Burning Mouth Syndrome (Women's Health Matters article)

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Burning Mouth Syndrome (Women's Health Matters article)

Author: Karen Grushka
Organization: Women's College Hospital, Women's Health Matters
It was still dark when Jane Black got out of bed. As usual, she headed to the kitchen, eyes half-closed, switched on the radio and the coffee maker, and started eating her bowl of cereal. But this morning, something was different: her tongue felt hot and burnt, and the milk tasted sour.

She couldnÌt remember eating anything spicy or hot the day before, so Black assumed that the strange feeling in her mouth would go away. But days and then weeks passed, and even though her mouth and tongue looked perfectly normal in the mirror, the burning was still there and the foods that sheÌd always eaten didnÌt taste quite the same.

Burning mouth syndrome (BMS) is a frustrating and elusive disorder. Its symptoms can include a feeling of burning on the lips, tongue, palate and throat, taste changes, loss of taste and a sensation of dryness.

These symptoms can occur spontaneously, although some patients have reported onset following dental treatment or a course of medication, like antibiotics, or a viral infection. The cause is unknown. BMS affects seven times more women than men, and usually occurs in post-menopausal women.

It's not all in your head

Historically, scientists and clinicians assumed that BMS was a psychological disorder since many patients respond poorly to medications Ò and, as a result of ongoing pain and discomfort Ò may experience anxiety and depression.

ÎOne of the worst parts of having BMS is that people thought I was crazy,Ì said one patient, who suffered with BMS for over three years.

ÎMy dentist and doctor kept looking in my mouth for signs of anything, but my mouth always looked normal; nobody knew how to treat the burning, so it went on day after day while I went from one specialist to another, until finally, my dentists and doctors gave up. They just assumed that I was making it up.Ì

Nerve pain

In the early 1980s, however, a growing body of research about BMS started to emerge. BMS is now considered to be related to altered nerve function (neuropathy). Researchers have identified a pattern common in BMS sufferers Ò constant pain that increases over the course of the day and that tends to decrease during eating.

Associated complaints include a feeling of burning in the tongue and less commonly, the palate and lips, most often with a bilateral (two-sided) pattern. BMS patients commonly have evidence of damage to some of the nerves associated with taste sensation.

One of the important clues in uncovering the mystery of BMS, was the discovery of Îsupertasters.Ì

Scientists have classified human taste acuity into categories of Înontasters,Ì ÎmediumtastersÌ and Îsupertasters,Ì with nontasters being the least sensitive of the three.

Supertasters more at risk

Supertasters Ò more often women than men Ò usually experience the greatest intensity in taste sensations. They are also more likely to have intense feelings of oral pain and irritation. BMS sufferers may also be supertasters. Damage to taste sensation may lead to awareness of oral pain and burning.

There is no scientific consensus on treatment. Many clinicians will treat BMS with low doses of benzodiazepines, such as clonazepam; tricyclic antidepressants, such as amitriptyline or nortriptyline; anticonvulsants, such as gabapentin; or rinses made from capsaicin Ò the active ingredient in hot peppers.

In addition to medications, clinicians may recommend that patients change their diet to mild foods less likely to irritate the mouth, maintain good oral hygiene, and seek psychological support for BMS.

Some patients recover spontaneously without treatment, but sometimes only after years of suffering, and sometimes not at all.

And what happened to Jane Black? After several months of suffering with BMS, Black was on the verge of a breakdown.

ÎI wasnÌt sleeping. My children and husband were tired of hearing me complain. I was actually thinking of taking time off work because I was having so much trouble concentrating. All I could think about, day in and day out, was the burning and pain in my mouth.Ì

Find an oral medicine specialist

Finally, a friend recommended that Black see a dentist who specializing in oral medicine, who diagnosed her with BMS and prescribed medications. Her pain decreased significantly. Her sleep returned to normal. And her ability to concentrate at work returned.

ÎAll I can say is that IÌm so happy to be feeling better. The body is a mysterious thing. You think that youÌve contemplated all the diseases that could possibly affect you Ò cancer, diabetes, arthritis Ò until something like BMS hits you, and then your world is turned upside down and you wonder how you could have ever worried about anything else.Ì

EditorÌs Note:
Written by Karen Grushka, a freelance writer and law graduate, who is currently working as a research assistant. For this story, she interviewed Dr. Miriam Grushka who runs an oral medicine/orofacial pain practice in Toronto; Dr. Sujay Mehta, who runs an orofacial pain practice in Vancouver; and Dr. Joel Epstein who works with Dr. Mehta in Vancouver.