I have had continuous canker sores in my mouth for approximately six months. Now the lining of my mouth around the inside of my lips is sensitive and my tongue feels like I have burned it, but I haven't. Any suggestions?

S.

Canker sores are obnoxious and painful little ulcers, known also by the medical terms "aphthous ulcers" and "aphthae." It is very worrisome that you have had this problem continuously for the past six months. Aphthae can be a sign of serious systemic problems, such as vitamin deficiency, cancer or even infection with HIV (human immunodeficiency virus, which causes AIDS). I recommend you see your internist immediately about this problem. If you are more inclined to visit a specialist, dermatologists and ear, nose and throat specialists (ENTs) are both knowledgeable with regard to aphthous ulcers.

Your second symptom is known as glossopyrosis, which translates as "burning tongue." It is important to realize that glossopyrosis is a term that describes a symptom (like vertigo for whirling dizziness, or neuralgia for pain) and is NOT a diagnosis. Glossopyrosis, oddly enough, almost always occurs in postmenopausal women. While this would suggest a strong hormonal connection, many women with this problem are on appropriate levels of estrogen supplements. Nevertheless, if my patient is a postmenopausal woman and she is not taking an estrogen supplement, I usually recommend that she ask her internist or gynecologist if she is an appropriate candidate for estrogen therapy. (As you may know, estrogen supplementation is controversial in women who have a personal history of breast cancer, or even a strong family history of breast cancer.)

There are many other possible causes of glossopyrosis:

B vitamin deficiency. Several of the B vitamins have been implicated, and many people have speculated about deficiencies of other vitamins or minerals (especially folate). Consequently, I usually recommend that the patient take a multivitamin and mineral daily supplement, if she is not already doing so.

Oral yeast infection (thrush). While this is often obvious on examining the mouth, it can, on occasion, be a very subtle infection.

Sensitivity to toothpaste, mouthwash or denture-cleaning agents. Most of these substances contain a detergent called sodium lauryl sulfate. Some patients note great improvement of their symptoms if they eliminate these substances entirely. You can find some very creative alternatives. (You can, for example, brush your teeth or dentures with baking soda. It is nasty-tasting stuff, but it does the job quite well.)

Plummer-Vinson syndrome. This is a group of symptoms related to iron deficiency. It includes anemia, a variety of oral lesions, "spoon-shaped" fingernails and webbing of the esophagus.

GERD (gastroesophageal reflux disease). Reflux (backflow) of stomach acid and digestive enzymes into the esophagus and mouth can theoretically cause glossopyrosis. Some folks speculate that GERD may also contribute to recurrent ear infections in children! Now, that's high reflux.

Idiopathic causes.When doctors don't know what has caused a problem, they say the cause is "idiopathic." That sounds much better than "I don't know." Unfortunately, many cases of glossopyrosis are idiopathic. Doctors have devised a variety of "magic cocktails" for such cases. These cocktails include substances such as steroids, antifungal drugs, antibiotics, antihistamines, Milk of Magnesia and artificial flavors and colors (I'm not kidding.)

Once again, you should see your doctor at once about your problems. Print out a copy of this letter and bring it with you when you see the doctor. Most doctors are familiar with aphthous ulcers and glossopyrosis, but unfortunately some are relatively unfamiliar with these conditions.