I have suffered with a burning tongue for almost four years and can find no permanent relief. I have tried different vitamins, toothpastes, mouthwashes, tongue scrapers and even acupuncture. None of those things stop the burning. I have been taking Ativan at bedtime and sometimes during the day if the burning gets too bad. I also have tried all the Biotene products, including the gum, which does give some relief but it doesn't last. I don't like having to depend on Ativan. Can you help? I have been to several doctors (internist, ENTs, oral pathologists, etc.) but no one has been able to figure it out.

H.C.

This problem is common enough to have earned its own name, "glossopyrosis" (burning tongue). It appears to be most common in postmenopausal women.

Successfully treating glossopyrosis depends greatly on accurately diagnosing its cause. Many different conditions can lead to glossopyrosis, so it is essential that you see a doctor who will examine you with a broad differential diagnosis in mind. (The "differential diagnosis" is the mental list of possible diagnoses that a doctor must consider for any given symptom.) Here are some of the possible problems that can lead to glossopyrosis:

• vitamin B deficiency
  
• diabetes mellitus
  
• gastroesopha geal reflux disease
  
• hypothyroidism (low thyroid hormone)
  
• estrogen deficiency
  
• AIDS
  

A number of other factors are also occasionally associated with glossopyrosis, and may in some cases cause it:

• dry-mouth syndromes, due to medication side-effects or the autoimmune disease Sjogren's syndrome
  
• persistent mouth-breathing caused by nasal-airway obstruction
  
• sensitivity to particular foods, mouthwashes, denture adhesives/detergents or toothpastes
  
• oral yeast infection (called "candidiasis," or "thrush")
  
• temporomandibular joint dysfunction (TMJ).
  
• recurrent trauma to the tongue such as habitual tongue-thrusting
  
• referred pain from other oral structures (such as the teeth or gums)
  

If the cause of your glossopyrosis remains unknown despite an aggressive search, you and your doctor unfortunately must continue to pursue a "shotgun approach" to treatment, trying many different therapies in the hopes that one will be effective. Your doctor must be stubborn and persistent, and you must be patient. Unfortunately, some patients continue to suffer from glossopyrosis despite all attempts at treatment. On the other hand, glossopyrosis may vanish as mysteriously as it arrived, even after having been present for several years.