Differential Diagnosis for Sensation of Burning in Tongue after Drinking Water

• Single most likely diagnosis:
  • Glossitis: This is an inflammation of the tongue that can cause a burning sensation, especially after consuming certain substances like water. It's often related to nutritional deficiencies, allergies, or irritants.
• Other Likely diagnoses:
  • Oral candidiasis (thrush): A fungal infection that can cause a burning sensation in the mouth and tongue.
  • Dry mouth (xerostomia): Reduced saliva flow can lead to a burning sensation, especially when drinking water.
  • Aphthous ulcers: Although more commonly associated with pain, aphthous ulcers can sometimes cause a burning sensation, especially if they are on the tongue.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
  • Oral cancer: Though less common, a burning sensation in the tongue could be an early sign of oral cancer, particularly if it's persistent and accompanied by other symptoms like difficulty swallowing or a lump in the neck.
  • Neuropathic pain: Conditions affecting the nerves, such as trigeminal neuralgia, can cause severe burning or stabbing pain in the face, including the tongue.
• Rare diagnoses:
  • Pernicious anemia: A condition where the body can't make enough healthy red blood cells due to a lack of vitamin B12, which can lead to neurological symptoms including burning sensations in the tongue.
  • Geographic tongue: A condition characterized by the appearance of single or multiple, well-demarcated areas of erythema (redness) on the tongue, which can sometimes cause a burning sensation.
  • Burning mouth syndrome (BMS): A chronic pain disorder that primarily affects the tongue, but can also affect the lips, gums, and the roof of the mouth, characterized by a burning sensation without visible signs of oral disease.