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Burning mouth syndrome

Burning mouth syndrome (BMS) occurs predominantly in middle aged men and women. It is also called glossodynia or stomatodynia. This syndrome occurs in the oral cavity affecting the gums, lips and the tongue. In severe cases, the tongue becomes scalded and has a bruised appearance. Burning mouth syndrome can occur because of preexisting medical and dental conditions such as menopause, oral thrush caused by yeast infection and also some forms of allergies. The exact cause of the burning mouth syndrome is not identified, however when it is diagnosed it becomes absolutely necessary to evaluate the underlying conditions associated with its cause.


Burning mouth syndrome is high among post-menopausal women. Patients often complain of metallic taste; followed by numbness in the oral cavity. The chronic pain caused due to burning mouth syndrome gradually increases and persists. Some patients complain of these symptoms after undergoing a dental procedure. In case of burning sensation, the tongue becomes scalded and patches on the tongue can be seen. The scalded patch is usually 6-9 cm.

Another important condition associated with burning mouth syndrome is xerostomia which is also called dry mouth. In this condition, the salivary flow to the mouth is reduced to a large extent and the person experiences taste aberrations such as metallic taste or bitter taste in the mouth. Studies indicate that this syndrome is caused because of changes associated with neurotransmitter molecules of the central nervous system. Some clinical findings reveal that the major factor associated with BMS is stress. Stressful conditions often release neurotransmitters as a hormonal response. Any changes or insufficiency in these neurotransmitters can lead to BMS.

Diagnosing Burning Mouth Syndrome

Burning mouth syndrome can be treated effectively by working up a diagnostic pattern. The diagnostic measures taken are associated with the patient's history of underlying medical conditions, stress and lifestyle patterns. Patients who undergo cancer treatment and antimicrobial therapies have greater chances of BMS. In addition these factors, BMS is also caused due to trauma to the nervous system in the oral region.

Patients who suffer BMS are treated with an anesthetic mouthwash to reduce the pain and burning sensation. If the pain persists then the salivary glands are carefully examined. This enables detection of a neurological condition called Sjogren syndrome which is associated with salivary gland flow functionality. Patients are tested for their taste patterns and salivary flow analysis is done to assess the type of treatment required. Other patients who have normal taste patterns and BMS are examined for history of reflux disease and previous dental procedures.

Treating Burning Mouth Syndrome

Many patients are counseled to avoid stress as it plays a major role in the onset of BMS. Antidepressant drugs such as clonazepam are recommended for some patients. In case of dry mouth, patients are advised to drink plenty of water or even use sugar free chewing gum to facilitate the salivary flow. Many dietary recommendations are also given to patients suffering with BMS. Patients are advised to avid spicy food, carbonated drinks, acidic juices and also chewing of tobacco. Adequate protein intake along with fiber is recommended to avoid gastrointestinal reflux related BMS and malnutrition associated BMS.

Myotonia

In medical terms, Myotonia is a neuromuscular condition. It is characterized by delayed relaxation of muscles after voluntary muscle contraction. It can affect any muscle type, the skeletal muscles, cardiac muscles (obvious) and smooth muscles (not obvious). The condition is usually inherited.


Myotonia is a characteristic feature in Myotonic Dystrophy, Myotonia Congenital and Paramyotonia Congenital. Myotonia is only a part in myotonic dystrophy. In Myotonia congenital and paramyotonia, it is the only main symptom. Also, in people who have a group of neurological disorders called the channelopathies, Myotonia is a symptom.


What happens in Myotonia?

Extra effort is required to relax the muscle soon after contraction. When the same action is repeated immediately, the condition improves as the muscles have warmed up.

Releasing the grip on objects or difficulty rising from a seated position is common with people with Myotonia. Immediately after rising from a seated position the individual may walk with a stiff, awkward gait. The posture improves after taking few steps forward. Another incidence is the time lag in opening eyes after initial tight eyelid closure.


What causes Myotonia?

Myotonia is caused by mutations in the chloride sodium or potassium channels that regulate the muscle membrane. Specific triggers that have been recognized so far include stress and exposure to cold.


What is the treatment for Myotonia?

If the condition is mild, exercise would suffice. If the condition is severe, treatment is necessary. Neurologist or medical geneticist with specific knowledge of the condition treats Myotonia. After a physical examination and a detailed family history, doctors prescribe medicines. Sodium channel blockers such as procainamide, phenytoin and mexiletine, tricyclic antidepressant drugs such as clomipramine or imipramine, benzodiazepines, calcium antagonists, taurine and prednisone are prescribed for the treatment. Physical therapy and other rehabilitative measures are recommended to help muscle function.


What is the prognosis for Myotonia?

Recognized as a chronic disorder, prescription medications when combined with physical therapy and other rehabilitative measures help alleviate symptoms later in life.



Melancholic depression

Melancholic depression is a severe form of depressive disorder or mental illness and is psychotic in nature. It is primarily caused by biological and genetic factors rather than psychological factors. It is a mental state that is characterized by feelings of extreme sadness, hopelessness and loss of interest and pleasure in almost everything. Person with Melancholic depression becomes non-responsive to happy incidents or surroundings even for the short period. Melancholic depression also leads to psychomotor disturbances such as low energy, poor concentration, slowed or agitated movements.


Causes of melancholia

It is believed that certain biological factors and genetic factors play an important role in development of this clinical depression. Studies also show that those who suffer from melancholia generally have a family history of depression disorders. Melancholia may not be an outcome of few negative incidents in life, but surely such events act as a trigger and initiate the problem. Biologically, melancholic depression is believed to be caused by a chemical imbalance or malfunctioning of the neurotransmitters in the brain.

Symptoms of Melancholia


  • Little or no response to positive and pleasant events.
  • Total loss of interest in things.
  • Low moods in the morning hours associated with low energy levels.
  • Strong feeling of guilt without any apparent reason.
  • Psychomotor Retardation with lack of facial expressions, slowing down of speech and body movements. They may also exhibit Psychomotor agitation such as pacing, twirling the hair, gesturing extensively, speaking incoherently, or aggression.
  • Cognitive impairment such as poor concentration and inattention.
  • Significant weight loss due to lack of interest in food.
  • Sleep problems, either insomnia or excessive sleep.

A person is diagnosed as suffering from melancholia when constantly experiencing extreme sadness accompanied by any 3 or 4 features mentioned above.

Treatment options

Unlike situational depression which is caused by sad events in life, melancholia is caused by biological disorder. Hence counseling and psychotherapy is probably not the solution. Treatment requires physical intervention via antidepressant drugs and also Electroconvulsive therapy (ECT) or shock treatment in case of extreme severity. Electroconvulsive therapy is recommended only for the severest forms of depressions, when a patient is not responding to antidepressant treatment or is posing a threat to self or others. Electroconvulsive therapy has certain side effects like short and long-term memory loss, hence it is advised only when the situation demands.

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Collection of Pages - Last revised Date: June 24, 2019