Bitterness in the mouth: causes, diagnosis and treatment

How does a bitter taste in the mouth occur?

The taste in your mouth doesn't have to be overtly bitter; it can feel metallic, sour, or just plain unpleasant. Usually its appearance is associated with certain conditions:

immediately after eating (if you overeat or eat certain foods);
after taking medications, especially if a person takes them on an empty stomach;
after physical activity;
immediately after waking up.

Bitterness is felt as a foreign, strong, unpleasant taste that comes from the oropharynx or has no obvious source. It may be part of a symptom complex. Along with a bitter taste, the following may appear:

heaviness in the side;
abdominal pain;
white coating on the tongue;
nausea, vomiting;
heartburn;
belching;
dry mouth or, on the contrary, excessive salivation;
dizziness;
bloating;
bleeding gums;
cold symptoms (sore throat, cough, fever, weakness);
decreased appetite;
deterioration of smell and other symptoms.

By exactly when bitterness appears and what other symptoms arise, one can judge the causes of the condition. To make a diagnosis, you need to see a doctor and describe to him in detail how you feel.

Causes of bitter taste in mouth

Bitterness in the mouth can appear due to diseases of the digestive system, teeth and gums, due to changes in hormonal levels, taking certain medications and for other reasons (Fig. 1). At the same time, the accompanying symptoms and conditions under which a person feels a bitter taste in the mouth will be different.

Figure 1. Some causes of bitterness in the mouth. Source: MedPortal

Poor quality food

Foods cooked with a lot of oil, fat or burnt can cause a bitter taste in the mouth. Sometimes the bitter taste is associated with drinking black coffee or very strong tea. It can also appear if a person has eaten sunflower seeds or nuts. The bitterness will go away if you drink cool water, but a slight unpleasant aftertaste may persist for a while. If the bitter taste comes from food, there will be no other symptoms (pain, indigestion).

Age-related changes

With age, a person's taste perception gradually changes. Older people are less able to discern tastes, but may still experience bitterness. This is associated with a number of other health changes, for example, decreased saliva production, dry mucous membranes, and a gradual deterioration in oral health.

Smoking

If a person smokes frequently, they perceive the taste of food less well, and this can increase the bitter taste in the mouth. Also, bitterness in the mouth of smokers may be associated with the taste and smell of tobacco smoke. The resins contained in it linger on the mucous membrane of the oral cavity and settle on the surface of the tooth enamel. This is the cause of bad breath, deteriorating dental health and the associated persistent bitter taste. You can beat it with chewing gum or mints, but it is better to quit smoking or at least reduce the number of cigarettes you smoke.

Pregnancy

In the first trimester, bitterness in the mouth may appear along with other symptoms of toxicosis. It usually worsens with nausea or after vomiting. Fluctuations in estrogen levels can affect the perception of tastes. Cholestasis of pregnancy can also cause bitterness. This is a relatively rare syndrome that develops in the third trimester and is characterized by pruritus and cholestatic jaundice. Cholestasis in pregnancy resolves after childbirth and is considered a relatively harmless condition, but if symptoms appear, you should inform your obstetrician-gynecologist.

Functional dyspepsia

Functional dyspepsia is a disorder in which a person does not have severe diseases of the digestive system, but experiences pain, early satiety and a feeling of fullness after eating, and a burning sensation in the upper abdomen. In this condition, the feeling of bitterness occurs due to slow digestion of food. It may be accompanied by abdominal cramps and other unpleasant sensations. Functional dyspepsia is associated with a number of factors, including stress, smoking, heredity, and recent infectious diseases. You can relieve the bitter taste in your mouth by drinking water with lemon juice. If the condition does not go away or the pain intensifies, diarrhea, vomiting or other severe symptoms appear, you should immediately consult a doctor.

Hepatitis

Bitterness in the mouth is the initial symptom of hepatitis and accompanies liver inflammation. In this case, the bitter taste appears in the morning, immediately after waking up or 30-60 minutes after eating. This is accompanied by heaviness in the right hypochondrium, pain, nausea and vomiting containing bile. With toxic hepatitis, symptoms appear for a short time and disappear after starting treatment. With viral hepatitis, bitterness in the mouth persists almost constantly.

