Dental Science - Review Article

Gustatory dysfunction
T. Maheswaran, P. Abikshyeet1, G. Sitra2, S. Gokulanathan3, V. Vaithiyanadane4,
S. Jeelani2

Department of ABSTRACT
Oral Pathology and
Tastes in humans provide a vital tool for screening soluble chemicals for food evaluation, selection, and avoidance
Microbiology, Vivekanandha
Dental College for
of potentially toxic substances. Taste or gustatory dysfunctions are implicated in loss of appetite, unintended
Women, Elayampalayam, weight loss, malnutrition, and reduced quality of life. Dental practitioners are often the first clinicians to be
Tiruchengode, 1Kalinga presented with complaints about taste dysfunction. This brief review provides a summary of the common causes
Institute of Dental Sciences, of taste disorders, problems associated with assessing taste function in a clinical setting and management
Bhubaneswar, 2Oral options available to the dental practitioner.
Medicine and Radiology,
Indira Gandhi Institute
of Dental Sciences,
Puducherry, 3Periodontics,
Vivekanandha Dental
College for Women,
Elayampalayam,
Tiruchengode, 4Physiology,
Vivekanandha Dental
College for Women,
Elayampalayam,
Tiruchengode, India

Address for correspondence:

Dr. T. Maheswaran,
E-mail: maheswaranmds@
yahoo.in

Received : 30-03-14
Review completed : 30-03-14
Accepted : 09-04-14 KEY WORDS: Ageusia, dysgeusia, hypergeusia, hypogeusia, phantogeusia, taste disorders, taste disturbances

T he chemosensory functions of taste and smell play a vital

role in human physiology. They determine the flavor and
palatability of foods and beverages, the selection of nutrients
essential for life, and the warning of toxic vapors, fire, and
spoiled foodstuffs. Chemosensory dysfunctions have serious
implications for the preservation of oral and systemic health,
with dramatic effects on quality‑of‑life.[1] Patients frequently
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DOI:
10.4103/0975-7406.137257
report increased use of sugar and salt to compensate for
diminished sense of taste, a practice that is detrimental to those
with diabetes mellitus or hypertension.[2]
Anatomy and Physiology of Taste
The specialized sense organ for taste (gustation) consists
of approximately 10,000 taste buds, which are ovoid bodies
measuring 50-70 µm. There are four morphologically
distinct types of cells within each taste bud: Basal cells,
dark cells (Type I), light cells (Type II), and intermediate
cells (Type III). Basal cells do not extend processes into the
taste pore and are likely to be undifferentiated or immature
taste cells. The later three cell types are sensory neurons that
respond to taste stimuli or tastants. In humans, the taste buds

How to cite this article: Maheswaran T, Abikshyeet P, Sitra G, Gokulanathan S, Vaithiyanadane V, Jeelani S. Gustatory dysfunction. J Pharm Bioall Sci 2014;6:S30-3.

 S30 Journal of Pharmacy and Bioallied Sciences July 2014 Vol 6 Supplement 1
 Maheswaran, et al.: Gustatory dysfunction

