Burning mouth syndrome

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Burning mouth syndrome

Overview

Burning mouth syndrome (BMS) is a complex, vexing condition in which a burning pain occurs on your tongue or lips, or over widespread areas involving your whole mouth, without any obvious reason.

The disorder has long been associated with a variety of other conditions — including menopause, psychological problems, nutritional deficiencies, and disorders of the mouth, such as oral thrush and dry mouth (xerostomia). More recently, some researchers have suggested dysfunctional or damaged nerves as a possible cause. But the exact cause of burning mouth syndrome is often difficult to pin down, and pain may continue for months or years.

Treatment is highly individualized and depends on your particular symptoms and on the underlying cause or causes, if they can be identified. Most people with burning mouth syndrome can decrease their symptoms through tailored treatment plans.

Other names sometimes used for burning mouth syndrome include scalded mouth syndrome, burning tongue syndrome, burning lips syndrome, glossodynia and stomatodynia.

Signs and symptoms

Burning mouth syndrome affects up to 4 percent of U.S. adults — women seven times as often as men. It generally occurs in middle-aged or older adults. But it may occur in younger people as well.

The main symptom of burning mouth syndrome is a burning sensation in your tongue, lips, gums, palate or throat. People with the syndrome may describe the sensation in the affected areas as hot or scalded, as if they had been burned with a hot liquid.

Other symptoms may include:

* Dry mouth
* Sore mouth
* A tingling or numb sensation in the mouth or on the tip of the tongue
* A bitter or metallic taste

Some people with burning mouth syndrome don't wake up with mouth pain, but find that the pain intensifies during the day and into the evening. Some awake with a constant daily pain, while others feel pain on and off throughout the day.

Causes

The possible causes of burning mouth syndrome are many and complex. Each of the following possible causes applies to only a small portion of all people who complain of a burning mouth. More than one-third of people have multiple causes. Identifying all of the causes is important so that your doctor can develop a treatment plan tailored for you. Possible causes include:

* Dry mouth (xerostomia). This condition can be related to use of certain medications, including tricyclic antidepressants, central nervous system depressants, lithium, diuretics and medications used to treat high blood pressure. It can also occur with aging or Sjogren's syndrome, an autoimmune disease that causes dry mouth and eyes.

* Other oral conditions. Oral yeast infection (thrush) is a common cause of a burning mouth that may also occur with other causes, such as diabetes, denture use and certain medications. Geographic tongue, a condition that causes a dry mouth and a sore, patchy tongue, also may be associated with burning mouth syndrome.

* Psychological factors. Emotional disorders, particularly depression but also anxiety and fear of cancer, are often associated with burning mouth syndrome. Although such problems can cause a burning mouth, they may also result from it.

* Nutritional deficiencies. Being deficient in nutrients, such as iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12), may affect your oral tissues and cause a burning mouth. These deficiencies can also lead to vitamin deficiency anemia.

* Irritating dentures. Dentures may place stress on some of the muscles and tissues of your mouth. The materials used in dentures also may irritate the tissues in your mouth.

* Nerve disturbance or damage (neuropathy). Damage to nerves that control taste and pain in the tongue may also result in a burning mouth.

* Allergies. The mouth burning may be due to allergies or reactions to foods, food flavorings, other food additives, fragrances, dyes or other substances.

* Reflux of stomach acid (gastroesophageal reflux disease). The sour- or bitter-tasting fluid that enters your mouth from your upper gastrointestinal tract may cause irritation and pain.

* Certain medications. Angiotensin-converting enzyme (ACE) inhibitors, used to treat high blood pressure, may cause side effects that include a burning mouth.

* Oral habits. These include often-unconscious activities such as tongue-thrusting and teeth-clenching (bruxism), which can irritate your mouth.

* Endocrine disorders such as diabetes and underactive thyroid (hypothyroidism). Your oral tissues may react to high blood sugar levels that occur with diabetes.

* Hormonal imbalances, such as those associated with menopause. Burning mouth syndrome occurs most commonly among postmenopausal women, although it affects many other people as well. Changes in hormones may affect the composition of your saliva.

* Excessive irritation. Irritation of the oral tissues may result from excessive brushing of your tongue, overuse of mouthwashes or consuming too many acidic drinks.

Often, more than one cause is present. Despite careful evaluation, doctors are sometimes unable to find the cause of burning mouth symptoms.

* Dry mouth
* Sjogren's syndrome
* Oral thrush
* Geographic tongue
* Depression
* Vitamin deficiency anemia
* Heartburn/GERD
* Bruxism
* Diabetes
* Hypothyroidism
* Menopause

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.

Screening and diagnosis

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.

Coping skills

Burning mouth syndrome can be painful and frustrating. The good news is that it's a treatable condition. Although it may take time, you can usually improve your symptoms by working with a team of health professionals to find a treatment plan that's right for you.

In the short term, you may gain some relief by avoiding irritating substances, such as alcohol-based mouthwashes, cinnamon or mint products, and cigarette smoke. Chewing on ice chips or sugar-free gum also may help. So can keeping your dentures out all night and brushing your teeth with baking soda instead of toothpaste. Ask your doctor for other tips to manage your pain and discomfort.

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