Pathologies of the gastrointestinal tract

If food digestion is impaired, an unpleasant taste appears in the mouth. The sensation of bitterness may occur due to a change in taste perception. It occurs, for example, with pancreatitis and may be accompanied by vomiting and the appearance of a yellow or grayish coating on the tongue. A common cause of bitterness in the mouth is gastroesophageal reflux disease (GERD). In this disease, stomach contents (stomach juice and food particles) regularly back up into the esophagus, causing heartburn and a bitter taste in the mouth (video 1).

Video 1. Symptoms of gastroesophageal reflux disease.

If a person has chronic gastritis or duodenitis, a bitter taste appears when he violates the recommended diet. In diseases of the digestive system, a feeling of bitterness in the mouth is always associated with food intake (appears some time after it).

Biliary system damage

A bitter taste may appear in the mouth due to cholelithiasis, cholecystitis, cholangitis and other diseases of the biliary system (gall bladder and bile ducts). At first, bitterness may appear only after drinking alcohol, fatty or fried foods.

“Burning in the mouth, tongue covered with a yellow coating, discomfort, and so on. In 95% of cases, this is due to the reflux of bile from the duodenum into the stomach. In the stomach, this bile is mixed with hydrochloric acid, thrown into the esophagus and then into the oral cavity.”

Karasev I. A., candidate of medical sciences, gastroenterologist, surgeon, endoscopist.

Without treatment, the condition will gradually worsen. The bitter taste will bother you more often and last longer. Along with it, nausea, pain in the hypochondrium on the right side, and stool disorders may occur. The feeling of bitterness becomes permanent if a severe inflammatory disease of the gallbladder or bile ducts develops (cholangitis, cholecystocholangitis, cholecystitis and others). Also among the possible causes are biliary dyskinesia, due to which the outflow of bile is disrupted, and cholelithiasis. Less commonly, the disorder is associated with parasitic liver disease (giardiasis, opisthorchiasis or echinococcosis).

Dental diseases

The feeling of bitterness can be caused by the presence of tartar, caries, gingivitis or other dental problems. There are usually other symptoms:

toothache;
enamel sensitivity (reaction to cold or hot, sweet, sour);
bleeding gums;
tooth mobility;
gums look red or swollen;
There is a noticeable plaque on the enamel that cannot be removed by regular teeth brushing.

Problems with the health of teeth and gums may be associated with xerostomia, a condition in which insufficient saliva is produced and the mouth constantly feels dry. This increases the risk of tooth decay and gum disease, and causes an unpleasant odor in the mouth, which is perceived as bitter. Xerostomia can occur due to smoking, mouth breathing, aging, diabetes, or autoimmune diseases. This condition requires consultation with a dentist.

Sometimes bitterness in the mouth appears after dental treatment. This may be due to the use of certain medications or materials, or the installation of dentures, braces and other structures in the mouth. If the bitter taste does not go away or persists for several days, you should contact your dentist.

Neurological disorders

The mouth may taste bitter due to damage to the brain structures that process taste information. In this case, taste perception is disrupted: for example, sour foods may seem sweet, salty foods may seem sour, and a person may not perceive some tastes. This can occur after a traumatic brain injury or stroke. Sometimes taste disturbances are associated with Alzheimer's disease and other age-related diseases in which neurodegenerative processes occur.

Complications of pharmacotherapy

There are more than 250 types of medications that can cause taste disturbances, including the appearance of bitterness in the mouth. This can happen if the drug affects the taste buds of the brain, if part of it remains in the saliva and changes its taste, if the drug suppresses the microflora, which is why fungal diseases develop. Among the drugs that can cause a bitter taste in the mouth:

antibiotics;
medications for arrhythmia, diuretics, statins and other drugs used for cardiovascular diseases;
drugs used in chemotherapy;
muscle relaxants, migraine medications and other neurological drugs;
neuroleptics, sedatives, hypnotics, antidepressants;
non-steroidal anti-inflammatory drugs;
bronchodilators;
antihistamines;
antiviral drugs;
nicotine replacement therapy products.

Rare causes

Sometimes bitterness in the mouth becomes a symptom of endocrine disorders: diabetes mellitus, hypothyroidism, hypocortisolism and others. It can accompany some cancers and respiratory diseases. Rarely, the cause is an infection of the salivary glands. A bitter taste may occur in cases of poisoning due to accidental ingestion of a toxic substance. In all these cases, the appearance of bitterness is accompanied by other symptoms of the underlying disease.

