The pathophysiology of glossal pain in patients with iron deficiency and anemia

Background: It is well known that prolonged anemia causes atrophy of tongue papillae, glossal pain, and dysphagia, but it is uncertain whether iron (F e) deficiency induces glossal pain without any objective manifestation. To resolve this matter, the relationship between Fe deficiency and glossal pai n was examined. Methods: Eighteen patients with Fe deficiency and 7 anemic patients manifesting spontaneous irritation or pain of the tongue without a ny objective abnormalities participated in this study. To ascertain the cau se of glossal pain and the oral pathophysiology in Fe deficiency and anemia , peripheral blood was examined and the glossal pain threshold and salivary flow rates (SFRs) were estimated along with Candida albicans cell culture tests. Results: Compared with patients with Fe deficiency, those with anemi a had a longer history of tongue pain. in patients with anemia, painful are as of the tongue were more numerous than in patients with Fe deficiency. Pa in thresholds were decreased in the painful portions, and both nonstimulate d and stimulated SFRs were suppressed. Each patient was treated with oral F e; within 2 months, most patients exhibited increased serum ferritin level (P < 0.02, paired t-test), pain threshold (P < 0.05) and salivation (P < 0. 05) and glossal pain subsided. Conclusions: Fe deficiency causes glossal pa in and the degree of glossal pain increases as Fe deficiency advances to an emia, manifesting hyposalivation and abnormalities of glossal papillae.