Bitterness in the mouth may indicate problems with the digestive system. Severe or persistent bitterness in the mouth is a reason to consult a doctor.
From time to time you may experience an unpleasant bitter taste in your mouth. As a rule, this is due to a sudden release of bile into the gastrointestinal tract. In this case, some bile may enter the esophagus and cause a bitter sensation in the mouth.
. Often a bitter taste in the mouth is felt in the morning, since bile can enter the stomach during sleep (especially if you sleep on your left side and dinner included fatty foods).
Bile is a secretion produced by the liver and is necessary for digesting food. The bile duct carries bile from the liver to the gallbladder, which acts as a storage reservoir. During the active digestive phase, bile from the gallbladder enters the duodenum. Some substances have choleretic properties, that is, they increase the production of bile. Eating foods with choleretic properties (for example, pine nuts) can provoke a sharp increase in the flow of bile into the intestines and, as a result, the appearance of bitterness in the mouth. Some medications have the same effect - both medical preparations and traditional medicine (St. John's wort, sea buckthorn oil, etc.).
However, bitterness in the mouth should not be ignored
. Its appearance indicates that not everything is in order with the digestive system. For example, a bitter taste may appear after eating fatty (heavy) foods. Fatty foods stimulate bile secretion. Normally, the secreted bile should not enter the stomach and esophagus, but should be released exactly as much as is necessary for the digestive process in the intestines. The appearance of bitterness indicates that this is not the case. And we need to figure out what caused this. If bitterness in the mouth occurs frequently or persists for a long time, then it is better not to delay a visit to the doctor.
Causes of bitterness in the mouth
Bitterness in the mouth can be a symptom of various diseases.
Most often it is caused by diseases of the organs responsible for the production and movement of bile in the body, such as chronic cholecystitis
(inflammation of the gallbladder),
cholelithiasis
(in this case, the formation of stones interferes with the proper outflow of bile),
biliary dyskinesia
(impaired motility). Sometimes patients who previously had a bitter taste in the mouth due to cholelithiasis or inflammation of the gallbladder, and who had a cholecystectomy (surgery to remove the gallbladder), are surprised by the return of the symptom. But a bitter taste in the mouth can occur even in the absence of a gallbladder, because bile is still produced and can enter the stomach, and from it into the esophagus. If a person has had their gallbladder removed but has not changed their eating habits, the return of digestive problems and a bitter taste in the mouth is very likely
Bitterness in the mouth can occur with various disorders of the digestive system, for example with chronic gastritis
or
chronic pancreatitis
Liver diseases can lead to changes in the composition of saliva, which may also result in a bitter taste in the mouth.
Another group of reasons for the feeling of bitterness in the mouth is diseases of the oral cavity (stomatitis, inflammation of the tongue). A bitter taste can also be a reaction to dentures if they were chosen incorrectly (the individual intolerance of the material from which they are made was not taken into account).
Sometimes bitterness in the mouth is caused by other reasons: toxicosis (in pregnant women), acute poisoning, cancer.
Burning mouth syndrome
Probably every gastroenterologist in his practice has encountered a patient with complaints of pain or burning of the tongue. Turning to this specialist in the first place is probably due to the following logical chain: the tongue is in the oral cavity, where the digestion process begins, which means that if a problem arises, you should visit a gastroenterologist. Old publications also come to the aid of patients and doctors of other specialties, in which chronic diseases of the digestive organs were considered as the causes of burning tongue.
But is it really that simple? Is pain and burning of the tongue a separate disease and who should treat it?
A little history and terminology.
Pain/burning in the tongue has many synonyms: glossalgia, glossodynia, stomatodynia, glossopyrosis, oral paresthesia, neurogenic glossitis, tongue neurosis, glossalgic syndrome. This condition is traditionally part of the so-called burning mouth syndrome or “burnt mouth syndrome,” in which pain/burning sensations are localized in various areas: tongue, upper palate, gums, lower lip, pharynx.
Burnt mouth syndrome (SMS) was first described back in 1880; in the 20th century, the term glossodynia, i.e., appeared. pain in the tongue, since unpleasant symptoms from the tongue were most common. This syndrome was first identified as a separate disease in 2004.
Almost all existing review articles and recommendations consider glossodynia within the framework of the SOP. General recommendations for the diagnosis and treatment of ROP may be applicable to the special case of glossodynia.
Definition
The International Association for the Study of Pain has designated glossodynia and oral burning as chronic pain, specifically “burning pain of the tongue or other mucous membranes of the mouth.”
Later, a detailed definition was given for ORS: “a burning sensation or sensation of altered sensitivity in the oral cavity, repeated daily for more than 2 hours a day for more than 3 months, without obvious causative lesions on clinical examination and examination.”
