What treatments work for burning mouth syndrome?

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What treatments work for burning mouth syndrome?
BMJ Group, Thursday 5 February 2009 00.00 GMT

There's no definite cure for burning mouth syndrome. That's because we don't know exactly what causes it.

Your doctor may suggest different treatments, including a talking treatment (psychotherapy), taking antidepressant drugs, using mouthwash or takingfood supplements. But there hasn't been much research to tell us whether these treatments work.

You may feel better once you know that your mouth pain isn't a sign of a serious disease. If you can stop worrying about the pain, you might find that you stop noticing it so much. But if you do decide to go ahead with treatment, this is what we found.

* A kind of talking treatment called cognitive behaviour therapy may help some people with burning mouth syndrome.
* We don't know whether any of the other treatments work, because there hasn't been much research.

We've looked closely at the research and put these treatments into categories, according to whether they work.
Treatments that are likely to work

Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) is the treatment that is most likely to help you if you have burning mouth syndrome. CBT is a form of talking treatment.

CBT may help reduce the pain you feel by helping you feel less anxious or depressed. Even if you aren't anxious or depressed, CBT can help you to cope with the pain better.

You work with the therapist to make your thinking and behaviour more positive. You usually have one session a week, for six weeks to 12 weeks. Each session lasts about an hour. Your doctor may refer you to a therapist, but there may be a waiting list for treatment.

We found one small good-quality study (a randomised controlled trial) of CBT in people with burning mouth syndrome. The people had 12 to 15 sessions of CBT over three months. Most of these people found the burning feeling became much less painful during or after the treatment. More than a quarter of people found that their pain disappeared, either during the treatment or afterwards.[1]

But the study only included 30 people and there were some problems with the quality of the research. This means we can't be sure that CBT will work for everyone with burning mouth syndrome.[1]

The study didn't say whether there were any side effects from CBT.
Treatments that work, but whose harms may outweigh benefits
Clonazepam

Clonazepam (brand name Rivotril) is usually used for treating epilepsy. You need a prescription from your doctor to take this medicine.

One small study looked at whether sucking clonazepam tablets might help people with burning mouth syndrome.[2] [3] It showed that people had less pain after using clonazepam three times a day for two weeks.

Clonazepam has serious side effects, including drowsiness, tiredness, dizziness, poor concentration and confusion. You may also get side effects if you suddenly stop taking it.[4]

Clonazepam isn't often used for treating burning mouth syndrome in the UK.
Treatments that need further study

Antidepressants

Antidepressants are medicines that are usually used to treat depression. They're only available with a prescription from your doctor. If your doctor recommends that you try antidepressant tablets for burning mouth syndrome, it doesn't mean they think you are depressed. This is because besides helping with depression, antidepressants can relieve some types of nerve pain.

There are several types of antidepressant. But we don't know if they work for burning mouth syndrome.

Tricyclic antidepressants are the first group of antidepressants that have been studied in people with burning mouth syndrome. Studies looked at a tricyclic antidepressant called trazodone (brand name Molipaxin).[5]

In the study we looked at, taking trazodone didn't work any better than taking a dummy treatment (a placebo) in people with burning mouth syndrome. But the study was small and there were problems with its quality. So the results are unreliable.[5]

Trazodone can cause side effects such as drowsiness and dizziness.[5]

Selective serotonin reuptake inhibitors (called SSRIs) are the second group of antidepressants that have been studied for burning mouth syndrome. SSRIs are a newer type of antidepressant. The SSRIs that have been tested are sertraline (Lustral) and paroxetine (Seroxat).[6]

Amisulpride, another drug that is sometimes used for treating burning mouth syndrome, has also been tested.[6]

The study we found looked at how well SSRIs and amisulpride worked in people with burning mouth syndrome.[6] It showed that people taking an SSRI or amisulpride felt better after eight weeks of treatment. But the study was too small so we can't be certain whether the results are reliable. Also, the drugs were only compared with each other and not with a placebo. So we don't know if the people taking the medicines would have felt better if they hadn't had treatment.

