is involved. The word “cicatricial” means “scarring”, and if the disease affects the eye, the scarring that results often leads to blindness if the condition is not diagnosed early enough and treated properly.

Not everyone who has pemphigoid of the mouth will develop pemphigoid in their eyes, but about one person in four will. This is why we advise our patients to be evaluated by an ophthalmologist (medical doctor specializing in eye disease) who is familiar with the signs of eye involvement with cicatricial pemphigoid.

How is pemphigoid treated?
The type of treatment for cicatricial pemphigoid usually depends on the extent of the disease. There are several ways to treat pemphigoid, including tetracycline with niacinamide, cortisone-type drugs that suppress the immune reaction, or a sulfa-type drug called dapsone. With mild oral involvement, topical (surface) application of a cortisone-type medication a few times each day may be able to control the symptoms. Another alternative is the use of tetracycline and niacinamide, taking one capsule of each, four times daily. On the other hand, if symptoms are more generalized or if the eye is involved, then more serious, cortisone-type drugs that are taken internally may be necessary. If the cortisone-type drugs don’t work well or if their side effects are too severe, then dapsone may be tried. A special blood test has to be done, however, to find out if the patient can take dapsone safely.

Can pemphigoid be cured?
In the sense that strep throat, for example, can be cured by a shot of penicillin, no, pemphigoid cannot be cured. The symptoms, however, can usually be controlled with the right medication or combination of medications. Pemphigoid is a condition that may wax and wane on its own to a certain extent, but it usually doesn’t go away completely. Fortunately, it rarely causes death, but the possibility of blindness is certainly serious, and the sores and blisters can be quite a nuisance. The goal of your treatment, then, is to keep the sores and blisters under control so that you can lead a relatively normal life. But please realize that this is a very difficult and complex disease to manage, and cooperation and communication between the patient and doctor are necessary to achieve the best possible treatment results.

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What is geographic tongue? 
Geographic tongue (also known as benign migratory glossitis or erythema migrans) is a harmless condition that affects about 2% of the population. Geographic tongue is typically seen as well-defined, reddened areas on and around the sides of the tongue. These red areas usually have a slightly white or yellow-white, raised line around their edges. The condition usually waxes and wanes in severity, with the red patches appearing in one area during a period of several hours to a few days, persisting for a period of time (days to weeks to months, depending on the individual), and clearing up; however, the process usually repeats itself in a different area or areas after a few more days, weeks or months. When the condition is “active”, the tongue is often sensitive (feels like it has been scalded) to hot, spicy or acidic foods.

What causes geographic tongue?
Noone really knows what causes this condition — all we know is that it is not a serious problem. It is not caused by an infection, and it is not related to any other disease. If a biopsy were to be taken from your tongue, it would look a little like psoriasis of the skin (“psoriasiform mucositis”). Geographic tongue patients usually don’t have psoriasis; however, psoriasis is a common skin condition that also has an unknown cause, and occasionally we see a patient with both problems. This may be nothing more than coincidence in many instances.

Who gets geographic tongue? Can people catch this from me?
Anyone can potentially develop geographic tongue, just like anyone can potentially develop, for example, an allergy to penicillin. Why does one person develop the allergy and the next person doesn’t? No one knows. And we can say the same for geographic tongue. No one knows why some people develop the condition. We know that this is not any sort of infection, however, so you don’t have to be worried about passing this on to anyone else.

Is there any cure for geographic tongue?
No, there is no “cure” for geographic tongue, just as there is no cure for arthritis, psoriasis or allergies. Most patients will experience this condition as a mild nuisance or irritation. Infrequently, powerful topical anti-inflammatory drugs (cortisone-like drugs) may have to be prescribed to help control the discomfort for those few patients who are very bothered by the problem.

Will it turn into cancer?
No. Geographic tongue has never been demonstrated to undergo transformation to cancer. Of course, if any oral sore develops which doesn’t behave like typical geographic tongue, the prudent thing to do would be to have it evaluated by the oral pathologist or other health care practitioner with experience in diagnosing oral disease.