Oral Health Post-Bariatric Surgery: A Case of Burning Mouth Syndrome

• Published in: Obesity (Silver Spring, Md.) Md.), 2022-11, Vol.30, p.261-261
• Main Authors: Bailey, Kelsey, Morales, Jessica, Simonetti, Juliana
• Format: Article
• Language: English
• Subjects: Dental caries; Gastrointestinal surgery; Mouth; Oral hygiene; Tongue
• ISSN: 1930-7381; 1930-739X

Background: There are clinical reports of the relation between bariatric surgery and increased tooth decay. Pathophysiology of the deleterious oral health post-bariatric surgery is associated with decrease in pH caused by GERD and high frequency of sugar ingestion. Low oral pH can lead to tooth demineralization (caries and erosion) and hypersensibility. In addition, decrease in production of saliva due to low intestinal absorption of nutrients also contributes to tooth decay. These complications are more commonly seen in sleeve-gastrectomy versus a Roux-en-Y Gastric-Bypass (RYGB). Burning Mouth Syndrome (BMS) is a chronic painful condition often described as a burning or tingling sensation of tongue, lips, gums, palate, and throat. Most individuals also experience taste disturbances with commonly bitter and metallic taste. There is no clear etiology for BMS, however secondary causes contributing to this condition include: xerostomia, GERD, mouth irritation, nutritional deficiencies (iron, zinc, folate, thiamine, riboflavin, pyridoxine, and vitamin B12). Treatment includes addressing underlying causes, drinking cold beverages, avoiding irritants such as alcohol, topical or systemic clonazepam. Methods: This is a case of a 65-year-old female who presented to our clinic after having RYGB in 2008 followed by band-over-bypass in 2014, with symptoms of gastro-esophageal reflux disease (GERD), tooth decay, and severe burning sensation on her tongue and mouth which she described as if she had eaten a hot pepped. Results: Her post-bariatric laboratory results were overall normal, except for low ferritin at 6 ng/ml (range 18-340 ng/ml) with normal CBC. She reported taking bariatric vitamins as prescribed. Oral cavity exam revealed multiple upper teeth decay and no oral lesions. She was evaluated by an oral surgeon and diagnosed with Burning Mouth Syndrome (BMS), believed to be related to recurrent tongue abrasion on upper teeth remnants. Conclusions: Physicians should consider dentition problems in the post-bariatric patient, particularly in those who have ongoing issues with GERD and xerostomia.