Burning tongue may be burning mouth syndrome

         DEAR DR. ROACH: I have a “burning tongue.” I’ve had it since my 40s. I’m now 84 years old. I could cook an egg on my tongue. It never goes away. I once mentioned this to my doctor, but she just shook her head and didn’t have a clue. I’m convinced I’ll never know what causes this. Any ideas? — C.B.
         ANSWER: Burning mouth syndrome is the term used to describe a burning sensation in the mouth when no medical or dental cause can be identified. It is most common in women after menopause, and symptoms may be only on the tongue or even just the tip of the tongue. It sometimes is associated with a dry mouth or with abnormal taste sensation.
         There are some conditions that can look like burning mouth syndrome but have known causes, such as oral herpes and aphthous ulcers, but a careful exam should find these (and 40-some years is way too long). Some nutritional deficiencies can cause these symptoms, but in your case, I am pretty certain you have the “idiopathic” (no known cause) type. Some authorities believe it is related to trigeminal neuralgia.
         No treatment is effective for everyone, but a tricyclic antidepressant (such as amitriptyline, which works on pain fibers), gabapentin and pramipexole have been effective for some people. A neurologist might be a useful consultant, since your doctor was remarkably unhelpful and lacking in curiosity.
         DEAR DR. ROACH: It’s that time of year again and my husband and I are having the “thermostat wars.” I’m sure we’re not the only ones! He wants to keep the house too warm, and it’s not comfortable. I’ve heard that it’s better to keep the temperature cooler and dress warmly in layers. Hope you can help us and others who are dealing with this issue. — R.C.
         ANSWER: I’m not sure I can successfully negotiate an end to the “thermostat wars,” since from a health perspective, as long as the temperature is reasonable, neither a little warm nor a little cool is likely to cause harm.
         My independent viewpoint is that it is easier to get comfortable wearing warm clothing if it’s cool than to be comfortable when it is too warm. You’ll also spend less on energy.
         DEAR DR. ROACH: I received a Zoster (Zostavax) shot in 2014. I am 65 years old. Now my nurse practitioner says I need to get the Shingrix shot. There are two doses costing $300 per dose. This is not covered by Medicare. Is this really necessary? I am looking for a second opinion. — S.M.
         ANSWER: Coverage for vaccinations under Medicare comes from Part D, which not everyone has, and which may be provided by multiple insurers. Most Medicare Part D plans do cover the Shingrix shot (and I agree with your NP that it is a good idea — it gives additional protection on top of what you got from the Zostavax). There may be different “cost-sharing” amounts you have to pay, only some of which may be reimbursed. You also may have a deductible that needs to be paid before getting any coverage.
         You can call your Medicare Part D plan’s member services department to find out whether Shingrix is covered, or when it will be.
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         Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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