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At this time, about 2 million adult Americans are affected by taste or smell disorders. Very little is known about these problems. Our Taste and Smell Clinic established in 1981 with funds from the National Institutes of Health, is one of six such taste and smell research centers in the country and the only one in New England.
A Multidisciplinary Approach
Our Taste and Smell Clinic uses a multidisciplinary approach to identify the underlying cause of a patient’s taste and smell disorder. The team includes Denis Lafreniere, MD, otolaryngologist, and a smell testing technician who does chemosensory testing. A complete evaluation for a typical patient includes smell testing, ear, nose, and throat evaluation, including flexible nasopharyngoscopy, and neurological evaluation. Evaluations may also include, as necessary: full laboratory diagnostic services, allergy evaluation, and CT and/or MRI scans. Treatment is offered when appropriate.
Taste & Smell Clinic Services
Burning Mouth Syndrome
Burning mouth syndrome (BMS) is defined as burning sensation in the mouth without any observable abnormalities.
Many people with BMS also describe oral dryness; some of these people with oral dryness have findings consistent with Sjögren’s syndrome (a condition that classically causes dryness of the eyes and mouth). Because of this association we screen all of our BMS patients for Sjögren’s and other conditions manifested by oral dryness.
Burning mouth patients, including those with Sjögren’s, sometimes have an oral candidal (thrush) infection that is not readily apparent on examination. Because the treatment is benign (Nystatin vaginal troches slowly dissolved in the mouth, one troche four times a day), we recommend a two week treatment for possible candidiasis. (We use vaginal troches because there is no sugar in them and patients with dry mouth are prone to more cavities in their teeth if they use a sugar-containing troche.) If the oral burning improves, we treat for an additional 6 weeks. Some patients require a full three months of treatment to eradicate the infection, especially if their mouths are dry. During treatment, it is important to disinfect any dentures simultaneously so that the infection is not reintroduced into the mouth. Your dentist will provide you with disinfectant recommendations for your dentures. Your doctor can obtain an oral candidal culture prior to treatment with Nystatin, but our recommendation is to treat regardless of culture results because we have seen improvement even when cultures are negative.
In addition to the above, we screen for nutritional deficiencies (B1, B2, B6, B12, folic acid and iron) and diabetes mellitus in all patients, because some of our patients have low vitamin and/or mineral test results, and elevated serum glucoses. Both nutritional deficiencies and diabetes have been reported to be associated with oral burning in other studies.
Lastly, if evaluation to this point is unrevealing, we suggest an MRI scan of the head, to make certain that there is nothing in the brain causing the burning sensations. For example it is possible that a small “stroke” in a specific area can cause oral burning symptoms.
Dental Problems
Oral conditions may affect chemosensation either directly, by altering the underlying biology of the taste system, or indirectly by introducing exogenous stimuli that produce abnormal taste and smell sensations. Among the most commonly cited oral conditions associated with taste alterations are periodontal disease, salivary flow changes, prosthodontic appliances, “galvanism,” and oral mucosal lesions. However, most reports are anecdotal.
Head Trauma
Smell and/or taste problems can also be caused by trauma to the head. Somewhere between 5% and 30% of head trauma patients will lose their sense of smell. Taste loss is estimated to occur in 0.5% of head trauma patients. Parosmias and dysgeusias may also occur. There is no known treatment for chemosensory problems caused by head trauma. Some patients will get better with time, although this may take years. Spontaneous recovery rates of 8% to 39% have been reported for smell function, with the majority of patients showing improvement within three months of injury.
Viral Damage & Nasal Sinus Disease
Losing your sense of smell can have many causes, such as microorganisms, nasal polyps, allergies, trauma, and medications. At our Taste and Smell Clinic, our specialists can distinguish the cause of smell loss and create the right treatment plan.