Burning mouth syndrome - Treatments
There's no definite cure for burning mouth syndrome. That's because no-one knows exactly what causes it.
Your doctor may suggest different treatments, including talking treatment (psychotherapy), antidepressant drugs, mouthwash or a food supplement. But there hasn't been much research to tell us whether they work.
You may find that you feel better once you know that your mouth pain is not a sign of a serious disease. If you can stop worrying about the pain, sometimes you will stop noticing it so much. But if you do decide to go ahead with treatment, this is what we found:
* A form of talking treatment called cognitive behaviour therapy is likely to help some people with burning mouth syndrome.
* We don't know if any other treatments work because there hasn't been much good-quality research.
We've looked closely at the research and put these treatments into categories, according to whether they work.
Treatments that are likely to work
Cognitive behaviour therapy
Cognitive behaviour therapy (CBT) is the treatment that is most likely to help you if you have burning mouth syndrome. CBT is a form of talking treatment.
CBT may help reduce the amount of pain you feel by helping you feel less anxious or depressed. Even if you're not anxious or depressed, CBT can help you to cope with the pain better.
You work with a therapist to change your thinking and behaviour in a positive way. You usually have one session a week, for six weeks to 12 weeks. Each session lasts about an hour. Your doctor may be able to refer you to a therapist, but you may find there is a waiting list for treatment.
We found one small good-quality study (a randomised controlled trial) of people with burning mouth syndrome who had 12 to 15 sessions of CBT over three months. Most of these people found the burning sensation became much better during or after the treatment. More than a quarter found that it disappeared altogether, either during the three months of treatment or afterwards.
However, the study only included 30 people and there were some problems with the quality of the research. This means we can't be sure that CBT will work for everyone with burning mouth syndrome.
The study didn't report any side effects from CBT.
Treatments that need further study
Antidepressants are medicines that are usually used to treat depression. They're only available with a prescription from your doctor. If your doctor recommends that you try antidepressant tablets, it doesn't mean they think you are depressed. Some antidepressants can relieve some types of nerve pain besides helping with depression.
There are several different types of antidepressant. But we don't know if they work for burning mouth syndrome.
The first group of antidepressants that have been studied in people with burning mouth syndrome are the tricyclic antidepressants. The ones that have been tested are clomipramine (brand name Anafranil), mianserin and trazodone (Molipaxin). 
In the studies we looked at, the antidepressants didn't work any better than a dummy treatment (called a placebo) in people with burning mouth syndrome. But the studies were small and not of good quality, which makes their results unreliable. 
Antidepressants can cause side effects such as drowsiness, dry mouth, blurred vision and constipation. 
The second group of antidepressants that have been studied for burning mouth syndrome are a newer type called selective seroton in reuptake inhibitors (SSRIs). The ones that have been tested are sertraline (brand name Lustral) and paroxetine (brand name Seroxat).
Another medicine, called amisulpride, sometimes used for burning mouth syndrome, has also been tested.
The study we found showed that people taking an SSRI or amisulpride felt better after eight weeks of treatment. However, the study was too small to be sure whether the results are reliable. Also, the drugs were only compared with each other and not with a placebo (dummy treatment). So we don't know if the people taking the medicines would have felt better if they'd not had treatment.
SSRIs can cause side effects such as sweating, shaking, dry mouth, constipation, dizziness and stomach upsets.
Benzydamine is a painkiller that you can take in a mouthwash. The brand name for this mouthwash is Difflam Oral Rinse or Difflam Sore Throat Rinse. You can buy it in a pharmacy. We don't know if it works for burning mouth syndrome because there haven't been any good-quality studies that have shown that Difflam works. You may find the mouthwash stings your mouth. If this happens, you can dilute it half and half with water.
We looked at the research on two food supplements for burning mouth syndrome.
Alpha-lipoic acid (sometimes called ALA) is a food supplement sold by health food shops and some pharmacies. There is a theory that it protects the nervous system, which is why it was tested for burning mouth syndrome.
We found three small studies that showed that alpha-lipoic acid might help some people with burning mouth syndrome.   But the studies weren't very good so the results aren't reliable. The studies didn't mention any side effects.
Oryzanol is a food supplement made from rice bran oil, which is used for burning mouth syndrome in China. But we didn't find any good evidence that oryzanol works. One study found that hormone replacement therapy (HRT) worked better, although there were problems with the quality of this research.
Hormone replacement therapy
Burning mouth syndrome is more common in women who are going through or have had the menopause. So some doctors have looked at whether hormone replacement therapy (HRT) might help.
HRT means taking medicines to replace hormones that the body stops making during the menopause. You can take HRT in different forms: tablets, patches, gels, nasal sprays or vaginal creams. You'll need a prescription from your doctor for this treatment.
There are different types of HRT. Most types contain the hormone oestrogen or oestrogen combined with another sex hormone, progestogen (known as combined HRT). The type used in the study we found is a fairly new type called tibolone (brand name Livial).
Tibolone is similar to your natural sex hormones but it is made in the laboratory. It's usually used to treat symptoms of the menopause such as hot flushes and vaginal dryness. It has fewer side effects than ordinary HRT. The most common side effect is spotting or bleeding from the vagina.
We found one small study that showed tibolone might help some women with burning mouth syndrome who have been through the menopause. However, the study was not of good quality, so the results are unreliable.
Another study found that tibolone increases your risk of getting breast cancer, although less so than combined HRT. HRT with oestrogen, or oestrogen and progestogen, can increase the risk of getting clots in your blood, getting heart disease or having a stroke. The increase in risk is small but it does go up the longer you take HRT.
As tibolone is quite new, there isn't much evidence about whether it increases your risks of these conditions. We need more long-term studies of this treatment before we can say for sure.
Treatments that work, but whose harms may outweigh benefits
Clonazepam (brand name Rivotril) is usually used for the treatment of epilepsy and is only available with a prescription from a doctor.
One small study looked at whether sucking clonazepam lozenges might help people with burning mouth syndrome.  It showed that people had less pain after using the treatment three times a day for two weeks. Clonazepam has serious side effects, including drowsiness, tiredness, dizziness, poor concentration and confusion. It may also be habit-forming.