Symptoms associated with dry mouth

Dry mouth in most cases manifests itself as a complex of symptoms described as:

"viscosity" or "stickiness" in the mouth;
thirst;
irritation of the oral mucosa (burning and itching), the appearance of a bright border of the lips, cracks on the lips and in the corners of the mouth;
dry tongue. The tongue turns red and becomes rough. It becomes more difficult to speak, chew and swallow. Decreased taste perception;
dry throat. The voice becomes hoarse and more hoarse;
there is an unpleasant odor from the mouth.

Help before diagnosis

Even if a diagnosis has not yet been made, several measures can be taken to alleviate the condition:

Adjust your diet, remove fatty and fried foods, eat more often and in small portions.
Stop smoking or reduce the number of cigarettes you smoke.
Limit alcohol consumption.
Drink more water.

Monitor the quality of oral hygiene. You should brush your teeth twice a day, as well as use mouthwash and floss. If you have problems with your teeth, you need to visit a dentist.

Photo: goffkein/freepik.com

Important! You should not try to use folk remedies or treat yourself - this can be dangerous. If a bitter taste in your mouth appears regularly, you should consult a doctor and get recommendations for treatment.

Prevention

To avoid the appearance of a bitter taste in the mouth and xerotomy, it is recommended:

timely treatment of infectious-inflammatory and dental diseases, elimination of digestive problems;
normalization of work and rest regimes;
refusal of heavy (fried, fatty, etc.) foods, smoking and alcohol;
air humidification in working and living areas;
control of the psycho-emotional state to avoid the occurrence of neurological problems.

Thus, the feeling of bitterness and dryness of the oral mucosa are signals notifying about various malfunctions in the body. As a rule, the “culprits” are diseases of the digestive tract (especially the biliary tract), but the problem can also be caused by dental, respiratory, hormonal and neurological disorders. In any case, when the discomfort is not temporary, but permanent, accompanied by thirst, vomiting, abdominal pain and other unpleasant symptoms, it is necessary to seek help from a doctor and undergo treatment.

When to see a doctor?

If the appearance of bitterness in the mouth is not associated with drinking coffee, burnt or poor-quality food, if the bitter taste appears regularly or persists for a long time, if it is accompanied by other symptoms, you should consult a doctor. This could be a dentist, if the bitterness in the mouth is associated with diseases of the teeth and gums, a gastroenterologist, if the cause may be diseases of the digestive organs or biliary tract, a hepatologist, if there are symptoms of liver disease.

Important! In some cases, you need to urgently seek medical help. If bitterness in the mouth is associated with accidental ingestion of poison, if it appears along with other severe symptoms (difficulty breathing, swelling of the tongue, lips, difficulty swallowing, paralysis, changes in consciousness), you should immediately call emergency medical help.

Which doctor treats bitterness in the mouth?

First of all, bitterness in the mouth is considered as a symptom of gastroenterological disorders, so when the first signs appear, you need to make an appointment with a gastroenterologist.

To make an appointment with a doctor, choose any method:

call the clinic +7 (495) 103-99-55,
order a call back,
leave a request for an appointment using a convenient form on the website:

Often people do not pay attention to bitterness in the mouth, explaining the occurrence of the symptom with overeating, an uncomfortable position in bed and some other reasons.

IMPORTANT! Rarely does anyone think that bitterness in the mouth is a signal indicating the development of serious pathology of the liver and gastrointestinal tract.

If you have been experiencing this symptom for a long time, do not engage in self-diagnosis and self-medication - make an appointment with a specialist at the Kuntsevo Treatment and Rehabilitation Center! An experienced gastroenterologist will collect anamnesis, complaints, conduct an objective examination, and refer you for laboratory and instrumental diagnostics to understand the cause of the pathology.

Diagnostics

You can start diagnosing with a consultation and examination with a doctor. To do this, you need to contact a therapist, gastroenterologist, hepatologist or dentist. The doctor will conduct a survey and refer the patient for examination.

Photo: okfoto / freepik.com

During the consultation, the doctor needs to describe in detail the existing symptoms, tell how often and under what circumstances bitterness appears. Information about lifestyle, diet, and existing diseases will be useful.