are located in the mucosa of the epiglottis, palate, and pharynx pathways, and neurotransmitters) results in altered taste
and in the walls of the papillae of the tongue.[3] Each taste bud perception at any age. The mechanistic cause of gustatory
has receptors at the apical portion exposed to the oral cavity dysfunction can be of three types: Transport, sensory or neuronal
and a basolateral area separated by a tight junction.[1] Taste problem [Table 1].[1] Drug‑induced taste disorder was found
buds across the oral cavity serve similar functions. Although, to be the most common etiology among the patients visiting
there are subtle regional differences in sensitivity to different a taste clinic in Japan [Table 2].[13] The drug interactions and
tastants, the concept of a “tongue map” defining distinct zones side‑effects index lists over 200 drugs with chemosensory
for sweet, bitter, salty, and sour has largely been discredited.[4] dysfunction. A partial list of these medications affecting taste
Taste sensation can be evoked by a diverse group of chemicals is shown in Table 3.[14]
ranging from simple ions (H+, Na+) to inorganic molecules to
carbohydrates and complex proteins.[5] Oral sources of altered taste function are common and can be
evaluated by a dentist. Trauma (burns, lacerations, surgery,
Taste modalities generally fall into five established basic tastes and local anesthesia), local antiplaque medicaments and drugs
according to the receptor type most strongly activated: Sweet, excreted into saliva, infections (dentoalveolar, periodontal,
sour, salty, bitter, and umami.[6] Accumulating evidence suggest soft tissue), vesiculobullous conditions, removable prostheses,
a taste component for free fatty acids in humans as the sixth metallic dental restorations, and salivary dysfunction can
modality of taste.[7] The sensory nerve fibers from the taste directly or indirectly affect taste function.[1] Gastroesophageal
receptors reach the gustatory nucleus of the medulla oblongata
by VII, IX, and X cranial nerves. From there, the signals reach Table 1: Mechanistic cause of gustatory dysfunction[1]
the ventral posteromedial nucleus of the thalamus through the
Disorder Description Examples
axons of the second order neurons. From the thalamus, the third
Transport Stimulus cannot Salivary dysfunction, oral
order neurons reach the gustatory cortex.[3]
problem reach the receptor candidiasis
Sensory Damage to peripheral Radiotherapy,
Taste is also commonly confused with somatosensory sensations problem sensory organs chemotherapy, burn, trauma
such as the cool of menthol or the heat of chili peppers Neuronal Damage to peripheral Tongue surgery, neoplasm,
perceived through trigeminal nerve. The capacity of cutaneous, problem nerves or CNS brain tumor
including trigeminal, glossopharyngeal (IX cranial), and vagal CNS: Central nervous system
(X cranial) nerve fiber endings, to detect chemicals is known as
chemesthesis or cutaneous chemosensation. Oral chemesthesis
Table 2: Etiology of gustatory dysfunction in 2,278 patients[13]
explains the pungent or sharp feel of many different foods
and spices such as chili peppers, horseradish, the coolness of Cause Total no. Percentage
peppermint, the tingle of carbonated drinks, and the irritation Drug‑induced 495 21.7
produced by substances such as raw garlic extracts.[8] Idiopathic 341 15.0
Zinc deficiency 330 14.5
Psychogenetic 243 10.7
Terminologies Flavor disorder 171 7.5
Systematic disease 169 7.4
Smell or olfaction is the perception of odor by the nose, whereas Oral disease 146 6.4
Postinfluenza taste and smell disorder 60 2.6
taste or gustation is the perception of salty, sweet, sour, or bitter Peripheral nerve disorder 59 2.6
by the tongue. Flavor is the combination of taste, smell, and CNS disorder 38 1.7
trigeminal sensation. Trigeminal stimulation (pain, tactile, Endocrine disorder 23 1
and temperature) contributes to flavor perception throughout Other 203 8.9
the eating process.[1] Gustatory dysfunctions are classified Total 2278 100
as quantitative or qualitative disorders.[9] Quantitative taste CNS: Central nervous system
disorder include ageusia, hypogeusia and hypergeusia, while
qualitative disorders are dysgeusia and phantogeusia. Ageusia
Table 3: Drugs causing gustatory dysfunction[14]
is an absence of the sense of taste; hypogeusia is a decreased
Class Agents
sensitivity to all tastants.[10] Hyperguesia refers to enhanced
gustatory sensitivity.[11] Dysgeusia or pargeusia is an unpleasant Antibiotics Ampicillin, macrolides, metronidazole, quinolones,
sulfamethoxazole, trimethoprim, and tetracycline
perception of a tastant and phantogeusia, is a perception of taste
Neurologic Antiparkinsonians, CNS stimulants, migraine
that occurs in the absence of a tastant.[3,10] medications medications, and muscle relaxants
Cardiac medications Many antihypertensives, diuretics, statins,
Etiology antiarrhythmics
Endocrine medications Most thyroid medications
Psychotropics Most tricyclic antidepressants, some
Majority of the gustatory dysfunctions are caused by impairment antipsychotics, anxiolytics, mood stabilizers, and
of smell rather than taste perception. The most common hypnotics
causes of olfactory dysfunction include allergic rhinitis, chronic Other Antihistamines, antineoplastics, bronchodilators,
rhinosinusitis and upper respiratory infection.[12] Any condition anti‑inflammatories, smoking cessation aids,
that results in a compromised environment for the mediators antifungals, and antivirals
of chemosensation (e.g. tongue, saliva, oral mucosa, neural CNS: Central nervous system

