DEAR DR. DONOHUE: I have burning mouth syndrome and am very discouraged at my prospects. Vitamin deficiencies, fungal infections and nerve conditions have been ruled out. The doctor told me that, aside from temporary relief with a mouth rinse, nothing can be done. Do you have any insights? – M.P.

DEAR DR. DONOHUE: Do you know about burning mouth syndrome? I have had it for four months. It is a nightmare. I need some answers. – R.R.

ANSWER: Burning mouth syndrome is every patient’s and every doctor’s nightmare. The patient suffers from constant pain; the doctor suffers from a lack of information on its cause and its treatment. It’s something that happens most often to postmenopausal women. The tongue feels like it’s on fire, and often the lips, gums, roof of the mouth and throat are involved.

A number of conditions are sometimes seen in association with it – diabetes, lichen planus, anemia, viral infections, yeast infections, the dry mouth of Sjogren’s syndrome, iron deficiency, deficiencies of some B vitamins and ill-fitting dentures. In honesty, although looked for, these disorders are rarely found.

Rinses might provide more than temporary relief. Rinsing with cold apple juice helps some people. A mouth rinse composed of equal parts Benadryl elixir and Kaopectate, both nonprescription items, can be effective. The mixture is used three times a day and again before bedtime, and it is swished in the mouth for 20 seconds and then spit out. A rinse made with a few drops of Tabasco sauce in a teaspoon of water is another homemade remedy. Swish it in the mouth briefly, and then spit it out. Tabasco contains capsaicin, which depletes nerve chemicals that generate pain. It temporarily worsens the burning. If it increases the pain too much, ditch this treatment.

Doctors have prescribed Klonopin (an anti-anxiety medicine) and amitriptyline (an antidepressant) as adjuncts in controlling the pain of burning mouth syndrome.

DEAR DR. DONOHUE: I quit smoking two years ago. I had smoked for 50 years. I used nicotine gum to quit, and that is the problem. I still use it. I tried other ways, like the nicotine patch, but it irritated my skin. I tried nicotine tablets, but they messed with my head. Sometimes I chew only two or three pieces a day, but if I am stressed, I chew six or seven pieces. Did I help my health by changing my addiction? – I.C.

ANSWER: The gum is supposed to be a short-term help to ease a person over nicotine withdrawal. By not smoking, you have greatly reduced your chances for lung cancer, chronic obstructive pulmonary disease, bladder cancer, esophageal cancer and pancreatic cancer. Those things are caused by materials in cigarette smoke other than nicotine. You’ve also lessened the threat of a heart attack and a stroke. Nicotine, however, is the addicting chemical that keeps people lighting up or chewing. I hate to suggest another medicine to you, but you might want to try Chantix to get your over nicotine withdrawal symptoms. It can take you six to eight weeks to achieve that goal.

DEAR DR. DONOHUE: Several of my friends have undergone knee replacement surgery. Their surgeon insists on their taking several antibiotics before a visit to the dentist, and says it’s a lifetime thing. I thought this was done only for two years after surgery. Would you enlighten us? – H.F.

ANSWER: The American Dental Association and the American Academy of Orthopedic Surgeons advise antibiotics before dental procedures in select patients: those within two years of having an artificial joint implanted; people with rheumatoid arthritis, lupus or type 1 diabetes; those having radiation therapy or on immunosuppressant drugs; those who had or have cancer; those with HIV; and those who have had previous artificial joint infection. Giving antibiotics is done to prevent infection from any mouth bacteria that find their way into the blood. Procedures considered high risk for such infections are tooth extractions, periodontal procedures, implants and root canals.

The recommendations have been relaxed because infections following dental work pose less of a risk than does taking antibiotics.

DEAR DR. DONOHUE: Five years ago I had my first colonoscopy. The doctor told me I had diverticulosis. He said if I keep my fiber intake over 35 grams a day, I can eat whatever I want. I have a friend who had colon cancer 20 years ago. Her doctor told her that she has diverticulosis and a hole in her colon. Another man told her that he has several holes in his colon from diverticulosis. What causes these holes? And why do so many people have diverticulosis? – L.R.

ANSWER: Let me give you a clear picture of diverticulosis. A diverticulum is a tiny pouch that springs up on the outside colon wall. Dry, hard stool makes the colon work very hard and makes it generate great force to push undigested food through it. That same force drives the colon lining through the colon wall, where it forms a tiny, pea-sized bulge like an inner tube bulging through a tire. That’s a diverticulum. The diverticulum still communicates with the center of the colon through a tiny opening. I believe that the opening of the diverticulum must be the hole that your friends speak of.

If the opening of a diverticulum becomes plugged, then the bacteria inside of it multiply and cause the diverticulum to expand. The expansion can become so great that the diverticulum bursts. That is diverticulitis, a painful and potentially dangerous condition.

So many people in industrialized countries have diverticulosis because their diets consist of refined grains – grains with their outer bran coat removed. Bran is an excellent source of fiber. Without fiber, undigested food dries out and begets the forces that end up producing diverticula. That’s why diverticulosis is so prevalent in Canada and the United States. Our diets are devoid of fiber. Do what your doctor told you, and you won’t come down with diverticulitis and won’t form more diverticula.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.