Epidemiology
Data on the prevalence of ROP and tongue pain/burning separately still vary from study to study. The average incidence of all cases of oral burning (including but not limited to tongue burning) is 0.1-3.7% of the population. Women suffer from this syndrome 2.5-7 times more often than men, especially often over the age of 60 and after menopause.
Common causes of pain and burning in the mouth.
There are two groups of reasons why patients notice a burning sensation in the mouth:
1) Primary (idiopathic), when there are no diseases of the oral cavity and other organs and systems, this will be the true SOR.
2) Secondary, caused by local (localized in the oral cavity) and systemic causes (autoimmune diseases, deficiency conditions, etc.)
Causes of secondary burning sensation in the mouth/burning tongue.
Possible causes of secondary burning sensation in the oral cavity are diverse and, oddly enough, are rarely associated with pathology of the digestive organs. A review published in 2022 on this problem identified the following conditions and diseases responsible for the occurrence of burning sensation in the mouth:
Local factors:
A. Diseases, conditions and damage to the oral cavity:
- fungal infection (eg candidiasis)
- lichen planus
- pemphigoid
- pemphigus
B. Trauma
1) Mechanical
2) Chemical
A. From the patient's side:
- toothpastes with abrasives
- use of mouth rinses with ethyl alcohol
- medications such as aspirin (applied to the sore tooth); over-the-counter medications containing phenols, peroxide, sulfuric acid
- vitamin C (citrus fruits)
- sour drinks
- lozenges and cough suppressants with high menthol content
b. From the dentist:
- Irrigation of the oral cavity with solutions containing methyl methacrylate, formaldehyde, formocresol, sodium hypochloride
- acrylic resin
- eugenol
3) Thermal: spicy or hot food or drink
C. Parafunctional habits
- Tongue sticking out, cheek biting, excessive tongue brushing
- mouth breathing
D. Xerostomia or impaired quality/quantity of saliva
- consequences of radiation or chemotherapy, Sjogren's syndrome, pathology of the salivary glands
- side effects of medications (antihistamines, antidepressants, diuretics, steroid hormones, non-steroidal anti-inflammatory drugs, amphetamines)
- smoking
E. Allergic reaction/contact hypersensitivity
- products, additives, flavors
- colorings and flavors from oral care products
- dental materials (nickel sulfate, cobalt, zinc)
System factors
A. Deficiency conditions: decreased levels of iron, zinc, folic acid, vitamins B1, B2, B6, B12
B. Endocrine pathology
- diabetes
- hypothyroidism
- hormonal disorders (changes in cortisol/sex hormone levels)
C. Autoimmune diseases
- Sjögren's syndrome
- lichenoid reactions
- systemic lupus erythematosus
D. Other diseases
- gastroesophageal reflux disease
- celiac disease
- multiple sclerosis
- Parkinson's disease
- Fabry disease
E. Medicines
- angiotensin-converting factor inhibitors
- antiretroviral therapy
F. Peripheral and central neuropathies
- diabetic polyneuropathy, neuropathy due to renal failure, neuropathy due to systemic connective tissue diseases, neuropathy due to HIV infection, postherpetic neuropathy, neuropathy due to chemotherapy
As can be seen from this huge list, most cases of burning of the tongue and in the oral cavity in general are caused by a dental problem/pathology, neurological, endocrine and autoimmune diseases. Gastroenterological causes (for example, gastroesophageal reflux disease) are rather the exception to the rule.
Primary burning sensation in the oral cavity (BOR) and its causes.
If there are no indications of secondary causes of burning in the oral cavity, most likely there is a true SOR. This is an independent disease, the cause of which is still unclear. In its development, the role of psychological factors and mental disorders, changes in the nerve endings and conductive nerve fibers of the oral cavity, as well as the central nervous system is assumed.
Clinical manifestations of ROP.
Symptoms that may bother patients with ROP are:
1) Pain and/or burning in the mouth of varying intensity. Some patients describe these sensations as tingling or irritation, as well as impaired sensitivity. The pain often occurs spontaneously, is often symmetrical and does not necessarily affect only one area. In the case of glossodynia, pain/burning is most often localized in the anterior 2/3 of the tongue, on its back, and lateral surfaces. The pain is minimal in the morning immediately after waking up, increasing in intensity throughout the day. Eating spicy, hot foods and drinks, as well as stress and fatigue increase the pain/burning sensation.
2) More than 70% of patients, in addition to pain/burning, note changes in taste, a decrease in its intensity, as well as the appearance of a foreign taste (bitter, metallic, or a combination of both). Most often, the sensation of sweet and salty tastes is reduced, and sour tastes are perceived more intensely.
3) Dry mouth (xerostomia) is noted by 46-67% of patients with SOP, while according to research data, an objective decrease in the amount of saliva is not observed in them.