Journal of Pharmacy and Bioallied Sciences July 2014 Vol 6 Supplement 1 S31 
 Maheswaran, et al.: Gustatory dysfunction
reflux disease can produce apparent phantogeusia, which
may be intermittent or persistent and are often described
as sour.[15]
Systemic conditions such as diabetes mellitus, pernicious
anemia, Sjogren syndrome and Crohn’s disease are also known
to cause gustatory dysfunction.[16] Radiation therapy can injure
the taste buds, transmitting nerves, and salivary glands, resulting
in gustatory dysfunction.[16] Zinc deficiency is responsible for
taste perception abnormalities in otherwise healthy persons
and in drug‑induced taste disorders.[17] Finally, aging or factors
associated with aging may render individuals more vulnerable
to gustatory dysfunction.[15]
Occasionally, patients complain that the sweet orange juice
turns sour and bitter, if consumed immediately after they brush
their teeth. This effect on sweet taste is transient and can be
explained by the action of the detergent sodium dodecyl sulfate,
a common ingredient in toothpastes.[5]
Clinical Assessment and Diagnosis
A clinician evaluating a patient who has gustatory dysfunction
must understand that “taste” complaints are usually symptoms
of an olfactory dysfunction. The distinction between true
gustatory loss (bitter, sweet, salty, sour, or umami) and
olfactory loss, the inability to perceive complex flavors of
food, will help clarify the patient’s diagnosis.[18] Qualitative
gustatory dysfunction is more frequent than the quantitative
dysfunction.[9] The incidence of taste disorders is the same
among men and women, but that women with milder symptoms
are more likely to seek treatment.[13] Gustatory dysfunction
is often associated with nausea, decreased appetite, and dry
mouth, especially in patient undergoing chemotherapy.[19]
When examining patients with gustatory dysfunction,
comprehensive subjective assessment of the chief complaint,
objective head, neck, oral evaluation, and review of the patient’s
medical, dental, medication, and social history is necessary.[1]
Examinations using imaging techniques to rule out or prove
the presence of damage to central nervous structures, and
in particular to the brain stem, thalamus and pons, may be
necessary. If bacterial or mycological diseases are suspected,
swab tests may be carried out.[11]
Assessment of taste sensation can be done in an outpatient
clinic by electro‑ or chemo‑gustometry. In electrogustometry,
weak electrical currents are applied to the various taste bud fields
in the oral cavity. In chemogustometry, specific taste solutions
are used to examine the taste sensitivity. A whole‑mouth taste
test is used to assess the patient’s ability to detect, identify,
and evaluate the intensity of different concentrations of
sweet, salty, sour, and bitter taste solutions.[16] A spatial test
is used to assess the different areas of the oral mucosa since
localized areas of impairment can be undetected. A cotton
swab dipped in a special taste solution is applied in different
areas of the oral mucosa. The throat is evaluated by having a
patient swallow part of each taste solution. The individual is
 S32 Journal of Pharmacy and Bioallied Sciences July 2014 Vol 6 Supplement 1
requested to assess the quality and intensity of the taste.[16]
Other test methods are based on presenting the stimuli in the
form of a tastant‑saturated filter paper or so‑called taste strips
with the dried tastants – the task of the patient is to identify
the taste. When compared to taste solution, taste strips have
the advantage of a long shelf life.[11]
For evaluation of a gustatory dysfunction, one can apply a topical
anesthetic such as unflavored 2% lidocaine to the dorsal surface
of the tongue. The anesthetic is applied starting from the left
anterior 2/3, progressing toward the posterior 1/3, followed by
the contralateral side in the same fashion. If the complaint is
eliminated, then the source of taste disorder may be local. If
the complaint persists and is unchanged, then the cause may
be systemic or may originate from the central nervous system.[5]
Management
The success of treatment for gustatory dysfunction depends
upon the etiology. An orofacial cause can usually be traced,
treated and followed by the dental surgeon.[1] Many patients
become concerned about the seriousness of their disorder and
also develop depression. The thought of an untreatable, but not
life‑threatening disease, as most chemosensory disorders are, is
often more acceptable for a patient than an undiagnosed one.
Some taste disorders do not need any treatment, since they may
resolve spontaneously.[5]
Zinc supplementation has been shown to be effective in
the treatment of patients with taste disorders, especially
patients undergoing radiotherapy or chemotherapy.[17] In
cases of dysgeusia and burning mouth disorder (prevalent
in postmenopausal women), tricyclic antidepressants and
clonazepam can be helpful.[16] In case of severe dysgeusia
topical anesthetics like lidocaine gel is indicated.[9] In case of
trauma or surgery, no specific therapy is available, only time
will tell whether the condition will improve.[16] Drug‑related
dysgeusia can be reversed with cessation of the offending
agent. An artificial saliva may be helpful in patients with
xerostomia.[2]
In the absence of specific treatment for a diagnosed gustatory
dysfunction, the most important aspect of treatment is teaching
the patient to cope with the disorder.[5] Some of the common
self‑care strategies used by patients with gustatory dysfunction
include eating smaller and more frequent meals, using more
condiments, using more fats and sauces, eating blander foods,
adding something sweet to meats, sucking on hard candy, eating
more boiled foods, using more salt, oral care before eating, eating
cold foods, avoiding beef, and spicy foods.[19]
The clinician should be sensitive to the patient’s psychological
state. Depression may be the result of a taste disorder or
contribute to a taste complaint. In either case, referral for
psychological counseling may be considered, although not as
a first step.[15] Furthermore, if a cause cannot be established,
patients should be referred to a multidisciplinary taste and
smell center.[1]
 Maheswaran, et al.: Gustatory dysfunction

