Prescribe Chewing Gum for sore tongue

SHERRY BOSCHERT (San Francisco Bureau)

WINNIPEG, MAN. — Emotional stress underlies most cases of glossodynia, and—after ruling out dermatologic causes ranging from contact allergy to cancer—the best prescription for patients may be relaxation, Dr. Robert Conklin said at the annual conference of the Canadian Dermatology Association.

Most of the many causes of glossodynia proposed in the literature either lack evidence of causation or don't fit with his definition of glossodynia, which is pain on the tip and sides of the tongue with no inflammation, masses, or atrophy, Dr. Conklin said. These proposed causes include drugs, postmenopausal hormone levels, vitamin or mineral deficiencies, diet, infection, inflammatory diseases, lichen planus, pemphigoid, contact allergy, thrombosis, amyloidosis, and cancer.

Xerostomia, often cited as a cause of glossodynia, involves increased friction, but the pain of xerostomia usually derives from secondary candidiasis. Another common suspect, acid reflux, isn't the cause, because tests have shown similar pH levels on the tongues of people with or without glossodynia. As for neuralgias—“Tell me a case of peripheral neuralgia or neuropathy starting with pain in the tongue without other signs elsewhere,” said Dr. Conklin of the University of British Columbia, Vancouver.

Always palpate the tongue to make sure there are no masses, he advised.

Dr. Conklin said he sees a fair amount of glossodynia in his practice, and about 90% is caused by emotional stress that leads to the habit of pressing the tongue against the teeth and palate, which produces pain in the tongue. It can be a frictional or pressure pain, or muscle pain. The other 10% of cases may be due to dental problems. The tongue “sort of seeks out things and goes at them, increasing friction,” he said.

Patients with glossodynia often will say the pain started fairly suddenly, usually at a time when they were worried or something serious happened in their lives. They report that the pain is worse in the evening and on the tip and sides of the tongue, consistent with a day of pressing against the teeth.

They also may complain of pain in the anterior soft palate or lips, or tightness at the root of the tongue. Reports of neck pain or other muscle pain are common and probably related to tension.

Physically, there may be little to see in a patient with glossodynia, or findings can include lingua serratia, linea alba, or papillitis. Pushing on the teeth may cause them to protrude or widen the gaps between teeth; hence, patients may say that flossing became easier. Inspect their mouths, and you may see that the cusps are worn.

Bruxing often coincides with glossodynia. ‘The whole muscle area is overactive,” Dr. Conklin said. Sucking is common behavior in people with glossodynia.

To treat glossodynia, first explain to the patients about the link between stress and their tongue movement habits. Most patients don't know they're doing this repetitive action, he said. Reassure them that they don't have a more serious problem such as cancer or infection, which are common concerns.

Sometimes on the return visit, patients will say they now notice the tongue behavior the physician pointed out, and they don't know why they do it, but they can't stop.

The key to treatment, and the difficult part, is trying to get patients to relax. “Chewing gum is the single most valuable treatment for glossodynia,” Dr. Conklin said. Sipping cool water on a regular basis also may be helpful.

If bruxing is present, using a bruxing splint to stop the clenching may lead the patient to stop pressing the tongue.

Some reports suggest treating with physiotherapy, benzodiazepines, or major tranquilizers. “We don't use drugs too often” for this condition, he said.

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Black groups band together to fight AIDS

By Lorinda Bullock

TORONTO (NNPA)-Just as the framers of the Declaration of Independence did when they gathered in 1776 to declare Americans free from the tyranny of England's King George III, another group of powerful American leaders gathered here on Aug. 14, this time on foreign soil, to reclaim Black America's freedom from the grips of a deadlier and stronger foe-AIDS.

Representatives from business, politics, civil rights, the Black church and other groups came together for the 16th International AIDS Conference and signed the "National Call to Action and Declaration of Commitment to End the AIDS Epidemic in Black America."

Leaders from organizations such as the NAACP, National Urban League, National Council of Negro Women and others pledged their support and resources to make Black America reverse the devastating statistics by promoting more testing and education about prevention, as well as protecting the rights of the infected. 

"AIDS in America today is a Black disease no matter how you look at it. By gender, by sexual orientation, by age, by socioeconomic class or education or region in the country in which you live, Black people bear the brunt of this epidemic," said Phill Wilson, founder and executive director of the Los Angeles-based Black AIDS Institute.

The Black AIDS Institute is a non-profit policy group leading the way in HIV education and advocacy of Black people fighting the disease in the U.S. The group was also responsible for the gathering of delegates that also included NAACP Board Chairman Julian Bond; actress/AIDS activist Sheryl Lee Ralph; filmmaker Bill Duke; Pernessa Seele, president of the Balm in Gilead; and Congresswomen Maxine Waters (D-Calif), Barbara Lee (D-Calif.) and Donna Christensen (D-V.I.).

Citing statistics from the Centers for Disease and Control, Mr. Wilson said that there are 650,000 Black people in the U.S. living with AIDS-a little more than half of AIDS cases in the U.S.

"We are here this afternoon to launch a national Black mass AIDS mobilization, with a goal of reversing the epidemic in Black America by 2011, just five years from now," Mr. Wilson stated. "We realize this is an ambitious goal; some might say unrealistic. We believe anything less would be immoral."

