What are the differential diagnoses for a woman aged 60 years with a metallic taste in her mouth and the sensation of a burning tongue? Objective findings of the head and neck are benign, with a normal MRI. — Veronica R. Wizes, MSN, FNP, Arcata, Calif.

The differential diagnosis for altered taste and burning tongue includes nutritional deficiencies (e.g., folate, zinc, and vitamins B, E and C), pernicious anemia and iron-deficiency anemia. Diabetes, thyroid disorders, nerve damage, glossitis, allergies, systemic lupus, herpes simplex, herpes zoster, Parkinson disease, side effects of medications, local infection, dental-alveolar diseases, salivary disorders, hormonal changes, gastroesophageal reflux, oral cancer and burning mouth syndrome (BMS) are also included in the differential.

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BMS is a chronic disorder that is most common in postmenopausal women, although younger men and women are affected. The etiology is unknown, and no systemic or underlying causes are identified in patients. Symptoms include burning sensation of the tongue and other soft tissue of the oral cavity.

Patients may also complain of altered taste, including metallic or bitter sensations and dry mouth. Coexisting anxiety or other psychological conditions are often seen in cases of BMS. Primary BMS is a diagnosis of exclusion once other causes have been ruled out. — Eileen F. Campbell, MSN, CRNP (160-5)