Burning mouth syndrome

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Burning mouth syndrome - Screening and diagnosis

When to seek medical advice

If you have persistent pain or soreness in your tongue, lips, gums or other areas of your mouth, see your doctor. Your doctor can search for the possible cause or causes to guide treatment.

Your doctor will review your medical history, examine your mouth and ask you to describe your symptoms, your oral habits and your oral care routine. In addition, he or she will likely perform a general medical examination, looking for signs of any associated conditions.

As part of the diagnostic process, you may undergo some of the following tests:

Complete blood cell count (CBC). This common blood test provides a count of each type of blood cell in a given volume of your blood. The CBC measures the amount of hemoglobin, the percentage of blood that's composed of red blood cells (hematocrit), the number and kinds of white blood cells, and the number of platelets. This blood test may reveal a wide variety of conditions, including infections and anemia, which can indicate nutritional deficiencies.

Other blood tests. Because nutritional deficiencies are one cause of a burning mouth, your doctor may collect blood samples to check blood levels of iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12). Also, because diabetes may cause a burning mouth, your doctor may check your fasting blood sugar level.

Allergy tests. Your doctor may suggest allergy testing to see if you may be allergic to certain foods, additives or even substances in dentures.

Oral swab culture or biopsy. If your doctor suspects oral thrush, he or she may take a small tissue sample (biopsy) or an oral swab culture to be examined in the laboratory.

Because burning mouth syndrome is associated with such a wide variety of other medical conditions, your doctor may refer you to a specialist for screening and diagnosis and possibly treatment. Your health care team may include a dermatologist, dentist, psychiatrist, psychologist or a doctor who specializes in ear, nose and throat problems (otorhinolaryngologist).

Treatment

Treatment triggers improvement in symptoms for many people with burning mouth syndrome. But the type of treatment depends on the underlying cause.

Dry mouth (xerostomia). Treating the cause of your dry mouth — Sjogren's syndrome, use of medications or some other cause — may relieve burning mouth symptoms. Drinking more fluids or taking a medication that promotes flow of saliva may help.

Other oral conditions. If the cause is oral thrush, treatment is with oral antifungal medications such as nystatin (Mycostatin) or fluconazole (Diflucan). If you wear dentures, your dentures may also need to be treated.

Psychological factors. For a burning mouth that may be caused by or associated with psychological factors such as anxiety and depression, your doctor may recommend tricyclic antidepressants or benzodiazepines, or psychiatric therapy, or both together.

Nutritional deficiencies. You may be able to correct nutritional deficiencies by taking supplements of B vitamins and minerals such as zinc and iron.

Irritating dentures. Your dentist may be able to adjust your dentures so they are less irritating to your mouth. If your dentures contain substances that irritate your oral tissues, you may need different dentures. You may also improve symptoms by practicing good denture care, such as removing dentures at night and cleaning them properly.

Nerve disturbance or damage (neuropathy). Your doctor may suggest medications that affect your nervous system and control pain, including benzodiazepines such as clonazepam (Klonopin), tricyclic antidepressants such as amitriptyline or nortriptyline (Pamelor, Aventyl), or anticonvulsants such as gabapentin (Neurontin). For pain relief, your doctor may also suggest rinsing your mouth with water and capsaicin — the active ingredient in hot peppers, which may also be called capsicum.

Allergies. Avoiding foods that contain allergens that may irritate the tissues of your mouth may help.

Certain medications. If a medication you're taking is causing a burning mouth, using a substitute medication, if possible, may help.

Oral habits. Tongue-thrusting and teeth-clenching (bruxism) can be helped with mouth guards, medications and relaxation techniques.

Endocrine disorders. If a burning mouth is associated with conditions such as diabetes or hypothyroidism, treating those conditions may improve your symptoms.

If doctors can't identify the cause of your symptoms, they may still recommend trying oral thrush medications, B vitamins or antidepressants. These medications have proved effective in treating burning mouth syndrome.

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