Bitter taste in mouth

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.

Causes

As a rule, diseases of the gastrointestinal tract (GIT), in particular the biliary tract, lead to a feeling of dryness and bitterness in the mouth. A bitter taste in the mouth is a consequence of the release of bile into the esophagus. So, the most likely causes of dryness and bitterness are the following diseases:

• cholecystitis;
• gastritis;
• ulcerative lesions of the duodenal and gastric mucosa;
• cholelithiasis;
• inflammatory processes in the intestines.

Other possible causes of bitterness and dry mouth: dental problems, dysguesia (changes in taste), hormonal imbalance in the body, poisoning with heavy metal salts. Neurological disorders can also lead to dry mucous membranes and a bitter taste in the mouth (for example, such symptoms often appear in people who constantly face stressful situations).

Bitterness and nausea in the morning are common problems among pregnant women. Due to the fact that in the first trimester the hormone prolactin is actively synthesized (responsible for the safety of the fetus), the tone of the muscular valve between the stomach and esophagus decreases - part of the acid, along with food particles, is thrown into the latter.

A temporary bitter taste in the mouth may be a consequence of yesterday's overeating, a runny nose, or occur against the background of hormonal imbalance during pregnancy.

In late pregnancy, such symptoms are a consequence of pressure from the enlarged uterus on the diaphragm and, as a consequence, the gallbladder and stomach. Dehydration (dryness) of the oral mucosa is a side effect of taking various groups of medications. Thus, the amount of saliva produced decreases with prolonged use of antibacterial and antihistamines, sedatives, painkillers, diet pills, diuretics, and antiemetic drugs.

If these symptoms occur at night or early in the morning, this usually indicates a violation of nasal breathing during sleep (for example, with a runny nose), allergies, eating “heavy” food for dinner, low humidity in the room, hormonal disorders (with pregnancy, including), renal dysfunction.

Why is it still bitter and dry in the mouth:

• ARVI;
• feverish conditions;
• undergone chemotherapy, radiation;
• head injuries, surgical interventions;
• intoxication of the body;
• smoking.

Thus, dry mucous membranes (xerotomia) accompanies the course of many infectious and inflammatory diseases and occurs against the background of elevated body temperature and fever. More serious diseases can also provoke such a problem - for example, the appearance of malignant neoplasms or autoimmune processes in the body (in particular, Sjögren's syndrome, which affects the salivary glands).

Impaired bile flow in various gastrointestinal diseases is the most common cause of constant bitterness in the mouth. Poorly performed dental treatment is also fraught with xerotomy and bitterness in the mouth, especially if the patient has an allergic reaction to certain drugs or elements of dentures (metals).

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.

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.

What to do if you have a bitter taste in your mouth

The first thing you need to do is make an appointment with a gastroenterologist as soon as possible. The doctor will conduct a diagnosis and find out why bitterness and dry mouth occur and how to get rid of these sensations.

At the first consultation, the doctor interviews the patient. It is necessary to establish the period of maximum manifestation of symptoms. For example, increased bitterness in the mouth after eating may indicate overeating or disease of the bile ducts. If an alarming sign appears after taking medications, then most likely there is a violation of the intestinal microflora or a negative reaction of the liver. Bitterness in the mouth can occur in the morning or evening, after drinking alcohol, physical activity, and be accompanied by dry mucous membranes. All manifestations must be reported to your doctor.

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.

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

Symptoms

If constant dryness and a bitter taste on the oral mucosa are accompanied by such signs as heartburn, a grayish-white coating on the tongue, belching, this usually indicates:

Why does a white coating appear on the tongue?

• for biliary dyskinesia;
• gingivitis (inflammation of the gums);
• gastritis;
• cholecystitis;
• duodenal or gastric ulcer;
• cholelithiasis (GSD).

Alarming symptoms that should be a reason to visit a doctor are: a constant feeling of thirst (a “signal” of diabetes), dryness not only in the mouth, but also in the throat, nasal mucosa, painful swallowing, burning on the tongue and increased viscosity of saliva. Manifestations such as fetid putrid odor from the mouth, changes in timbre, hoarseness of voice, and changes in taste sensations should cause concern.

Refusal of “heavy” indigestible foods is an important component of the complex treatment of any diseases of the digestive tract.

Thus, thirst, frequent urination, sudden weight gain (loss), skin rashes and itching, strong appetite are classic symptoms of diabetes mellitus, for which it is necessary to seek help from an endocrinologist. Xerotomia in combination with abdominal pain is usually an indicator of intestinal diseases.

Diarrhea, vomiting, problems with stool (constipation, diarrhea), “haunting” the patient for more than a month, indicate the so-called irritable bowel syndrome. It is noteworthy that these manifestations worsen after intense physical exertion or stress. Dry mucous membranes combined with weakness and dizziness are symptoms of hypotension (low blood pressure).

The appearance of a grayish-white coating on the tongue in combination with dryness and bitterness in the mouth indicates serious disruptions in the functioning of the stomach, intestines, liver, duodenum and gall bladder. Emergency hospitalization is required:

• with confusion, lack of coordination, pre-fainting;
• partial or complete immobilization of the facial muscles;
• respiratory dysfunction;
• swelling of the lips and tongue.

These symptoms “signal” about severe poisoning, an allergic reaction, which can lead not only to serious systemic disorders, but also death.