One by one, after explaining how their organizations would contribute to the war on AIDS, the leaders each signed a large poster board patterned after the original U.S. Declaration of Independence on a brown, weathered paper background with Old English lettering.

Mr. Bond said although the NAACP has been in the fight since 1998, they know they must do more. He said the NAACP would send delegates to every future International AIDS Conference, provide HIV screenings at all seven of its regional conferences and at the national convention and lobby for the reauthorization of the Ryan White Care Act, federal legislation that provides funding for, among other things, uninsured HIV patients.

 The NAACP's newest initiative, Mr. Bond said, was to heavily promote mandatory HIV testing on prisoners entering and exiting America's correctional facilities.

"We can't accept that healthy men and women enter our systems for short stays on minor charges or longer stays for serious charges and then are released with a death sentence from which there is no pardon or parole," he said.

Sandra Goodridge, director of Health and Quality of Life programs for the National Urban League, said the civil rights group would also launch more testing programs and would participate actively in World AIDS Day and the National Day of Service.

Understanding that Black women have started to become infected with HIV/AIDS at rapid rates, Cheryl Cooper, executive director of the National Council of Negro Women, said they would use their resources and join with the Coalition of 100 Black Women and the Black AIDS institute this year to reach out to Black women.

"Unbelievably, 68 percent of women newly infected with HIV are African American women, our women," she said.

Ms. Seele, explained that while stigma and reluctance to discuss HIV and AIDS in Black churches still exist, her organization has united thousands of Black churches across the nation not afraid to reach out, test the community and open clinics for infected people in their churches.

"I am happy to say that we have not done all that we can do, but we're going to do more," Ms. Seele said.

She said the most recent gain is the AME, AME Zion and CME churches signing on with Balm in Gilead to have health coordinators for every Episcopal district in the U.S.

In the Black media, National Newspaper Publishers Association (NNPA) News Service Editor George Curry pointed out that the NNPA already syndicates a column by Phill Wilson and has been providing extensive coverage of the pandemic, including staffing this convention.

Speaking after one panelist admitted that he was openly gay, Mr. Curry said, "I am a straight Black man and the issue is not whether one is straight or gay. The issue is whether we're going to save lives."

Congresswoman Waters, known for her in-your-face style, including being an advocate for needle-exchange programs and being vocal about the ineffectiveness of the "abstinence only" policies in the U.S., said that when it comes to AIDS, she has actually been too mild.

"I'm taking the gloves off. I'm not so nice about this anymore," she said as congresswomen Lee and Christensen stood beside her. 

Rep. Waters also stressed the importance of HIV testing in the corrections system and said she is fighting on Capitol Hill to make that happen. She also said that in addition to the need to reauthorize the Ryan White Care Act, money for another massive federally funded AIDS program-the Minority AIDS Initiative-is also dwindling, while the need is growing.

She said the initiative got as much as $156 million in 1999, but funding was stagnant during the Bush administration. She and 119 members of Congress are currently pushing to appropriate $610 million to the initiative, to properly care for Blacks, Latinos, Asian and Native Americans struggling with the disease.

She also pointedly challenged the pharmaceutical industry, urging them to assume a more active role in combating HIV and AIDS 

But before any government or corporate support can take place, Rep. Waters explained it starts with individual commitments.

"Get your heads out of the sand and understand you are just as vulnerable as anybody else," she said. "First, take responsibility, so that we can demand from others that they take responsibility."

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Diabetes Forecast Gets Scarier

CDC Ups Diabetes Prediction to 48.3 Million Cases by 2050

Sept. 11, 2006 -- Greatly increasing a prediction made just three years ago, the CDC now predicts 48.3 million Americans will have diabetes by 2050.

That's triple the number of people living with diabetes today -- and 9.3 million more than the CDC forecast in 2003.

The new figures come from K.M. Venkat Narayan, MD, and his CDC colleagues. Narayan, formerly chief of the CDC's diabetes epidemiology and statistics branch, is now at Emory University's Rollins School of Public Health.

"The numbers are very worrying," Narayan tells WebMD. "There is an epidemic going on that -- if left unchecked -- will have a huge effect on the U.S. population and on health care costs."

The new numbers sound an alarm, says Ronald B. Goldberg, MD, chief of the Diabetes Research Institute at the University of Miami Leonard M. Miller School of Medicine.

"This worsens the predictions that all of us have been making about the future problem that diabetes is going to represent, not only in the U.S. but around the world," Goldberg tells WebMD. "The consequences are more and more suffering -- eye complications, amputations, and markedly more heart disease … And just from an economic point of view, it will cripple our health care budgets."

The new calculations appear in the September issue of Diabetes Care.

Future Diabetes Hits Minorities Hardest

By the middle of the century, Narayan's team predicts, diabetes will increase by 481% among Hispanics, 208% among blacks, and 113% among whites.

One reason for the increase is that, with better care, people with diabetes are living longer. But that accounts only for about a tenth of the growth; the ongoing rise in new diabetes cases accounts for almost 90% of the spiral upwards.

As scary as these numbers are, they assume the rate of new cases will level off at 2004 levels. If this doesn't happen, we can expect to see yet another leap in diabetes predictions.

Will this happen? Diabetes is being driven by the obesity epidemic. So far, the needle on the scale has been going up, not down.