Chronic Dry Mouth and Tongue Pain: Unraveling the Mystery of Symptoms

Dry mouth and tongue pain for many years without a definitive diagnosis?

Hello Doctor, my mother has been experiencing symptoms of reduced saliva for about 30 years.
She has seen dentists, rheumatologists, and family medicine doctors, and underwent a sublingual gauze test which confirmed the decrease in saliva.
However, no physician has been able to identify the exact cause, leading to the conclusion of "coexisting peacefully" with her condition.
Now, thirty years later, her symptoms have worsened, and she has begun to experience swelling and pain in her tongue and throat, which has even affected her sleep quality.
In May of this year, she visited a large hospital's rheumatology department but returned without any resolution.
In July, by chance, she consulted a rehabilitation physician who took X-rays of her left palm and conducted blood tests.
The results showed some deformity in her left hand, and the blood tests revealed RF 83, ANA 1:80 (+), with Anti-Ro/La antibodies all negative.
Based on these findings, the rehabilitation physician suspects my mother has a rheumatic disease and informed us that symptoms can vary among patients.
The pain in her tongue and reduced saliva are likely due to an autoimmune attack on the salivary glands.
However, this damage is irreversible, and even with medication, it can only be managed, not fully restored.
The rehabilitation physician prescribed the following medications: one tablet of Ketorolac, one tablet of Baclofen, and two tablets of Celecoxib.
My mother has followed the physician's instructions and has been taking the medications for three weeks, but she only feels a slight reduction in pain with no significant difference otherwise.
Additionally, my mother has hepatitis B and seems reluctant to take medication long-term, and she has some reservations about the diagnosis made by the rehabilitation physician.
As her child, I am quite distressed about her condition, so I am seeking your advice.
Do you think my mother should undergo further examinations, such as a salivary gland biopsy? Furthermore, in your judgment, is it possible that my mother has a rheumatic disease causing her oral discomfort, or could there be other potential causes aside from rheumatic disease? I would greatly appreciate any insights you can provide.
Thank you.

ANN, 30~39 year old female. Ask Date: 2023/07/24

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
My suggestions are as follows:
1.
You may consider returning to a rheumatology clinic for evaluation.
If necessary, a salivary gland biopsy may indeed be required, as sometimes the diagnosis of Sjögren's syndrome necessitates this examination.
2.
Hepatitis B requires regular follow-up appointments.
Poor control of hepatitis B can also lead to symptoms of dryness.
3.
In addition to Sjögren's syndrome, other rheumatic diseases can also present with dry symptoms, such as rheumatoid arthritis.
Therefore, I recommend finding a rheumatologist you trust and collaborating with them.
If necessary, please have your mother undergo relevant examinations to confirm the underlying cause.
4.
Sometimes, rheumatic diseases may not exhibit their typical characteristics early on, which can complicate diagnosis.
Therefore, consistent monitoring is essential to observe changes in symptoms and laboratory test results.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is concerned about your well-being.

Reply Date: 2023/07/24

More Info

Chronic dry mouth, also known as xerostomia, and tongue pain can significantly impact a person's quality of life, especially when these symptoms persist over many years. Your mother's situation, having experienced reduced saliva production for about 30 years, is indeed concerning and warrants a thorough investigation.
Firstly, it's important to understand that dry mouth can arise from various causes, including medications, systemic diseases, and autoimmune disorders. Given that your mother has already been evaluated by multiple specialists, including dentists and rheumatologists, and has undergone tests such as the sublingual gauze test, it seems that the medical community has recognized the symptom but has struggled to pinpoint a definitive cause.

The mention of autoimmune conditions is particularly relevant here. Conditions like Sjögren's syndrome, which is characterized by dry mouth and dry eyes, can lead to the destruction of salivary glands. This could explain the chronic nature of your mother’s symptoms, especially if the rheumatologist suspects an autoimmune process. The presence of anti-Ro/La antibodies, even if negative, does not rule out Sjögren's syndrome, as the diagnosis often relies on a combination of clinical symptoms, serological tests, and histopathological findings from salivary gland biopsies.

The pain and swelling in her tongue and throat could also be linked to the dry mouth. Saliva plays a crucial role in maintaining oral health; it helps in digestion, protects against infection, and keeps the mucous membranes moist. When saliva production is low, it can lead to discomfort, difficulty swallowing, and an increased risk of dental issues, which may further exacerbate her symptoms.

Considering the complexity of her symptoms and the potential for an autoimmune disorder, it would be prudent for your mother to undergo further evaluation. A salivary gland biopsy could provide valuable insights into whether there is an autoimmune process at play. This procedure can help confirm or rule out conditions like Sjögren's syndrome by examining the tissue for signs of inflammation and damage.

Additionally, it may be beneficial for her to consult with an oral medicine specialist or a maxillofacial specialist who can provide a more focused approach to her oral symptoms. They may also consider other potential causes of her symptoms, such as vitamin deficiencies (like B12 or folate), infections, or even systemic conditions that could manifest as oral pain and dryness.

In terms of management, while medications like pilocarpine or cevimeline can stimulate saliva production, they may not be suitable for everyone, especially considering her history of hepatitis B. Therefore, a careful evaluation of her overall health and any potential drug interactions is essential.

Lastly, lifestyle modifications can also help manage dry mouth symptoms. Encouraging her to stay hydrated, using saliva substitutes, and maintaining good oral hygiene can alleviate some discomfort.
In summary, your mother's symptoms could indeed be related to an autoimmune disorder affecting her salivary glands, but further investigation is necessary to confirm this. A salivary gland biopsy, along with a consultation with specialists in oral medicine or autoimmune diseases, could provide clarity and guide appropriate treatment options. Your concern for your mother's health is commendable, and advocating for her to receive comprehensive care is crucial in managing her condition effectively.

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