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16
New Mexico Dental Journal, Fall 2016
By Lionel M. Candelaria, DDS; Matthew Hanchett, DMD
P
ainful or burning sensation
(glossodynia) of the tongue is
commonly encountered in our
dental practices and can be difficult to
diagnose and treat. The purpose of this
article is to focus on Atrophic Glossitis
and Glossodynia Secondary to vitamin
B
12
deficiency.
The differential diagnosis of glossodynia
includes primarily, local fungal infection,
vitamin B
12
deficient, burning mouth
disorder and to a lesser frequency, trau-
ma, hyperesthesia from nerve damage
and neuropathic pain syndrome.
1
Vitamin B
12
is an essential component
of nucleic acid metabolism, methyl
transfer and myelin synthesis and re-
pair. In addition, is necessary for the
formation of normal red blood cells. vi-
tamin B
12
deficiency is most commonly
as a result of a GI malabsorption of vita-
min B
12
due to lack of intrinsic factor/
pernicious anemia. Intrinsic factor is
secreted by the parietal cells in the gas-
tric mucosa. Intrinsic factor binds with
vitamin B
12
and facilitates its absorption
in the terminal ilium.
6
Vitamin B
12
is
transported in the plasma by transco-
balamins to the liver where it is stored
for physiologic needs.
2
Vitamin B
12
de-
ficiency usually results from inadequate
absorption, impaired storage or drugs as
summarized in the following table:
Insufficient dietary intake Vegan diet, alcoholic malnutrition
Impaired absorption
1. Lack of intrinsic factor (primarily autoimmune
metaplastic atrophic gastritis)
2. Intrinsic factor inhibition
3. Decreased gastric acid secretion
4. Small bowel disorders: for example, celiac
disease, inflammatory bowel disease,
5. AIDS
6. In the elderly Vitamin B
12
deficiency decreased
gastric acid and intrinsic factor production.
Impaired storage
1. Liver disease
2. Transcobalamins (transport)
deficiency or abnormality
Drugs
1. Antacids
2. Metformin
3. Repeated exposure to nitrous oxide
Relevant causes of B
12
deficiency
(reproduced in part from the Merck Manual)
Atrophic Glossitis and Glossodynia
Atrophic Glossitis
and Glossodynia
Secondary to Vitamin B
12
(cobalamin) Deficiency