What Is Burning Mouth Syndrome?

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What Is Burning Mouth Syndrome?
By Sook-Bin Woo, Harvard Health Publications

Q: My husband was diagnosed with burning mouth syndrome. This seems to be a mystery syndrome. What can you tell us about it?

A: As the name suggests, people with burning mouth syndrome feel a persistent burning sensation in or around the mouth. The patients that I see with this problem tend to be women over age 50, but men get the syndrome too.

The burning sensation can be painful and make people feel absolutely miserable. Some patients describe it as feeling like they had been burnt by hot coffee. People feel the burning on the tops of their tongues (the most common site), their lips, or the part of the hard palate right behind the upper front teeth. But any part of the mouth may be involved. Often people wake up feeling fine or with only slight burning, but as the day goes on, the burning starts or gets worse. In addition to the burning sensation, people sometimes get a metallic taste in their mouth that won’t go away, or the mouth dries out.

The diagnosis of primary burning mouth syndrome — burning that’s not related to another medical condition — can be tricky. The tongue and other oral tissues will often look perfectly healthy. And a burning sensation in the mouth can be a symptom secondary to a number of conditions, ranging from anemia to type 2 diabetes to lichen planus, a rashlike inflammation that causes sore areas in the mouth. Those secondary causes have to be ruled out before a diagnosis of primary burning mouth syndrome is made.

Primary burning mouth syndrome is most likely a neuropathic disorder, meaning that the discomfort is the result of malfunctioning nerves: the nerves are “overactive” in some way. We don’t really know what causes them to misfire in that way.

I often see depression and anxiety, obsessive-compulsive disorder, or post-traumatic stress disorder along with burning mouth syndrome. I’ve also seen many patients who have become more aware of their mouth than normal — they sense even the subtlest change in how it feels. So in treating this syndrome, it’s essential to address any psychological or psychiatric problems that may be present.

Because the cause isn’t fully understood, treatments target symptoms. I usually start patients on clonazepam (Klonopin), an anti-anxiety medication that helps with the hypervigilance and anxiety over the condition; this drug also directly reduces the burning sensation. If it isn’t effective, I sometimes try low doses of a tricyclic antidepressant such as amitriptyline (Elavil) or nortriptyline (Pamelor).

A home remedy that sometimes works is a mouth rinse of water and a few drops of Tabasco sauce. Fighting fire with fire? Not exactly. Capsaicin, the chemical in Tabasco sauce and chili peppers that makes them hot, depletes substance P, a pain-signaling chemical in nerve cells. I also talk to patients about exercising more and taking steps to reduce stress, which can include something like taking yoga classes or just spending more time with friends.

Many people with burning mouth syndrome have been to other doctors who dismissed their condition because they couldn’t see anything physically wrong. I think part of the reason patients get better when they come to us is that we have a specific protocol to diagnose and treat the condition, first ruling out any other factors that may bring on secondary burning symptoms. We also take time to explain to patients what we know about the condition and try to allay their fears that they may have something more ominous, such as mouth cancer.

Last Updated: 05/08

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