Burning Mouth Syndrome

Burning mouth syndrome is a condition characterized by an ongoing or recurrent burning sensation in the mucosa of the mouth, particularly the tongue with or without involving the lips.

It may appear suddenly or develop slowly over time, but without any obvious cause. It occurs most frequently, but not solely in peri-menopausal and postmenopausal women.

Unfortunately, most of the times, the cause cannot be determined. The discomfort affects

• the tongue,
• gums,
• lips,
• inner portion of your cheeks,
• roof of your mouth
• diffuse areas of your whole mouth.

The burning sensation can be very severe, which may feel as if you have scalded your mouth. There are no specific tests for burning mouth syndrome, which makes it hard to diagnose.

Although this makes the treatment more challenging, you can bring your condition under better control by working closely with your health care team.

Your doctor will advise medications that help relieve

• pain,
• dry mouth,
• other symptoms.

The main symptom of burning mouth syndrome is pain in the mouth that is of burning, scalding, or tingling type. Burning mouth syndrome does not cause any noticeable changes in the physical appearance of your tongue or mouth. 

Other symptoms include:

• A sensation of dry mouth with increased thirst
• Alterations in your taste perception such as a bitter or metallic taste
• Loss of taste

The pain and discomfort occurring from burning mouth syndrome typically has several different patterns. It may:

• Feel as constant pain every day, with little discomfort when you wake up, which slowly becomes worse as the day progresses
• Occur as pain that starts increasing as soon as you wake up and lasts all day
• Come and go

Whatever is the pattern of your mouth discomfort, burning mouth syndrome can last for months to years. Rarely, symptoms disappear suddenly on their own or may recur less frequently. Sometimes, the pain may get temporarily relieved while eating or drinking.

When to see a doctor

If you feel any burning sensation or soreness in your tongue, lips, gums or other areas of your mouth, consult your doctor or dentist. Often, a multidisciplinary approach is required to find out the exact cause and develop an effective treatment plan.

The causes of burning mouth syndrome are classified as either primary or secondary.

Primary burning mouth syndrome

If tests do not show any clinical or lab abnormalities that reveal an underlying medical problem, the condition is called primary or idiopathic burning mouth syndrome. Some studies suggest that primary burning mouth syndrome is caused by damage to the taste and sensory nerves of the peripheral or central nervous system.

Secondary burning mouth syndrome

When burning mouth syndrome is caused by an underlying medical condition, it is called secondary burning mouth syndrome. Common causes of secondary burning mouth syndrome include:

• Dry mouth (xerostomia), which can be caused by disorders such as Sjögren’s syndrome, problems with salivary gland function or the side effects of various medications or cancer treatment such as certain drugs and radiation therapy

• Other oral conditions, such as yeast infection of the mouth (oral thrush), an inflammatory condition called oral lichen planus or a condition called geographic tongue that gives the tongue a map-like appearance

• Nutritional deficiencies, such as low levels of iron, zinc, folate (vitamin B9), thiamin (vitamin B1), riboflavin (vitamin B2), pyridoxine (vitamin B6), and cobalamin (vitamin B12)

• Dentures, especially if they don't fit well, which can place stress on some muscles and tissues of your mouth, or if they contain materials that irritate mouth tissues

• Allergies or reactions to foods, food flavorings, other food additives, fragrances, dyes or dental products (metals)

• Reflux of stomach acid (gastroesophageal reflux disease or GERD) that enters your mouth from your stomach

• Certain medicines, particularly those that reduce high blood pressure

• Oral habits, such as tongue thrusting, biting the tip of the tongue and teeth grinding (bruxism)

• Endocrine disorders, such as diabetes or underactive thyroid (hypothyroidism)

• Excessive mouth irritation, which may result from overbrushing your tongue, overuse of abrasive toothpastes and mouthwashes or having excess amounts of acidic drinks

• Psychological diorders, such as anxiety, depression or stress

There is no single test that can diagnose whether you have burning mouth syndrome. You may consult your family doctor or dentist for mouth discomfort. For a diagnosis of burning mouth syndrome to be made, your doctor or dentist will refer you to another specialist, such as a skin doctor (dermatologist), a doctor who specializes in ear, nose and throat problems (ENT) or another specialist if required as burning mouth syndrome is associated with a wide variety of other medical conditions.

