Bitter taste in the mouth: causes and which doctor to see

For bitter taste in the mouth you can first see: Internal Medicine or Dentist or Ear, Nose & Throat (ENT) or Gastroenterology. In large hospitals, the Gastroenterology unit also deals with this. If you are not sure, a family doctor (general practitioner) can assess you first and refer you to the right specialist.

Common symptoms: a bitter or metallic taste, especially on waking in the morning; bitter-sour fluid coming up into the mouth and heartburn; food tasting different, or everything tasting bitter; dry mouth and bad breath; a white-yellow coating on the tongue. Symptoms vary from person to person; a doctor’s examination is needed for a diagnosis.

The most common causes: reflux and bile reflux (stomach or bile contents coming up into the mouth); gum inflammation, tooth decay and poor oral hygiene; dry mouth; some antibiotics, blood pressure medicines and vitamin and mineral supplements; hormonal changes in pregnancy; sinusitis and upper respiratory infections; less often liver, kidney disease and diabetes. Only a doctor’s examination can determine the exact cause.

A bitter taste caused by oral hygiene or a passing infection clears up in a few days. Bitterness caused by reflux eases within weeks with changes in eating habits and the treatment the doctor recommends. A taste change caused by a medicine goes away when the course ends or the doctor changes it. Taste changes in pregnancy usually ease after the first three months.

It is more common in: people with reflux or a hiatus hernia; people who have had their gallbladder removed; pregnant women; older people taking many medicines; smokers.

The doctor examines the mouth and teeth and asks about your medicines and at what times of day it gets worse. Liver, kidney and blood sugar tests are requested if needed; endoscopy may be done if reflux or bile reflux is suspected.

Regular oral care, drinking enough water, not eating heavy meals late and stopping smoking help prevent a bitter taste in the mouth.

The most common cause is stomach or bile contents rising at night while lying down (reflux) and the mouth drying out during sleep. Fatty evening meals eaten late make it worse.

Bile reflux and gallbladder problems can cause a bitter taste; however, most bitter tastes come from reflux and the mouth. If you have upper right abdominal pain, nausea after fatty meals or yellowing, see an internal medicine doctor.

Some medicines and vitamin supplements, gum inflammation, pregnancy and colds are common causes. A temporary bitter-metallic taste lasting days after eating pine nuts has also been reported. Long-lasting cases need a doctor’s assessment.

If the answer to any of these questions is yes, call 112 without delay: “Are you vomiting blood or something like coffee grounds, or passing black, tarry stools?” “With the taste change, did facial drooping, slurred speech or weakness in an arm or leg start suddenly?” “Is there yellowing of the eyes and skin, urine the colour of dark tea and pain in the upper right abdomen?” “Is there confusion, fainting or difficulty waking up?” “Is there facial drooping, slurred speech or sudden weakness in an arm or leg?” “Are you struggling to breathe even at rest?”

See a doctor: the bitter taste lasts more than 2 weeks; there is heartburn, bitter fluid coming up or difficulty swallowing; there is loss of appetite, weight loss, yellowing or weakness; there is gum bleeding, tooth decay or a sore in the mouth (see a dentist).