Stomalgia and glossalgia - diseases manifested by almost constant pain and paresthesias in the area of \u200b\u200bthe tongue and oral mucosa. These diseases are widespread, according to Pannochka, an Internet publication for girls and women from 14 to 35 years old.. net Etiology and pathogenesis.

Local and general causal factors are distinguished in the occurrence and development of stomalgia and glossalgia..

Local factors include irritation of the oral mucosa with sharp edges of defective teeth, poorly made dentures, abundant tartar deposits, galvanosis with unlike metal inclusions, allergic reactions to acrylic plastic dentures, a decrease in occlusal height in patients with pathological abrasion of teeth, complete or partial.

The literature notes the appearance of paresthesia in the oral cavity during traumatic tooth extraction, their preparation during orthopedic manipulations, post-injection complications, diseases of the maxillofacial region of inflammatory and traumatic origin, diseases of the oral mucosa - candidiasis, lichen planus (Milovanov G. , 1965; Shargorodsky L. , 1975; Karapetyan I. , 1984).

Despite the fact that local factors are assessed by most patients as the cause of pain, oral debridement for patients with stomalgia usually does not bring relief.. It should also be borne in mind that these factors are often found in individuals who do not suffer from stomalgia and glossalgia..

According to a large number of researchers, in many cases, stomalgia and glossalgia are caused by somatic factors - diseases of the digestive system (hypocholecystitis, gastritis, gastric ulcer and duodenal ulcer, chronic colitis), endocrine disorders (diabetes, menopause), metabolic dystrophic changes in the cervical. , 1981; Attacks M. and etc. , 1984).

All patients have pronounced asthenic disorders, increased irritability, a tendency to anxiety disorders, the ease of occurrence of subdepressive and depressive conditions, hypochondriac manifestations, phobias, often carcinophobia. Sleep disorders are usually detected during the period of exacerbation of the disease or are permanent. In many cases, vegetative-vascular disorders are observed.

The impact of stress factors is a " The moment of onset of pain is always preceded by a situation of nervous overload, personally significant conflicts, often in combination with physical overwork (caring for a seriously ill loved one, childbirth, caring for a newborn in a conflict family, etc.. Any exacerbation of the disease, as a rule, is further provoked by psychogenic factors (including the careless statement of the doctor and general non-observance of deontological norms in working with patients).

Among patients suffering from glossalgia, there is not a single one in whom glossalgia would develop only under the influence of dental manipulations.. In all cases, there are previous psychoemotional disorders.

On the other hand, there is a group of patients in whom glossalgia developed only against the background of psychological trauma of a purely specific nature.. In the history of the life of all these patients, there was a death of a loved one from a malignant neoplasm of the tongue.. In the presence of carcinophobia in all patients with glossalgia, the psychogenic nature of the disease is certainly confirmed..

In the initial stage of the disease, phobic reactions are frequent, often pronounced. They are replaced by decreased mood, constant fixation on pain or paresthetic sensations, pathological interpretation of the disease. When studying the motivational sphere of patients, a narrowing of interests, withdrawal into illness, a change in life attitudes and their grouping around the disease, social isolation are also found..

Features of clinical manifestations.

The clinical picture is quite unambiguous: patients complain of discomfort, pain and paresthesia (burning, bursting, tingling) in various parts of the oral cavity - the tip of the tongue, lateral surface, gums, sometimes hard palate and pharynx.

The severity of the noted sensations is different - from very weak to unbearably painful. As the disease progresses, the zone of paresthetic and painful sensations expands to the point that it captures the entire mucous membrane of the oral cavity, sometimes the pharynx and esophagus, and the skin of the face.

According to literature data, glossalgia is described in patients aged 22 to 80 years.. In women, this pathology occurs 6 times more often than in men.. The age group in which the incidence is maximum (from 35 to 50 years old) is 62%, those who fell ill at a young age (from 22 to 35 years old) - 20%, over the age of 50 years - 18% (Karlov V. , 1991).

It is interesting to note that this disease is " If earlier it was attributed to the pathologies of old age, and then associated with the period of climacteric disorders, then over the next years the distribution of patients by age changed dramatically. The most common patients are aged 35 to 55 years..

When determining the somatic status of patients, it was found that only 5% of them do not suffer from somatic diseases.. In other cases, with glossalgia, a combination of several diseases is noted: most often diseases of the gastrointestinal tract (gastritis, colitis, duodenitis, cholecystitis, etc.. ), cardiovascular system, degenerative changes in the cervical spine.

Often, the disease, which began as glossalgia with a low severity of sensations and their limited localization in the area of \u200b\u200bthe tongue, eventually turns into stomalgia, i.e.. unpleasant sensations capture, in addition to the tongue, other parts of the oral cavity and become more pronounced and varied in nature.

During the day, the severity of paresthesia and pain changes. As a rule, they cause maximum anxiety in the second half of the day, forcing the patient to sharply limit the speech load..

The pathognomonic symptom for stomalgia and glossalgia is a decrease or complete disappearance of all unpleasant sensations while eating..

Most patients have complaints of a disorder of salivation.. At the same time, subjectively perceived by the patient dryness or increased salivation is not always noted corresponds to the disorders found during an objective study.. For many, the disease is accompanied by trophic disorders of varying severity, which are more often localized in the tongue, less often capture the mucous membrane of the gums and cheeks.

In some patients, sensitivity disorders are detected, more often in the form of hypo- or hyperesthesia, as well as their combination. Gustatory sensitivity is often disturbed.

Capillaroscopy revealed swelling of the capillary background, spasm of arterial branches, slowing down of blood flow, t. spastic and less often spastic-atonic syndrome. It is one of the factors confirming the dysfunction of the autonomic devices of the tongue and oral cavity with a predominance of signs of sympathicotonia in patients with stomalgia..

Differential diagnosis.

Glossalgia and stomalgia are sometimes mistaken for neuralgia of the trigeminal and glossopharyngeal nerves, more often with traumatic damage to the lingual nerve and dental branches, glossitis, lichen planus, etc.. A common symptom of all these diseases is pain syndrome, however, only with glossalgia and stomalgia, the pain sensations decrease or disappear while eating..

With neuralgia, the nature of the pain is acute, paroxysmal, there are trigger zones. With odontogenic neuropathies, the etiology of the disease can be identified (odontogenic factor, traumatic injury).

In diseases of the oral mucosa, elements of the lesion characteristic of this pathology (ulcers, aphthae, erosion, etc.). In patients with glossalgia and stomalgia, changes in the mucous membrane are not always observed and are in the nature of trophic dysfunction..

Stomalgia and glossalgia must be differentiated from fungal infections of the oral mucosa - candidiasis and leptotrichosis. There are many similarities in the clinical picture of these diseases: dry mouth, burning sensation, discomfort, taste disturbance. Microbiological analysis of scraping from the tongue helps in making the correct diagnosis: with candidiasis and leptotrichosis, a large amount of candida fungus, its mycelium, leptotrichia are sown.

It is important to distinguish true glossalgia from the galvanic syndrome of the oral cavity, which occurs in the presence of orthopedic structures made of dissimilar metals.. At the same time, patients are worried about a strong burning sensation and a metallic taste.. When measuring the potential difference between metallic inclusions, there may be data in excess of 10 ?A.

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