Burning Mouth Syndrome
Burning mouth syndrome (also called stomatopyrosis, stomatodynia, and oral dysesthesia) occurs most commonly among women after menopause. The most commonly affected part of the mouth is the tongue (glossodynia). Burning mouth syndrome is not the same as the temporary discomfort that many people experience after eating irritating or acidic foods. Burning mouth syndrome is poorly understood. It probably represents a number of different conditions with different causes but a common symptom.

A common cause is use of antibiotics, which alters the balance of bacteria in the mouth, leading to an overgrowth of the fungus Candida (a condition called thrush). Ill-fitting dentures and allergies to dental materials may be causes as well. Overuse of mouth rinses and sprays may lead to burning tongue syndrome, as can anything that leads to a dry mouth. Sensitivities to certain foods and food additives, particularly to sorbic acid and benzoic acid (which are food preservatives), propylene glycol (found as a moisturizing agent in foods, drugs, and cosmetics), chicle (found in some chewing gums), and cinnamon, may play some role. Deficiencies of vitamins, including B12, folic acid, and B-complex, can cause burning mouth syndrome. Iron deficiency has also been implicated.

A painful burning sensation may affect the entire mouth (particularly the tongue, lips, and roof of the mouth [palate]) or just the tongue. The sensation may be continuous or intermittent and may gradually increase throughout the day. Symptoms that commonly accompany the burning sensation include a dry mouth, thirst, and altered taste. Other possible symptoms include changes in eating habits, irritability, depression, and avoidance of other people.

The condition is easy for doctors to diagnose but difficult to treat. Frequent drinks of water or use of chewing gum may help keep the mouth moist. Antidepressants, such as nortriptylineSome Trade Names AVENTYL or anti-anxiety drugs, such as clonazepamSome Trade Names KLONOPIN are sometimes helpful, although these drugs may make the symptoms worse by causing dry mouth. Sometimes symptoms disappear without treatment, although they may return later.

A small percentage of older men and women (mostly women), generally at, or around the age of menopause develop a problem with chronic burning pain and phantom tastes in their mouths. It often centers on the tongue. The tongue itself looks perfectly normal. It just develops a burning sensation that progresses throughout the day. These patients may have seen numerous doctors to try to rid themselves of the annoying, and sometimes painful symptoms, but generally to no avail. The problem has been ignored for centuries because there seemed to be no physical reason for the symptoms, and because it was believed that it was a hysterical symptom brought on by emotional distress. In fact, the problem sometimes does respond to antidepressant drugs like Elavil.

11/5/2007 - EDWARDS AIR FORCE BASE, Calif. -- Burning mouth syndrome is a common problem that causes patients to experience a burning or scalding pain on the lips, tongue and sometimes throughout the mouth.

There are often no visible signs of irritation, and the syndrome may be caused by various factors such as the onset of menopause, psychological dysfunctions and vitamin deficiencies.

BMS may affect up to five percent of Americans and usually occurs in people age 60 and above.

Although members of both sexes are susceptible to BMS, it occurs more frequently in older women. Between 18 and 33 percent of post-menopausal women are estimated to have BMS.

There are a variety of symptoms associated with BMS. The main symptom is a moderate to severe burning sensation in an individual's mouth, throat, lips and tongue. Many patients have described the feeling as "scalding." Other symptoms include dry mouth or a bitter or metallic taste.

Patients with BMS often say the pain is gradual, intensifying as the day moves along. The discomfort and restlessness associated with BMS may cause difficulty in sleeping, mood changes, irritability, anxiety and depression.

The cause of BMS is difficult to determine. In 30 percent of cases, it is caused by a variety of existing conditions that affect oral and systemic health. Some conditions include the onset of menopause, diabetes and deficiencies in nutrients such as iron, zinc, folate, thiamine, riboflavin, vitamins B6 and B12, and complications from cancer therapy.

In majority of cases, no specific diagnosis for the symptoms can be made. BMS symptoms may occur from dry mouth, tongue thrusting, bruxism or teeth grinding, irritating or ill-fitting dentures and thrush.

Some research points to nerve disorders and damage; psychological factors, particularly depression and anxiety; allergies; acid reflux; and medications that cause dry mouth.

It's not unusual for a patient suffering from BMS to have more than one cause attributed to the ailment, or to have health care providers fail to find any cause at all.

About one-third of patients say BMS symptoms first appeared shortly after a dental procedure, recent illness or medication course.

BMS is difficult to diagnose because its cause can stem from any number of physical and psychological conditions. For this reason, it's important to consult with your dentist and physician to develop an appropriate treatment plan. Your dentist may refer you to a general physician or specialist for blood, allergy, liver or thyroid tests.

Treatment for BMS depends on the patient and the cause. If the cause is related to the oral cavity, your dentist has a variety of ways to provide relief.

For dry mouth, your dentist may advise that you drink more fluids or may prescribe medicine that promotes the flow of saliva.

Thrush, marked by white patches in the oral cavity, may be treated with oral antifungal medications such as nystatin or fluconazole.

If dentures are the culprit, your dentist can make adjustments so they won't irritate the mouth or replace them with better-fitting dentures. Topical capsaicin, the natural chemical in cayenne pepper, may provide pain relief for some patients with BMS.

If dentists determine there are no oral conditions causing BMS, they may refer you to your family physician or a specialist. The physician will most likely start with a complete blood test to determine the best course of treatment. If menopause is to blame, hormone replacement therapy may be recommended. They may also recommend other medicines or treatments to provide relief.
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