From the Guidelines
For a patient presenting with tongue pain or a burning sensation, I recommend ordering a full blood count, coagulation, fasting blood glucose level, HIV antibody, and syphilis serology examination as initial labs. These tests are crucial in identifying potential underlying causes of the symptoms, such as blood system diseases, diabetes, or infections 1. The full blood count can help detect anemia, leukemia, or other hematologic abnormalities, while coagulation tests can exclude biopsy contraindications 1. Fasting blood glucose level is essential to rule out hyperglycemia, which is a predisposing factor for invasive fungal infections 1. Additionally, HIV antibody and syphilis serology examination can help detect oral ulceration associated with these infections 1. Further targeted testing, such as evaluation for serum specific antibodies (e.g., Dsg1, Dsg3, BP180, and BP230), may be necessary if bullous diseases are suspected 1. It is also important to note that a biopsy may be considered if the diagnosis cannot be made after collection of clinical medical history and oral examination, especially if the symptoms persist for over 2 weeks or do not respond to treatment 1. Initial labs should be used to guide further examinations and diagnosis, rather than relying solely on symptom management. Some potential underlying causes of tongue pain or burning sensation that these labs can help identify include:
- Blood system diseases (e.g., anemia, leukemia)
- Diabetes
- Infections (e.g., HIV, syphilis, fungal infections)
- Bullous diseases
- Nutritional deficiencies (although not directly mentioned in the study, it is a potential cause of tongue pain or burning sensation) These laboratory tests are essential in real-life clinical practice to ensure timely and targeted treatment, rather than just managing symptoms.
From the Research
Labs for Tongue Pain or Burning Sensation
To diagnose the cause of tongue pain or a burning sensation, several laboratory tests may be ordered to rule out underlying conditions. The following are some possible labs that may be considered:
- Complete Blood Count (CBC) to check for anemia or other blood disorders 2, 3
- Blood chemistry tests to check for nutritional deficiencies, such as vitamin B12 or iron deficiency 2, 3
- Thyroid function tests to check for thyroid disorders 2
- Glucose tests to check for diabetes mellitus 2, 4
- Liver function tests to check for liver disease 2
- Kidney function tests to check for kidney disease 2
- Hormone level tests to check for hormonal imbalances, particularly in postmenopausal women 2, 4
- Allergy tests to check for allergies to food or other substances 4, 5
- Biopsy of the tongue to check for epithelial nerve fiber density, which may be reduced in patients with burning mouth syndrome 4, 5
Additional Tests
Additional tests may be ordered to rule out other conditions that may be causing the tongue pain or burning sensation, such as:
- Dental exams to check for oral infections, denture-related lesions, or other oral health issues 2, 4
- Neurological exams to check for neuropathic disorders 4, 5
- Psychological evaluations to check for depression, anxiety, or other mental health disorders 4, 5
Diagnosis of Burning Mouth Syndrome
Burning mouth syndrome (BMS) is a condition characterized by a burning sensation in the mouth, often without any visible signs of disease. The diagnosis of BMS is typically made by excluding other possible causes of the symptoms 2, 4, 3, 6, 5. Laboratory tests may be ordered to rule out underlying conditions, but the diagnosis of BMS is often based on the patient's symptoms and medical history.