From the Guidelines
Vitamin B12 deficiency is directly linked to glossodynia (painful tongue) through its role in nerve function and oral tissue health, and treatment involves B12 supplementation to alleviate symptoms and prevent long-term nerve damage. When B12 levels are insufficient, patients may experience burning sensations, pain, and altered taste in the mouth due to nerve damage and compromised oral mucosa integrity. B12 is essential for myelin production, which insulates nerve fibers, and its deficiency leads to neuropathic symptoms affecting the tongue and oral cavity 1.
Symptoms and Diagnosis
The symptoms of vitamin B12 deficiency can be diverse, including cognitive difficulties, eyesight problems, and abnormal findings on a blood count, such as anaemia or macrocytosis 1. For suspected vitamin B12 deficiency, either total B12 (serum cobalamin) or active B12 (serum holotranscobalamin) should be used as the initial test, and a further test to measure serum MMA concentrations may be considered in people with indeterminate total or active B12 test results 1.
Treatment and Management
Treatment of vitamin B12 deficiency involves immediate supplementation, with the dosage and administration route depending on the presence of neurological involvement and the severity of the deficiency 1. For people with neurological involvement, hydroxocobalamin 1 mg intramuscularly should be administered on alternate days until there is no further improvement, then hydroxocobalamin 1 mg intramuscularly every 2 months. For those without neurological involvement, hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks, followed by maintenance treatment with 1 mg intramuscularly every 2–3 months for life, is recommended 1.
Maintenance and Prevention
Regular monitoring of B12 levels is crucial to ensure maintenance of adequate levels and prevent symptom recurrence 1. It is also important to address underlying causes of vitamin B12 deficiency, such as pernicious anemia, strict vegetarian diets, or malabsorption disorders, to prevent future deficiencies. Improvement in symptoms usually begins within weeks of starting supplementation, though complete resolution may take months as nerves heal.
From the Research
Relationship Between Vitamin B12 Deficiency and Glossodynia
- Vitamin B12 deficiency can cause glossodynia, which is a painful sensation of the tongue 2, 3.
- Glossodynia related to nutritional deficiency, including vitamin B12 deficiency, is statistically uncommon but easily curable with replacement therapy 2.
- A case study reported a 73-year-old woman with glossodynia who was misdiagnosed with burning mouth disorder, but was later found to have atrophic glossitis and glossodynia secondary to vitamin B12 deficiency 3.
Clinical Manifestations and Diagnosis
- Clinical symptoms of vitamin B12 deficiency, including glossodynia, should receive high priority in establishing the diagnosis 4.
- Serum B12 concentration is useful as a screening marker, and methylmalonic acid or homocysteine can support the diagnosis 4.
- Patients with vitamin B12 deficiency-related glossitis often present with high gastrin-17 and low pepsinogen I levels 5.
- Oral manifestations of vitamin B12 deficiency include erythema and depapillation of the tongue, and may be less common in patients without a history of gastrectomy 6.
Treatment and Management
- Initial treatment with parenteral vitamin B12 is recommended for patients with acute and severe manifestations of vitamin B12 deficiency 4.
- High-dose oral vitamin B12 may be considered for long-term treatment 4.
- Prophylactic vitamin B12 supplementation should be considered for specific high-risk groups 4.
- Oral symptoms of vitamin B12 deficiency often respond to antifungals and vitamin B12 replacement 6.