Burning mouth a nightmare for patients, doctors

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Burning mouth a nightmare for patients, doctors
By Dr. Paul Donohue, Special to Times ColonistMay 20, 2009


Dear Dr. Donohue: I have burning mouth syndrome and am very discouraged at my prospects. Vitamin deficiencies, fungal infections and nerve conditions have been ruled out. The doctor told me that, aside from temporary relief with a mouth rinse, nothing can be done. Do you have any insights?

M.P.

Dear Dr. Donohue: Do you know about burning mouth syndrome? I have had it for four months. It is a nightmare. I need some answers.

R.R.

Burning mouth syndrome is every patient's and every doctor's nightmare. The patient suffers from constant pain and the doctor suffers from a lack of information on its cause and treatment. It's something that happens most often to postmenopausal women. The tongue feels like it's on fire, and often the lips, gums, roof of the mouth and throat are involved.

A number of conditions are sometimes seen in association with it: diabetes, lichen planus, anemia, viral infections, yeast infections, the dry mouth of Sjogren's syndrome, iron deficiency, deficiencies of some B vitamins and ill-fitting dentures. In honesty, although looked for, these disorders are rarely found.

Rinses might provide more than temporary relief. Rinsing with cold apple juice helps some people. A mouth rinse composed of equal parts Benadryl elixir and Kaopectate, both nonprescription items, can be effective.

The mixture is used three times a day and again before bedtime, and it is swished in the mouth for 20 seconds. A rinse made with a few drops of Tabasco sauce in a teaspoon of water is another homemade remedy. Swish it in the mouth briefly, and then spit it out.

Tabasco contains capsaicin, which depletes nerve chemicals that generate pain. It temporarily worsens the burning. If it increases the pain too much, ditch this treatment.

Doctors have prescribed Klonopin (an anti-anxiety medicine) and amitriptyline (an antidepressant) as adjuncts in controlling the pain of burning mouth syndrome.

Dear Dr. Donohue: I quit smoking two years ago. I had smoked for 50 years. I used nicotine gum to quit, and that is the problem. I still use it. I tried other ways, like the nicotine patch, but it irritated my skin. I tried nicotine tablets, but they messed with my head. Sometimes I chew only two or three pieces a day, but if I am stressed, I chew six or seven pieces. Did I help my health by changing my addiction?

I.C.

The gum is supposed to be a short-term help to ease a person over nicotine withdrawal. By not smoking, you have greatly reduced your chances for lung cancer, chronic obstructive pulmonary disease, bladder cancer, esophageal cancer and pancreatic cancer.

Those things are caused by materials in cigarette smoke other than nicotine. You've also lessened the threat of a heart attack and a stroke. Nicotine, however, is the addicting chemical that keeps people lighting up or chewing. I hate to suggest another medicine to you, but you might want to try Chantix to get your over nicotine withdrawal symptoms. It can take you six to eight weeks to achieve that goal.

Dear Dr. Donohue: Several of my friends have undergone knee replacement surgery. Their surgeons insists on their taking several antibiotics before a visit to the dentist, and says it's a lifetime thing. I thought this was done only for two years after surgery. Would you enlighten us?

H.F.

Orthopedic surgeons advise antibiotics before dental procedures in select patients: those within two years of having an artificial joint implanted; people with rheumatoid arthritis, lupus or Type 1 diabetes to name a few. Antibiotics can prevent infection from any mouth bacteria that find their way into the blood. Procedures considered high risk for such infections are tooth extractions, periodontal procedures, implants and root canals.
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