Conclusion 9. Welge‑Lüssen A. Re‑establishment of olfactory and taste functions.

Gustatory dysfunctions present a number of difficulties to
the clinicians like obscure etiology and inability to objectively
assess the nature and degree of dysfunction. Future research is
needed for a better understanding of chemosensory mechanisms
and establishing improved diagnostic procedures. However,
clinicians should be prepared to make appropriate evaluations,
treatment or referrals.
References
1. Ship JA, Chavez EM. Special senses: Disorders of smell and taste.
In: Silverman S, Eversole LR, Truelove ED, editors. Essentials of Oral
Medicine. Hamilton: BC Decker Inc.; 2002.
2. Bromley SM. Smell and taste disorders: A primary care approach.
Am Fam Physician 2000;61:427‑36, 438.
3. Barret KE, Barman SM, Boitano A, Brooks HL. Ganong’s Review of
Medical Physiology. 23rd ed. New Delhi: Tata McGraw Hill; 2010.
4. Lindemann B. Receptor seeks ligand: On the way to cloning the
molecular receptors for sweet and bitter taste. Nat Med 1999;5:381‑2.
5. Spielman AI. Chemosensory function and dysfunction. Crit Rev Oral
Biol Med 1998;9:267‑91.
6. Widmaier EP, Raff H, Strang KT. Vander’s Human Physiology. 12th ed.
New York: McGraw Hill; 2011.
7. Mattes RD. Accumulating evidence supports a taste component for
free fatty acids in humans. Physiol Behav 2011;104:624‑31.
8. Viana F. Chemosensory properties of the trigeminal system. ACS
Chem Neurosci 2011;2:38‑50.
GMS Curr Top Otorhinolaryngol Head Neck Surg 2005;4:Doc06.
10. Welge‑Lüssen A, Gudziol H. Etiology, diagnostic and therapeutic
management of taste disorders. Ther Umsch 2004;61:302‑7.
11. Hummel T, Landis BN, Hüttenbrink KB. Smell and taste disorders.
GMS Curr Top Otorhinolaryngol Head Neck Surg 2011;10:Doc04.
12. Malaty J, Malaty IA. Smell and taste disorders in primary care. Am Fam
Physician 2013;88:852‑9.
13. Hamada N, Endo S, Tomita H. Characteristics of 2278 patients visiting
the Nihon University Hospital Taste Clinic over a 10-year period with
special reference to age and sex distributions. Acta Otolaryngol Suppl
2002;546:7-15.
14. Doty RL, Shah M, Bromley SM. Drug‑induced taste disorders. Drug
Saf 2008;31:199‑215.
15. Cowart BJ. Taste dysfunction: A practical guide for oral medicine.
Oral Dis 2011;17:2‑6.
16. Mann NM. Management of smell and taste problems. Cleve Clin J
Med 2002;69:329‑36.
17. Najafizade N, Hemati S, Gookizade A, Berjis N, Hashemi M, Vejdani S,
et al. Preventive effects of zinc sulfate on taste alterations in
patients under irradiation for head and neck cancers: A randomized
placebo‑controlled trial. J Res Med Sci 2013;18:123‑6.
18. Wrobel BB, Leopold DA. Clinical assessment of patients
with smell and taste disorders. Otolaryngol Clin North Am
2004;37:1127‑42.
19. Rehwaldt M, Wickham R, Purl S, Tariman J, Blendowski C,
Shott S, et al. Self‑care strategies to cope with taste changes after
chemotherapy. Oncol Nurs Forum 2009;36:E47‑56.
Source of Support: Nil, Conflict of Interest: None declared.

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