Burning tongue treatment

First, rule out local and systematic factors before labeling as neuropathic burning tongue 

• • Be sure to assess if the patient is rubbing the tongue against the teeth, a thin protective tray may be fabricated (similar to a bleaching tray) 

• 1. Start topical Clonazepam 1 mg 

     • Crush tab and mix with small cup of water, swish for 2-3 minutes and spit twice daily for 2-3 weeks 

1. If no response, trial Clonazepam 0.5 mg PO nightly for 2-3 weeks 

2. Consider adding Alpha Lipoic Acid 300 mg twice daily for 4-6 weeks (at least)

3. If Clonazepam is not helpful or tolerated, consider starting with Nortryptiline or Gabapentin  

   1. For flare ups, consider adding Celecoxib, shown to hep when combined with Gabapentin 

   2. In patients with known depression and / or anxiety, consider starting

      • SSRI: Citalopram, Sertraline

      • SNRI: Duloxetine, Venlafaxine