Diabetes and Tongue Pain: Symptoms and Causes

Diabetes and Glossodynia

Three years ago, I started brushing my teeth four times a day due to fear of cavities, whereas I used to brush only twice.
Not long after, due to stress and poor sleep, my tongue began to hurt.
I brushed for a long time, keeping toothpaste in my mouth for at least 10 minutes.
Although I stopped immediately, the tongue pain began.
I have already consulted an ENT specialist and a dentist, both of whom only noted redness.
The condition has been fluctuating.
Additionally, I noticed what seemed like atrophy of my tongue, but the doctor only prescribed B vitamins.
It seems to hurt less when I take them, but it flares up again when I don't.

I would like to ask the doctor:
1.
Can diabetes cause tongue pain? However, my BMI is only 17.9, and I do consume sweet drinks occasionally.

2.
Could it be that the toothpaste was too irritating and disrupted my oral microbiome? Medically, is that possible? At one point, the dentist suspected a Candida infection, but later said it didn’t seem like it because there were no white patches.

Recently, I've noticed something strange: the pain starts after I shower and before bed, but not during the day.
Eventually, I couldn't stand it anymore, so I reduced my sweet drink intake and started using a sugar-free green tea mouthwash along with medicinal toothpaste (licorice-based, which was previously prescribed by the dentist).
I feel like there has been some improvement.
What do you think about my situation? Is it simply a deficiency of B2? (I have digestive issues with milk and do not consume red meat or organ meats.)

Niming, 30~39 year old female. Ask Date: 2021/05/13

Dr. Hong Yuanbin reply Internal Medicine

Hello,
1.
Diabetes can indeed cause neurological changes, and it is possible that the condition you mentioned is related to diabetes.
However, it is not certain that diabetes is the sole cause.
It is advisable to consult an oral specialist.
2.
The toothpaste itself has a minimal impact, but diabetes can also make individuals more susceptible to oral candidiasis.
It is recommended to have an oral specialist assess the underlying cause.
Regardless, maintaining oral hygiene and controlling blood sugar levels will be beneficial for related conditions.
Thank you for your inquiry.

Reply Date: 2021/05/13

More Info

Diabetes is a chronic condition that affects how your body processes glucose, leading to various symptoms and complications. Understanding the relationship between diabetes and tongue pain, as well as the potential causes of your symptoms, is crucial for effective management and treatment.

1. Diabetes and Tongue Pain
Diabetes can indeed contribute to oral health issues, including tongue pain. High blood sugar levels can lead to dry mouth (xerostomia), which can cause discomfort and pain in the tongue. Additionally, diabetes can impair the immune system, making individuals more susceptible to infections, including oral infections like thrush (oral candidiasis), which can manifest as a painful, burning sensation on the tongue.
Moreover, diabetic neuropathy, a common complication of diabetes, can lead to nerve damage that may cause pain or discomfort in various parts of the body, including the tongue. While your BMI of 17.9 indicates that you are underweight, which can also contribute to nutritional deficiencies, it is essential to consider that diabetes can still affect you regardless of your weight.

2. Oral Hygiene and Irritation
Your concern about the potential irritation caused by excessive brushing and the use of toothpaste is valid. Over-brushing can lead to trauma to the oral mucosa, resulting in inflammation and pain. Some toothpaste contains strong ingredients that may irritate sensitive tissues, especially if used excessively. If you were using a toothpaste with strong flavoring agents or abrasives, it could have disrupted your oral microbiome, leading to an imbalance that might cause discomfort.

The suspicion of oral thrush is also noteworthy. While the absence of white patches may suggest that it is not a classic case of thrush, it is still possible to have a mild infection that does not present with typical symptoms. The use of B vitamins, particularly B2 (riboflavin), can help if your pain is related to a deficiency, as it plays a role in maintaining healthy mucous membranes.

3. Stress and Sleep
Stress and poor sleep can exacerbate oral pain and discomfort. Stress can lead to behaviors such as teeth grinding (bruxism), which can cause muscle tension and pain in the jaw and tongue. Additionally, lack of sleep can weaken the immune system, making it harder for your body to fight off infections or heal from irritations.

Recommendations
1. Monitor Blood Sugar Levels: Regularly check your blood sugar levels to ensure they are within the target range. If you notice fluctuations, consult your healthcare provider for adjustments in your management plan.

2. Oral Hygiene Practices: Consider using a softer toothbrush and a toothpaste designed for sensitive mouths. Limit the frequency of brushing to twice a day, and avoid brushing too aggressively.

3. Dietary Adjustments: Since you mentioned a preference for sweet drinks, reducing sugar intake can help manage blood sugar levels and improve overall oral health. Incorporating a balanced diet rich in vitamins and minerals is essential.

4. Consult Healthcare Providers: If the pain persists, it may be beneficial to consult a dentist or an oral specialist who can provide a thorough examination and possibly recommend treatments such as antifungal medications if an infection is suspected.

5. Stress Management: Engage in stress-reducing activities such as yoga, meditation, or regular exercise to improve both your mental and physical health.

In conclusion, while diabetes can contribute to tongue pain, it is essential to consider all potential factors, including oral hygiene practices, dietary habits, and stress levels. A comprehensive approach that includes monitoring your diabetes, improving oral care, and managing stress can help alleviate your symptoms and improve your overall well-being.

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