Burning Mouth Syndrome (BMS)

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Burning mouth syndrome (BMS) is a poorly understood condition in which a person experiences ongoing moderate to severe pain in the tongue and/or mouth. Although the cause of BMS remains unclear, some patterns have become clear to researchers. The pain is generally worst in the late afternoon and early evening, but disappears at night. Most often, more than one part of the mouth is involved. Common areas of burning pain include the tongue, the hard palate (the front part of the roof of the mouth), and the lower lip. Many people recover spontaneously within six or seven years. Dry mouth and altered taste sensations often, but not always, accompany the pain.

BMS is thought to fall in the general category of “neuropathic pain,” meaning that it probably results from altered nerve function, possibly in the nerves carrying taste sensation. Use of drugs in the ACE inhibitor family has been implicated in some cases of burning mouth syndrome, but the reason for this apparent connection remains unclear.

Conventional treatment for BMS consists of drugs used to treat neuropathic pain in general, including anticonvulsants, sedatives in the benzodiazepine family, and tricyclic antidepressants. There is inadequate research at present to determine the precise efficacy of these treatments.
Principal Proposed Treatments for Burning Mouth Syndrome

The supplement lipoic acid has shown promise for the treatment of diabetic neuropathy, another form of neuropathic pain. Lipoic acid has also shown some promise for burning mouth syndrome.

In a double-blind trial, 60 people with burning mouth syndrome received either lipoic acid (200 mg 3 times daily) or placebo for a period of months.1 Researchers reported that almost all people receiving lipoic acid showed significant improvement, while none of those taking placebo improved, and relative benefits endured at 12-month follow-up.

While these are promising results, the total lack of benefit seen in the placebo group is somewhat difficult to believe, and raises concerns about the study’s reliability. Nonetheless, positive findings such as these are sufficiently encouraging to warrant a larger study by an independent research group.

It is not known how lipoic acid might help burning mouth syndrome; the supplement’s strong antioxidant effects might play a role. For more information, including dosage and safety issues, see the full Lipoic Acid article.
Other Proposed Treatments for Burning Mouth Syndrome

The yeast Candida albicans can infect the mouth, causing a condition called “thrush.” Thrush may cause symptoms similar to BMS. Some alternative practitioners believe that excessive candida, or hypersensitivity to it (see Yeast Hypersensitivity), is the cause of many illnesses. For this reason, they recommend using anti-yeast treatments to treat BMS. However, there is no direct evidence to support this approach, and it appears that people with BMS are no more likely to have measurable detectible candida in the mouth than people without it.2

Inconsistent evidence suggests that people with BMS might have deficiencies in various nutrients, such as vitamins B1, B2, and B6, and zinc.3 However, there is no evidence as yet that supplementation with these nutrients will have any effect on BMS symptoms.

A placebo-controlled trial involving 39 patients failed to show any significant benefit for 12 weeks of treatment with Hypericum perforatum extract (St. John’s wort).4
Herbs and Supplements to Avoid

Numerous herbs and supplements may interact adversely with drugs used to treat burning mouth syndrome. For more information on this potential risk, see the individual drug articles in the Drug Interactions section of this database.