On the Tip of the Tongue: Explanations for Burning Mouth Syndrome

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On the Tip of the Tongue: Explanations for Burning Mouth Syndrome
05/19/2004

People who do a lot of clenching are at increased risk. They keep their tongue pressed tightly against their teeth at night and they end up with their tongue scalloped. When the clenching is controlled, through medication or the use of mouth guards, they often feel better.
Are underlying medical conditions associated with burning mouth syndrome?
Certain conditions such as Sjögren's syndrome, diabetes, thyroid disease and liver dysfunction have been associated with burning mouth syndrome, but it just doesn't occur very often in these people. For example, most people with Sjögren's syndrome have very dry mouth and almost all of them have a yeast infection as a result. When the majority of Sjögren's patients are treated with antifungal medication, they no longer have burning mouth.
Can anxiety and depression cause burning mouth syndrome?
There have been many studies looking at the psychological profiles of burning mouth people, and almost all of them have found that there are psychological changes in this group of people. Twenty years ago, it was thought that anxiety and depression were what caused the changes. But with the more recent literature, it's assumed that the change in psychological profile is the result of the chronic pain rather than the cause of the chronic pain.

The thrust of the research now is looking at the organic changes rather than looking at a psychological profile and saying that these people are depressed and anxious.
Do any medications cause burning mouth syndrome?
ACE (angiotensin-converting enzyme) inhibitors, which are taken for high blood pressure, can cause burning mouth. Even when people go off the ACE inhibitors, the pain doesn't usually go away without treatment.
What can ease symptoms of burning mouth syndrome?
People often will chew ice chips. And I'm not sure if it's the cold or the fact that there's something in the mouth that helps to reduce the pain. Most typically people say they chew gum all day because that's seems to be the greatest help.
Are there any medications for burning mouth syndrome?
There is nothing specifically approved for burning mouth syndrome but some drugs approved for other conditions have been helpful. The drug of choice right now is Klonopin (clonazepam), which is a benzodiazepine. We think it works in the taste system and it inhibits spontaneous pain. Once people respond to medication, they often get better quickly and can start decreasing their medications. We often combine the clonazepam with Neurontin (gabapentin). And we sometimes use a third medication, Lamictal (lamotrigine), which is an anticonvulsant used to treat epilepsy.

Tricyclic antidepressants were used a lot in the '80s, because that's all there was. I think they're used much less now because there are a lot of side effects for a very small benefit.
Can people ever recover without medication?
Yes, we have early data from when we had much poorer medication to control it and we found two-thirds of people have spontaneous remission even with no medication. People usually had pain for three to five years before it remitted spontaneously. We think it's because of regeneration of the taste buds.

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