4) Association with burning/pain from other mucous membranes has also been described in patients suffering from ROP. Most often this is a burning sensation in the rectum and genital tract. An alternative may be a feeling of dry mucous membranes (eyes, genital tract in women)
5) Night sleep disturbances are common (in 80% of cases) in people with SRS
6) Anxiety and depression are frequent companions of SOR and glossodynia separately. A meta-analysis of clinical studies showed that anxiety conditions increase the risk of developing RAS by 2.6 times, and depression by 3.2 times. Cancerophobia, social phobia, neuroticism, etc. are also often noted.
7) ODS is characterized by an association with other diseases that manifest as chronic pain: fibromyalgia, chronic back pain, chronic pelvic pain, irritable bowel syndrome, etc.
Treatment of SOR.
1) Patient information and support
Many patients with chronic oral burning and pain do not understand why their symptoms persist for so long. An important task of the doctor is to explain to patients with SRS the possible mechanisms of the formation of unpleasant sensations. Patients should be reassured that their symptoms are not imaginary or related to any form of cancer. This support will reduce anxiety, depression, fear and frustration, especially in individuals who have had previous unsuccessful treatment experiences.
2) Local therapy
Local use of clonazepam in the form of mouth rinses showed good results in reducing the severity of pain/burning in the mouth. There is encouraging evidence for the topical use of capsaicin (a chili pepper alkaloid) in low concentrations.
3) Systemic therapy
Tricyclic antidepressants, antidepressants from the group of serotonin and serotonin/norepinephrine reuptake inhibitors, clonazepam, and antiepileptic drugs (pregabalin and gabapentin) are actively used as drugs for the treatment of ORA. The use of alpha-thioctic acid showed little effectiveness.
4) Non-drug psychotherapy
Given the frequent association of ODS with anxiety disorders, phobias and depression, non-pharmacological psychotherapy is an integral part of the treatment of this problem. Cognitive behavioral therapy, individual and group psychotherapy should be considered as methods of choice.
5) Physiotherapy and alternative treatments
Low-level laser therapy and acupuncture have been studied as methods for reducing pain. These methods were effective in some people with cerebral obstruction, but are not widely used.
Conclusion.
Identifying the causes of pain/burning in the oral cavity is a challenge for doctors of different specialties, but their friendly work allows us to solve the problem and improve the quality of life of patients.
Additional symptoms of bitterness in the mouth
Bitterness in the mouth may be accompanied by additional symptoms. If heaviness or pain is felt in the right side, this may indicate liver or gallbladder disease. If bitterness in the mouth is accompanied by nausea, heartburn, and belching, then the cause may be stomach diseases. If the cause is diseases of the oral cavity, then the feeling of bitterness may be accompanied by bad breath.
Provoking factors
For the first time, bitterness in the throat can appear at any age, even without previous symptoms and pathologies. This usually occurs after eating certain foods or on an empty stomach.
The symptom is often associated with the consumption of fatty fried foods, alcohol or medications.
It also happens that there may be no reasons at all, and bitterness appears regardless of a person’s actions. In the first case, the appearance of unpleasant sensations indicates temporary natural and self-healing digestive disorders. In the second, about a serious pathological process that affects the performance of the endocrine, nervous and digestive systems.
Independent reasons
Bitterness in the mouth can appear not only due to pathological processes, but also after exposure to external irritants or an aggressive environment.
Substance poisoning
Poisoning can be from heavy metals, poisonous gases, substances or medications. Substances enter the body through food, inhalation of contaminated air, or contact with exposed areas of the body. If possible, they should be washed off, gastric lavage performed, or leave the site of contamination. At the first symptoms of poisoning, you should immediately seek medical help.
Long-term medication use
When taken over a long period of time or in overdose, medications often cause side effects. Before use, you need to study the instructions and monitor any changes in the body.
If you experience bitterness or sore throat, intestinal discomfort or other symptoms, you should consult a specialist.
Drugs that cause bitterness or sore throat:
- antibiotics;
- antihistamines;
- hypotensive;
- hormonal contraceptives;
- corticosteroids;
- antiviral;
- antifungal;
- and others.
Smoking
After smoking cigarettes, an unpleasant smell and taste remains in the mouth. If there are no pathologies of the gastrointestinal tract, then bitterness and acidity in the throat may be left by some additive in the tobacco composition. To check, you need to change the brand of cigarettes and monitor the appearance of symptoms. If the bitterness remains as before, you need to seek advice from a specialist.
Stress
You can often hear from people about “a person’s gall,” that is, his anger and hatred of others. And this is no coincidence. With severe stress, negative emotions, hatred, the production of bile in the liver and its release into the intestines increases. Spasms of the smooth muscles of the intestine appear, blocking the exit of bile from the bladder or tract. Heaviness appears in the right hypochondrium and bitterness in the mouth. If pathologies of the biliary tract are present, symptoms may develop, as with cholelithiasis or hepatitis.