For diagnosis, the following studies are carried out:

Duodenal sounding. If a malfunction of the biliary tract is suspected, portions of bile are taken using a probe for bacteriological examination, and the rate of excretion of bile into the duodenum is also assessed.
Gastroscopy (EGDS, FGDS) is a study using a gastroscope. Allows you to examine the mucous membrane of the digestive organs and do a biopsy (take tissue samples for laboratory testing).
Ultrasound of the liver, gall bladder and other organs. It is carried out to assess the size and presence of changes in internal organs.
Lab tests. If diseases of the digestive organs or biliary tract are suspected, a stool test is prescribed. A biochemical blood test is performed if cholecystitis is suspected. A test for hCG and sex hormones, as well as a serological test if viral hepatitis is suspected, can also be performed.

Why do we need to treat bitterness in the mouth?

Since an unpleasant taste in the mouth is a symptom of some pathology, a comprehensive examination is needed, without which it is impossible to establish a diagnosis. Our clinic has the latest equipment for ultrasound diagnostics of the liver and gallbladder, gastroscopy, etc., which help identify the pathological process in a short time. Our own laboratory allows you to get test results within a few hours. It is the quick examination process that attracts many Moscow residents to our clinic, as well as experienced, qualified staff ready to help every patient.

Treatment

Treatment is prescribed based on diagnostic results, taking into account the causes of bitterness in the mouth.

Conservative therapy

Photo: freepik.com
A doctor may prescribe the following medications:

Choleretics and cholekinetics. These are choleretic drugs that are prescribed for cholangitis and cholecystitis.
Enzymes that stimulate digestion. They can be used not only for diseases of the digestive organs, but also for liver damage (in combination with hepatoprotectors).
Antispasmodics. They are prescribed if bitterness in the mouth appears along with abdominal pain and is associated with gastritis or other diseases of the digestive system. Antispasmodic drugs relieve pain and relax the smooth muscles of the stomach.

If the appearance of bitterness is associated with viral hepatitis, the doctor will prescribe complex therapy for the underlying disease. In case of parasitic infection, anthelmintic drugs are prescribed. Additionally, it is recommended to follow a diet, frequent, small meals and control the drinking regime.

Surgery

Surgical treatment is carried out for gallstone disease to remove and remove stones - calculi. If the gallstones are small, the ESWL (extracorporeal shock wave lithotripsy) technique is used, crushing the stones with a shock wave. In more severe cases, open or laparoscopic cholecystectomy is prescribed. It is carried out if neither diet nor ultrasound methods improve the condition. A cholecystectomy involves removing the gallbladder.

Stones extracted from the gallbladder. Photo: Alena1919 / Depositphotos

Solution

Treatment for bitter taste and dry mouth depends on why the abnormal symptoms occur. The patient may need help from both a gastroenterologist (if the “culprit” is a malfunction of the gastrointestinal tract), an ENT specialist (for respiratory pathologies), and an endocrinologist - reduced saliva production, thirst, bitter taste in the mouth are common symptoms of diabetes.

To normalize the functioning of the gastrointestinal tract, the patient is prescribed a gentle diet, sorbents and choleretic drugs (herbal, synthetic) are prescribed. It is useful to drink a glass of flax seed jelly every morning (it has a good effect on peristalsis). Freshly squeezed juices (vegetables, fruits) also contribute to improving the functioning of the gastrointestinal tract; it is better to drink 1-2 glasses of such drinks daily.

For any digestive disorders, it is better to avoid:

from sweets and baked goods;
fried, fatty foods;
smoked meats, sausages, canned food.

Important! The daily “dosage” of liquid is at least 2–2.5 liters. This drinking regimen has a beneficial effect on the functioning of the gastrointestinal tract and ensures the production of a sufficient amount of secretion. If the problem is neurological, the patient is prescribed natural sedatives - tincture of valerian, motherwort.

Often, in order for bitterness and dryness in the mouth to disappear, it is enough to simply humidify the air in the room (working, living). In addition, such signs at night or in the morning, combined with heaviness and abdominal pain, are the result of overeating the day before. To activate the salivary glands, it is useful to chew various spices (for example, clove seeds) and eat sour foods.

The fight against increased dryness of the mucous membrane and bitter taste on the tongue must be comprehensive; treatment measures are selected by the doctor depending on the cause of the problem.

The main causes of bitterness

What does bitterness in the mouth indicate? There are actually a lot of reasons why a person begins to feel this. In this way, the body may try to “indicate” diseases of the digestive system or a gallbladder disease. This sensation may also be a sign of poor nutrition or taking medications of various spectrums for too long (mainly those used to treat the liver).

