On the Tip of the Tongue: Explanations for Burning Mouth Syndrome

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On the Tip of the Tongue: Explanations for Burning Mouth Syndrome

More recent research shows the association between burning mouth and taste changes. Dr. Linda Bartoshuk at Yale has found is that there is almost a footprint of the disorder—a loss of bitter taste at the tip of the tongue. We can check the ability to taste sweet, sour, salt and bitter flavors at the front and then at the back of the tongue using a spatial taste-test. So someone with burning mouth syndrome may have normal tastes or somewhat reduced tastes for sour, sweet and salty flavors but the ability to taste bitter flavors, which is located at the tip of the tongue, is often gone.

The theory is that taste inhibits pain and, if there's a problem with taste (like loss of bitter taste at the tip of the tongue), there's a loss of inhibition of the pain fibers, so someone spontaneously begins to produce pain. And the pain is interpreted as burning mouth pain.

Another test is performed using a local anesthetic. When a local anesthetic is applied to the tip of their tongue where they have the burning, the pain often gets worse instead of getting better.

Who gets burning mouth syndrome?

It's most common in women after menopause. One of the reasons that this problem is found in older women relates to the loss of estrogen that occurs in the menopausal period and that causes a loss of bitter taste buds. We do see men with burning mouth, but it's less common. Sometimes I see younger people with it, but it is usually associated with a benign condition called geographic tongue. Geographic tongue causes inflammation on the surface of the tongue causing red patches that come and go and move around. That might affect the taste buds which then leads to the loss of pain inhibition and burning mouth.

What can increase the risk?

When the bitter taste is lost within the taste bud, the pain fibers surrounding that bud are the ones that experience a loss of inhibition and start becoming painful. An infection, a nutritional deficiency of B12, folate or iron can also damage taste buds.

And just to make it a little bit more complex, the people who are most at risk of developing burning mouth are called super-tasters—people who have the greatest number of taste buds on the tip of the tongue. This is a genetic difference: some people are non-tasters, some are medium-tasters and some are super-tasters. Flavors are much more intense for super-tasters, and they have different taste preferences than non-tasters and medium-tasters. Women are much more likely to be super-tasters than men. So most people with burning mouth syndrome are super-tasters who have had a taste loss for some reason.

People who do a lot of clenching are at increased risk. They keep their tongue pressed tightly against their teeth at night and they end up with their tongue scalloped. When the clenching is controlled, through medication or the use of mouth guards, they often feel better.

Are underlying medical conditions associated with burning mouth syndrome?

Certain conditions such as Sjögren's syndrome, diabetes, thyroid disease and liver dysfunction have been associated with burning mouth syndrome, but it just doesn't occur very often in these people. For example, most people with Sjögren's syndrome have very dry mouth and almost all of them have a yeast infection as a result. When the majority of Sjögren's patients are treated with antifungal medication, they no longer have burning mouth.

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