Page 44 Daily Mail, Tuesday, August 27, 2019People 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.
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.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.
THIS sort of complaint can have a
number of possible causes, so the
diagnosis involves some medicalQ
WRITE TO DR SCURR
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Replies should be taken in a
general context and always
consult your own GP with any
health worries.DR MARTIN
SCURR
ASK THE GP
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 endlessdrip-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.IN MY VIEW ... SOMETIMES
DOCTORS NEED A HALF DAY
What’s the cause of my
sore, cracked tongue?
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.A
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