Evaluation and Management of Taste Disorders

Screen Taste and Smell

A detailed history should include questions about the salivary flow, problems with taste and smell, chewing problems, pain in the oral cavity, problems with teeth and dentures, dental hygiene, and ear or upper respiratory infections.

A loss of taste can be both regional and quality-specific, with different thresholds for different substances in different regions of the tongue, palate, and pharynx. Primary care physicians can use easily available stimuli such as sugar (sweet), citric acid (acid), sodium chloride (salty), or caffeine or quinine (bitter) to do a quick and objective taste assessment in their office. A referral to an otolaryngologist may be warranted for detailed evaluation. Evaluation and management of upper respiratory infections, oral candidiasis, and basic blood work to rule out metabolic or endocrine disorders should be pursued.

A thorough review of medications can help identify medications contributing to dysgeusia. Based on the comorbidity and indication of the culprit medication, an evaluation to stop the medicine or change to an alternative medication with less taste distortion side effects may be warranted. Taste-related side effects should be discussed as part of the potential risks of prescribed medications prior to initiation of therapy.

Many older adults lack private dental insurance, and Medicare does not cover routine dental care. Medicaid dental coverage for adults varies by state, with only about one-half of the states paying for preventive dental care or restorative services. This greatly limits access to dental care for low-income older adults who rely on Medicaid. A dental referral for examination and treatment of oral disease should be a priority when there is a complaint of altered taste.

This should also include evaluation and management of dry mouth. Additionally, primary care physicians should discuss the importance of good oral hygiene and the role of good oral health in the overall health of an individual. Currently, there is insufficient evidence to recommend zinc supplementation to improve taste perception or acuity in zinc deficiency-related or idiopathic dysgeusia.


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