Lingual Pain: Causes and Solutions for Tongue Discomfort - Otolaryngology

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Understanding lingual pain can be quite complex, as it often involves multiple factors, including dental issues, nerve involvement, and even psychological aspects. Based on your description, it seems that your symptoms have evolved over time, and while you have sought help from various specialists, the underlying cause remains elusive.

Firstly, the pain and discomfort on the left side of your tongue, particularly the scraping sensation against your teeth, could indeed be attributed to dental issues. You mentioned that you have had dental work done, including the extraction of wisdom teeth and smoothing of sharp edges on your remaining teeth. These actions should ideally reduce the trauma to your tongue. However, if the pain persists, it may indicate that the issue is not solely mechanical.
The burning, tingling, and dry sensations you experience could be related to a condition known as burning mouth syndrome (BMS), which is characterized by a burning sensation in the tongue or other areas of the mouth without an obvious cause. This condition can be associated with various factors, including hormonal changes, nutritional deficiencies (such as vitamin B12 or iron), and even psychological stress. Given that your symptoms worsen in the afternoon and improve overnight, it may suggest a connection to your daily activities or stress levels.

The tightness and pain in your neck and shoulder area could also be contributing to your lingual discomfort. Muscular tension in the neck can lead to referred pain, which may manifest as discomfort in the tongue or jaw. This is particularly relevant if you find that pressing on certain areas of your neck alleviates your tongue pain. It’s possible that muscle tension or nerve compression in the cervical spine could be affecting the nerves that innervate the tongue, leading to the sensations you describe.

Given the complexity of your symptoms, it may be beneficial to consider a multidisciplinary approach. Here are some recommendations:
1. Dental Follow-Up: Continue to monitor your dental health. If you have not already, consider consulting an oral surgeon or a specialist in orofacial pain who can assess for any underlying dental issues that may not have been fully addressed.

2. Neurological Evaluation: Since you are experiencing symptoms that could be related to nerve involvement, a consultation with a neurologist may be warranted. They can evaluate for conditions such as neuropathy or other nerve-related issues that could be contributing to your symptoms.

3. Physical Therapy: If muscle tension is suspected, physical therapy may help. A physical therapist can provide exercises and techniques to relieve tension in the neck and shoulders, which may, in turn, alleviate your tongue discomfort.

4. Nutritional Assessment: Consider a nutritional evaluation to rule out deficiencies that could be contributing to your symptoms. A dietitian can help assess your dietary intake and suggest appropriate supplements if needed.

5. Psychological Support: If stress or anxiety is a factor, speaking with a mental health professional may provide strategies to manage these feelings, which could also help alleviate physical symptoms.

6. Further Investigations: If symptoms persist despite these interventions, further investigations such as imaging studies (like an MRI of the cervical spine) or blood tests may be necessary to rule out other underlying conditions.

In conclusion, while your symptoms may initially seem localized to the tongue, they could be part of a broader issue involving dental health, nerve function, muscle tension, or even psychological factors. A comprehensive approach that includes dental care, neurological evaluation, physical therapy, and nutritional support may provide the best chance for relief. If you feel that your current healthcare providers are not addressing your concerns adequately, seeking a second opinion or consulting a specialist in a related field may be beneficial.