Here is some information that helps you get ready for your appointment:

What you can do

When you make your appointment, ask if there is something you need to do before the appointment, such as dietary restrictions. Make a list of the following information:

• Your symptoms, including those that may seem unrelated to your mouth discomfort
• Key personal information, including any major stresses or recent life changes
• Regular medications, vitamins, herbs or other supplements that you take, and their doses
• Carry a copy of all previous test results you have had about this problem
• Ask a family member or friend to come with you, if possible, for support and help you remember everything the doctor says.

Preparing questions in advance gives you more time to discuss treatment options with your doctor or dentist.

Some basic questions to ask your doctor or dentist include:

• What is the most likely cause of my symptoms?
• What are other possible causes?
• What kind of tests do I need?
• Is my condition a temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• How can I best manage my other medical conditions together?
• Are there any restrictions that should be followed?
• Should I see a specialist?
• Is there a generic alternative to the medicine you prescribing?
• Are there any printed materials or websites that you recommend?

What to expect from your doctor

Your doctor or dentist may ask you a number of questions, such as:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Is there anything that seems to improve or worsen your symptoms?
• Do you use tobacco or drink alcohol?
• Do you eat acidic or spicy foods very frequently?
• Do you wear dentures?

Instead, your doctor or dentist will try to preclude other conditions before diagnosing burning mouth syndrome.

Your doctor or dentist will review your medical history and previous medications, examine your mouth, and ask you to describe your symptoms, oral habits, and oral care routine. In addition, your doctor will also perform a general medical examination to check for signs of other conditions. You may need some of the following tests:

Blood tests:

Blood tests that include complete blood count, glucose level, thyroid function, nutritional factors and immune functioning may be done. These may provide clues about the underlying cause of your mouth discomfort.

Oral cultures or biopsies:

Taking a oral swab and analysis of these samples can determine whether you have a fungal, bacterial or viral infection.

Allergy tests:

Allergy testing may be done to check whether you are allergic to certain foods, additives or even to materials from which dentures are made.

Salivary measurements:

Salivary tests can confirm whether your dry mouth is due to a reduced salivary flow.

Gastric reflux tests:

These tests may be done to determine whether you have GERD.

Imaging tests:

Your doctor may recommend an MRI, CT scan or other imaging tests to check for other health problems.

Temporary discontinuation of your medications:

If medications are suspected to contribute your mouth discomfort, your doctor may suggest stopping them temporarily, if possible, to check if your symptoms go away. Avoid doing this unless your doctor directs, because stopping certain medications can be dangerous.

Psychological questionnaires:

You may be asked to complete a questionnaire that helps determine whether you have symptoms such as depression, anxiety or other mental health conditions.

There is no known treatment method that can completely cure primary burning mouth syndrome, and there is no definitive way to treat it.

There is a lack of extensive research regarding the most effective methods of treatment. Treatment usually depends on your symptoms and is aimed at controlling them. As burning mouth syndrome is a complex pain disorder, the treatment that suits one person may not work for another person. You may need to try out several treatment methods before finding a combination that reduces your mouth discomfort.

The treatment of secondary burning mouth syndrome depends on any underlying medical conditions (diabetes, yeast infections) that are the cause of your mouth discomfort.

In addition, adjustment or replacement of the poorly fitting dentures or taking vitamin supplements for a deficiency condition may help ease your discomfort. That is why it is important to find out the exact cause. If any medication is the cause of secondary burning mouth syndrome, then your doctor will prescribe a different drug. Once the underlying causes are treated, the symptoms of your burning mouth syndrome go away.

