TONGUE PAIN

TONGUE PAIN: Excerpt from Differential Diagnosis in Primary Care

Examination of the tongue is a time-honored important diagnostic aid, but in my experience, it is unusual for patients to present with pain in the tongue. Nevertheless, there is a plethora of causes. The mnemonic VINDICATE lends itself best to prompting the recall of these causes.

1. V—Vascular suggests pernicious and iron deficiency anemia.
2. I—Inflammation recalls Vincent stomatitis, herpes simplex, tuberculosis, and syphilis. The referred pain from gingivitis and abscessed teeth should also be considered here.
3. N—Neoplasms remind one that carcinoma of the tongue often presents with pain.
4. D—Degenerative and deficiency diseases remind one of pellagra and other avitaminoses.
5. I—Intoxication and idiopathic call to mind tobacco, plumbism, mercurialism, and glossopharyngeal or trigeminal neuralgia.
6. C—Congenital anomalies of the tongue are rare.
7. A—Allergic and autoimmune diseases, on the other hand, suggest dermatomyositis and angioneurotic edema.
8. T—Trauma suggests the numerous times we bite our tongues and may prompt a search for epilepsy when a patient presents with syncope.
9. E—Endocrine reminds one of hypothyroidism.

Approach to the Diagnosis

The approach to the diagnosis includes a CBC, sedimentation rate, serum B12 and folic acid levels, serum ferritin, serology, tuberculin test, and perhaps biopsy of the lesion. A trial of vitamin therapy may be indicated.

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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