Q: For months I’ve had a sore tongue, and can’t eat hot food, citrus fruit or spices. My GP prescribed drops, followed by a mouth gel, for thrush, but neither helped. At a walk-in centre I was told I have a dehydrated and cracked tongue, given a mouthwash and told to see a dentist.

Name and address supplied.

A: This sort of complaint can have a number of possible causes, so the diagnosis involves some medical sleuthing. Presented with a patient with a sore tongue, most doctors I know first prescribe antifungal treatments, such as the nystatin drops or fungicidal gel you were given on the assumption that the problem is oral thrush.

But I think sometimes they prescribe antifungal medication more out of hope than logical thought, as thrush has such a characteristic appearance — white, curdy flecks that leave an area of bleeding when displaced — that without seeing this, antifungals don’t make sense.

Q: For months I've had a sore tongue, and can't eat hot food, citrus fruit or spices. My GP prescribed drops, followed by a mouth gel, for thrush, but neither helped. At a walk-in centre I was told I have a dehydrated and cracked tongue, given a mouthwash and told to see a dentist (stock image)

Q: For months I've had a sore tongue, and can't eat hot food, citrus fruit or spices. My GP prescribed drops, followed by a mouth gel, for thrush, but neither helped. At a walk-in centre I was told I have a dehydrated and cracked tongue, given a mouthwash and told to see a dentist (stock image)

Q: For months I’ve had a sore tongue, and can’t eat hot food, citrus fruit or spices. My GP prescribed drops, followed by a mouth gel, for thrush, but neither helped. At a walk-in centre I was told I have a dehydrated and cracked tongue, given a mouthwash and told to see a dentist (stock image) 

People who develop oral thrush tend to have had a history of antibiotic use or other trigger factors such as the regular use of a corticosteroid inhaler (for asthma, for instance).

Both of these can reduce levels of healthy bacteria, which gives fungi — in this case the candida strain — the opportunity to take hold.

In your case, given the symptoms you have listed, I see no real reason to suspect thrush is the culprit.

The more likely possibilities include a condition called burning mouth syndrome. The soreness may involve just the tongue or the entire mouth. It can also affect taste, and the mouth may feel dry.

It is rare, and mysterious in that there is no proper understanding of what causes it.

In my view … sometimes doctors need a half day 

The announcement last week that NHS England intends to withhold funds from GP practices, should they close for a half day, has once again reminded me that I’ve lived through a golden era, now long past.

When I started in general practice, my three partners and I each held nine surgeries every week; covered all out-of-hours emergencies; fitted in a baby clinic and immunisation sessions; visited patients in hospital; and supervised care of the long-term sick at home.

We also seamlessly covered palliative care when our patients reached the end of their lives.

This was genuine cradle-to-grave coverage — something each one of us had aspired to provide.

Since then, despite every practice being a small, ‘independent’ business, successive government policies have so shackled GPs that the freedom to do what’s best for patients has been lost: the endless drip-feed of interference has resulted in disillusioned senior GPs retiring early.

It’s led to a crisis of recruitment into general practice, too.

The upshot of NHS England’s inability to understand the nature of the task? Not enough professionals to do the job, and falling standards in medical care.

In fact, it’s entirely reasonable that a practice might close for half a day, in order to have time to phone patients unable to come to the surgery; for recruiting and training staff; supervising postgraduate trainees; preparing for annual appraisals; or any administrative tasks vital in the running of the practice.

When Jeremy Hunt was Health Secretary, he resolved to appoint 5,000 new GPs by 2020 — but, in fact, we now have fewer.

The latest financial punishment, foisted on those already in a state of festering crisis, will only make matters even worse.

Most of those who develop it are postmenopausal women.

A second possibility is fissured tongue, although this isn’t usually associated with soreness. Here the fissures or cracks that appear, and the changes in the surface of the tongue, are permanent and don’t respond to any treatment.

Its causes are unclear, though it is associated with underlying nutritional deficiencies, and syndromes such as Down’s syndrome.

Another possible cause is atrophic glossitis, where the papillae — the tiny lumps and bumps found on the top and side of the tongue — become so thin and wasted that the whole surface of the tongue appears red and shiny.

The common causes are nutritional deficiencies, with a lack of iron, vitamin B12, and folic acid at the top of the list.

Coeliac disease, where the immune system reacts to the protein gluten — which can remain undetected until well into adult life — can also cause atrophic glossitis, as this can lead to serious difficulties when it comes to absorbing nutrients from food, especially iron.

Personally, I think it is atrophic glossitis that fits the description of your symptoms best.

I’d suggest consulting your doctor again in the expectation that a simple blood test might be carried out to check your blood cell count, iron levels, and inflammatory markers. This may shed some light on the exact diagnosis.

If the tests are all normal then I recommend asking your pharmacist to advise you of the best liquid probiotic, though there’s only anecdotal evidence that this helps with a sore tongue.

It is possible that a change in the bacterial balance of the mouth and tongue is the cause of the problem.

A liquid probiotic, made up of ‘friendly’ essential bacteria, will coat the tongue. The bacteria it contains may alter the balance of bacteria in your gastrointestinal tract and mouth enough to bring about relief of your symptoms.

Take this for at least a month, as it can do no harm and it might resolve the soreness.

Write to Dr Scurr 

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — including contact details. 

Dr Scurr cannot enter into personal correspondence.

His replies cannot apply to individual cases and should be taken in a general context.

Always consult your own GP with any health worries.

Source: Martin Scurr

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