The main causes are diseases of the gastrointestinal tract (GIT):

Diseases of the duodenum. Bile from the duodenum, entering the stomach, causes corrosion of its walls. Bile contains acids that cause a feeling of bitterness.
Gastritis (see symptoms and treatment of gastritis). With this disease, the composition and amount of gastric juice produced by the body changes, the process is also accompanied by poor digestibility of proteins, fats, carbohydrates and other vitamins, and the removal of toxins worsens. Together, this causes heartburn, bad breath, constant belching and, accordingly, an unpleasant taste in the mouth.
Gastric dyspepsia. The cause of the bitter taste may be difficult digestion caused by disruptions in the functioning of the stomach.
Gastroesophageal reflux disease. This disease provokes surges of concentrated gastric juice to the very top of the esophagus, from where it enters the oral cavity. It can develop due to the abuse of spicy and fatty foods, as well as constant overeating (even healthy food rich in vitamins and minerals - an excess of it is also harmful).
Disturbances in motor activity of the stomach. With reduced motility of the biliary tract, bile stagnates in them; with increased motility, there are sharp releases of bile into the duodenum, then into the stomach, esophagus and oral cavity, causing bitterness, burning and heartburn.
Dysbacteriosis. Under normal conditions, a large number of beneficial bacteria live and function in the human intestine, capable of synthesizing vitamins, creating microflora and generally increasing the body’s immune strength. If the intestinal microflora is normal, then no problems are observed, but if an imbalance occurs, then dysbacteriosis appears, causing bitterness in the mouth.
Giardiasis. A disease caused by the penetration of Giardia (intestinal parasites) into the body, causing disorders in the functioning of the small intestine. Nausea, bitterness occurs, and sleep is disturbed.

Dental diseases:

Inflammation of the gums, mucous membrane of the tongue. This occurs if a person carelessly takes care of their teeth, and bad breath adds to the bitterness.
Increased sensitivity to external interventions - implantation of dental crowns, dentures or fillings. The bitter taste is often caused by raw materials for dentures, fillings or gel for fixing an artificial jaw.

Other reasons include:

If there is liver dysfunction (any disease), then increasing inflammatory processes negatively affect the production of bile and its transportation through the relevant systems of the body.
Nervous system disorders, in which the peripheral nerves responsible for the taste buds and sense of smell become inflamed, also alter the perception of the taste of food and make it bitter.
At moments when the level of glucose in the blood rises, vision begins to deteriorate, a feeling of weakness and heat appears in the palms and soles, along with this, a bitter taste becomes very noticeable in the mouth.
General intoxication of the body, which is observed when it is damaged by heavy metals such as mercury, lead, copper and others.
Disturbances in the functioning of the endocrine system lead to the fact that the thyroid gland, together with the adrenal glands, begins to produce huge amounts of adrenaline. As a result of this, the bile ducts narrow, which provokes the release of bile towards the esophagus and the appearance of bitterness.
Lack of zinc - an important trace element that is necessary for the normal functioning of cells and taste buds in particular.
Smoking for many years. Long-term exposure to tobacco and its derivatives has a detrimental effect on the taste buds, as a result of which the smoker begins to feel an unpleasant bitterness.

Classification

Physiological dry mouth, caused by natural causes, and pathological are possible. Taking into account the mechanism of development, neurogenic xerostomia is distinguished, which is caused by a violation of the central regulation of salivation, and medicinal, provoked by long-term use of antihypertensive drugs, atropine. In diagnostic terms, the most valuable is the classification by severity, based on subjective complaints of patients and objective signs. Based on this, there are three degrees of symptom severity:

I degree - compensated
. Saliva secretion is within normal limits: 1-5 ml for the parotid gland and 0.9-6.8 ml for the submandibular salivary gland. Patients report dryness after a long conversation. Sialography reveals increased accumulation of contrast in the glands.
II degree - partial decompensation
. Symptoms such as dry mouth when talking and the need to drink dry food with water are typical. The mucous membrane is moderately moisturized and retains its physiological shine.
III degree - decompensation
. The secretory function of the salivary glands is significantly reduced or absent. There is pain during eating and talking, burning of the lips and tongue. The mucous membrane is dry, covered with erosions. Caries, stomatitis, glossitis are detected.