Medications that block nerve pain can help control pain and relieve dryness of your mouth.

Other treatment options include:

• Saliva replacement products
• Stimulation of saliva release by chewing sorbitol-containing gum
• Mouthwash containing lidocaine
• Topical capsaicin, a pain reliever that comes from chili peppers
• An anticonvulsant medication – clonazepam (Klonopin)
• Certain tricyclic antidepressants
• Psychotherapy (cognitive behavioral modification and relaxation)
• Hormone replacement therapy

There are no known measures that help you prevent burning mouth syndrome.

But, avoiding irritants such as

• tobacco,
• acidic foods,
• spicy foods,
• carbonated beverages,
• reducing your stress

can help reduce the pain and discomfort caused by burning mouth syndrome or prevent your discomfort becoming worse.

Lifestyle modifications are necessary in order to cope with burning mouth syndrome.

In addition to the medical treatment and prescription medications, here are a few self-help measures that may reduce your symptoms and ease your oral discomfort:

• Drink lots of fluids to help ease the feeling of dry mouth
• Sip on a cold beverage, suck on ice chips or chew sugarless gum to help ease the pain
• Avoid irritating substances such as acidic foods and liquids, such as tomatoes, citrus fruits and juices, carbonated beverages, and coffee
• Avoid alcoholic beverages and products such as moutwashes containing alcohol, as they further irritate the mucosal lining of your mouth
• Avoid use of tobacco products
• Avoid eating hot-spicy foods
• Avoid products containing cinnamon or mint: Try a different mild or flavor-free brand of toothpaste, such as one made for sensitive teeth or one without mint or cinnamon
• Take steps to manage your daily stress effectively

Coping and support

Burning mouth syndrome is a frustating and an uncomfortable condition that can seriously affect your quality of life when no measures are taken to stay positive and hopeful.

Here are some techniques that help cope with the chronic discomfort of burning mouth syndrome:

• Practice relaxation exercises, such as Yoga and meditation
• Engage yourself in enjoyable activities, such as your favorite hobbies or physical activities, especially when you feel anxious
• Be socially active and try being close to understanding family and friends
• Consider joining a chronic pain support group

There are several risks and complications associated with burning mouth syndrome.

Burning mouth syndrome, sometimes occurs due to an underlying medical condition.

The problems linked to secondary burning mouth syndrome include the following:

• Dry mouth (xerostomia), which can be caused by salivary gland problems, other health problems, or as a side effect of various medications and cancer treatment

• Fungal infection of the mouth (oral thrush), an inflammatory condition called oral lichen planus or a condition called geographic tongue that gives the tongue a map-like appearance

• Deficiencies of iron, zinc, folate (vitamin B9), thiamin (vitamin B1), riboflavin (vitamin B2), pyridoxine (vitamin B6), and cobalamin (vitamin B12)

• Ill-fitting dentures, which can place stress on some tissues of your mouth, or if they contain components that irritate mouth tissues

• Allergic reactions to certain foods, food flavoring substances, other food additives, fragrances, dyes or dental restorative substances

• Chronic reflux of stomach acid (gastroesophageal reflux disease or GERD) that enters your mouth from your stomach

• Certain medications such as high blood pressure medications

• Oral habits, such as tongue thrusting, biting the tip of the tongue, and teeth grinding (bruxism)

• Endocrine disorders, such as diabetes or underactive thyroid (hypothyroidism)

• Excessive irritation to mouth tissues resulting from overuse of abrasive toothpastes or mouthwashes, overbrushing of your tongue, or drnking large amounts of acidic drinks

• Psychological factors, such as anxiety, depression or stress

Complications of burning mouth syndrome are mainly related to discomfort. These include:

• Sleep disorders or difficulty in falling asleep
• Trouble in eating
• Anxiety
• Depression