Burning mouth syndrome baffles docs

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Burning mouth syndrome baffles docs
July 07, 2005
Dr. Douma
L.A. Daily News
Dear Dr. Douma
I have a burning, stinging mouth that includes the tongue, lips and gums. I've sought help, but I get blank stares and no answers. It's so bad that I can't use tooth paste at all, but even food affects it. What kind of doctor treats burning mouth? -- E.H., Smithtown, N.Y.
Answer
Unfortunately, many people have burning or stinging sensations in their mouth, primarily on the tongue. This is called burning mouth syndrome (BMS). Although little is known about the condition, some research is being done to learn more about the causes and treatments of BMS.
BMS is estimated to affect up to 5 percent of the adult population in North America. Women are diagnosed with BMS seven times more frequently than males.
Although the definition of BMS varies, the most commonly accepted one is a burning sensation from normal-appearing oral tissue with no apparent underlying factors such as trauma or inflammation.
The painful burning sensation most commonly occurs in the front of the tongue. Other complaints include dryness and taste alterations. Many describe it as if they have blisters in their mouth.
Researchers have proposed many causes for BMS. Various local, systemic (body-wide) and psychological factors have been linked with BMS, but a single cause -- or even multiple causes -- has not been found.
The medical literature says more about what is not the cause and what does not treat the condition than what is a cause and what helps. Some researchers suggest that BMS is more of a "marker" of illness or stress than a disease in itself.
Conditions reported in association with BMS include chronic anxiety, depression, various nutritional deficiencies, type 2 diabetes, and changes in saliva glands. However, these conditions have not been consistently linked with the syndrome, and their treatment often is not associated with any change in BMS.
Some studies have found that 10 percent of people using tartar-control toothpastes will develop a burning sensation. Since you have stopped using all toothpaste, this is probably not the cause in your case.
Other recent studies have pointed to dysfunction of several cranial nerves (nerves in the head) associated with taste sensation as a possible cause of burning mouth syndrome.
This distressing situation regarding the lack of knowledge about the cause is also true with respect to treatment. Most treatments tried for BMS have had limited success.
Benzodiazepine anti-anxiety drugs, tricyclic antidepressants, or anticonvulsants are effective in some people with burning mouth syndrome. Topical capsaicin (the ingredient in peppers that makes them hot) has been helpful for some.
Because there is so little understanding of the cause of this problem -- and there are probably many causes -- it's even more important to try to remember changes in your life, including dietary changes, that occurred shortly before the symptoms started. Obviously, if you can think of anything that might be a cause, it would be worthwhile stopping it to see if your burning subsides.
I wish I could be more definite about what you should do. Although most people with this problem are treated by non-specialists, you may want to consider getting advice from an ENT (ear, nose and throat) specialist or a dentist.
Update on side effects
Because of all the recent media attention, most people are probably aware of increased problems with non-steroidal anti-inflammatory drugs (NSAIDs), including increased bleeding in the stomach.
Unfortunately, a recent study found that antidepressants also increase gastrointestinal bleeding to a degree similar to that caused by NSAIDs. Although some of these drugs carry a warning about bleeding problems, it's not commonly thought of when these medications are prescribed, especially for long periods of time.
Using drugs wisely requires understanding not only what a drug can do for you but also what they might do against you. Talk with your doctor and pharmacist about the drugs you're taking.