Three days before Thanksgiving, I suddenly developed a constant salty taste in my mouth that didn’t go away no matter how much I brushed and flossed my teeth, scraped my tongue, gargled with mouthwash or banished salty foods from my diet. Week after week, it persisted, driving me to distraction.

I consulted my dentist, periodontist, internist, allergist and naturopath, all to no avail.At the end of my rope, I went looking for an expert in the field.

That’s when I called Natasha Mirza, MD, a professor in the department of otorhinolaryngology–head and neck surgery at the University of Pennsylvania School of Medicine and a faculty member at the University of Pennsylvania Smell and Taste Center, both in Philadelphia.

She told me that I’m far from alone—in fact, she sees hundreds of patients each year who experience some version of this symptom. Some complain of a salty taste…a metallic taste…or a burning sensation in the mouth. Often there’s a medical explanation for their symptoms, but sometimes no cause can be found.

If you ever develop this problem, you’ll no doubt be as eager as I was to get to the bottom of it. Start by seeing your dentist, Dr. Mirza suggested—tooth decay, gum disease or an oral infection (such as thrush) could be the culprit. If no dental problem is detected, see your physician for a full physical exam.

Common underlying causes your doctor may investigate include…

• A digestive disorder, such as gastroesophageal reflux disease, which may improve with dietary and lifestyle changes and/or medication.

• A sinus infection, which could cause a salty postnasal drip. If the infection is bacterial (rather than viral), a short course of antibiotics may solve the taste problem.

• Medication side effects. Blood pressure drugs, decongestants, antihistamines, antidepressants, sedatives and numerous other drugs can alter taste and dry out the mouth in some cases—so switching medications may help.

• Hormonal fluctuations due to menopause. These may lead to degenerative alterations in certain small nerves in the mouth and trigger a phenomenon called burning mouth syndrome. This is characterized by taste disturbances, including “constantly feeling like you’ve just eaten chili peppers,” Dr. Mirza said.

For some people, symptoms seem to ease with a daily dose of 20 mg to 30 mg of zinc. For maximum absorption, do not take zinc supplements with protein, bran or coffee. And avoid taking too high a dose, as that could cause side effects such as nausea, abdominal pain or diarrhea, Dr. Mirza cautioned.
Rarely, a salty taste or other taste disturbance may be a sign of…

• Leakage of cerebrospinal fluid down the back of the throat, a possible complication of head surgery.

• Paraneoplastic syndrome, a rare disorder among patients with breast, ovarian or other cancers. Substances produced by the tumor affect the nervous system, leading to sensory perception problems and other symptoms.

• The chronic autoimmune disorder Sjögren’s syndrome, in which the immune system mistakenly attacks the body’s moisture-producing glands. This leads to dryness of the mouth, eyes, nasal passages and skin as well as joint pain, digestive upset and/or neurological problems.

If your doctor cannot determine the problem: Ask for a referral to a chemosensory center. There you may undergo an evaluation that includes a “sip, spit, and rinse” test, in which different chemicals are applied to different areas of your tongue.

Your sense of smell will be evaluated as well, probably by “scratch-and-sniff” tests. Dr. Mirza explained, “Smell and taste are very closely linked. So in some cases, patients who perceive an odd taste actually have a problem with smell and don’t realize it.” (For more info on what happens at chemosensory centers, visit the University of Texas Southwestern Medical Center’s Web page at http://bit.ly/GEQmYH.)

When an underlying cause is diagnosed, treating that problem may resolve the taste issue, as well. But what if the mystery remains? “It’s frustrating, I know. But there are two important things to note about such a condition.

First, once all the scary possible causes are ruled out, it’s reassuring to know that a taste disorder is not life-threatening. Second, most such taste disturbances are relatively short-lived, lasting from three to 12 months. So try to be patient—time may take care of the problem,” Dr. Mirza said.

As for me? To mask the icky taste, I found it helpful to chew sugar-free gum sweetened with xylitol…spritz my mouth with a moisturizing spray (my favorite is Spry Rain Oral Mist)…and drink a lot of water. I also halted the daily antihistamine I had used for years to prevent allergy flare-ups and now I take the medicine only when my allergy symptoms get really bad.

I’m relieved to report that, five months after the saltier-than-the-sea taste first appeared, it has finally faded from a constant aggravation to an occasional annoyance.

Source: Natasha Mirza, MD, is a professor in the department of otorhinolaryngology–head and neck surgery at the University of Pennsylvania School of Medicine, a faculty member at the University of Pennsylvania Smell and Taste Center and chief of otolaryngology at the Philadelphia VA Medical Center, all in Philadelphia.

Luv, Zen Lill