SSRIs can cause side effects such as sweating, shaking, dry mouth, constipation, dizziness and stomach upsets.[6]

Research has found that taking antidepressants of all kinds can make some people more likely to think about suicide or try to harm themselves.[7] Young people under 18 are especially at risk. Thoughts about self-harm are most likely to happen in the early stages of your treatment or if the dose of antidepressant you're taking is changed.[8] If you're taking an antidepressant and are worried about any thoughts or feelings you have, see your doctor or go to a hospital straight away.[8]
Benzydamine mouthwash

Benzydamine is a painkiller that you can take in a mouthwash. The brand name for this mouthwash is Difflam Oral Rinse or Difflam Sore Throat Rinse. You can buy it from a pharmacy. We don't know whether using this mouthwash works for burning mouth syndrome. There haven't been any good-quality studies that have shown that benzydamine mouthwash works.[3]

You may find the mouthwash stings your mouth. If this happens, you can dilute it half and half with water.[4]
Food supplements

We've looked at the research on two food supplements for burning mouth syndrome.

Alpha-lipoic acid (sometimes called ALA) is a food supplement you can buy from health food shops and some pharmacies. There is a theory that it protects your nervous system, which is why it was tested for burning mouth syndrome.[9]

Three small studies looked at taking alpha-lipoic acid for burning mouth syndrome. They found that it might help some people with this condition.[9] [10] [11] But the studies weren't good quality, so the results aren't reliable. The studies didn't mention any side effects.

Oryzanol is a food supplement made from rice bran oil, which is used for burning mouth syndrome in China. But we didn't find any good evidence that oryzanol works. One study found that taking hormone replacement therapy (see below) worked better, but there were problems with the quality of this research.[12]
Hormone replacement therapy

Burning mouth syndrome is more common in women who are going through or have had the menopause. So some doctors have looked at whether hormone replacement therapy (HRT) might help.

HRT means taking medicines to replace hormones that your body stops making during the menopause. You can take HRT in different forms: tablets, patches, gels, nasal sprays or vaginal creams. You'll need a prescription from your doctor for this treatment.

There are different types of HRT. Most types contain the sex hormone oestrogen. Some contain oestrogen combined with another sex hormone, progestogen (these are known as combined HRT). The HRT medicine used in the study we found is a fairly new one, called tibolone (brand name Livial).

Tibolone is similar to your natural sex hormones, but it's made in the laboratory. It's usually used to treat symptoms of the menopause such as hot flushes and vaginal dryness. It has fewer side effects than ordinary HRT. The most common side effect is spotting or bleeding from your vagina.[13]

One small study looked at how tibolone might help some women with burning mouth syndrome who have been through the menopause. But there were problems with the quality of this study, so the results aren't reliable.[12]

Another study looked at whether taking tibolone increases your risk of getting breast cancer. The study found it did, but not as much as taking combined HRT.[14]

HRT with oestrogen, or oestrogen and progestogen, can increase your chances of getting blood clots, getting heart disease or having a stroke. The increase in risk is small but it does go up the longer you take HRT.[15] As tibolone is quite new, there isn't much evidence about whether it increases your risks of getting these conditions. We need more long-term studies of this treatment before we can say for certain.
Other treatments

We haven't looked at the research on this treatment in as much detail as we've looked at the research on most of the treatments we cover. (To read more, see .) But we've included some information because you may have heard of it or be interested in it.
Capsaicin

Capsaicin is the chemical that makes chillies hot. Gels containing capsaicin can be used to treat joint pain, muscle aches and some types of nerve pain. By irritating your skin slightly, capsaicin produces a warming sensation that can be soothing.[16]

Gels and creams containing capsaicin aren't suitable for use inside your mouth. However, some doctors have suggested mixing one teaspoon of a hot sauce (such as Tabasco) with two teaspoons of water.[17] You swish the mixture round your mouth and spit it out. You can try a stronger mix if like, but don't make it more concentrated than one teaspoon of sauce to one teaspoon of water.

We haven't looked in detail at the research on capsaicin, so we can't say whether it works. Some people who try this treatment say they don't like the taste.[17]

© BMJ Publishing Group Limited ("BMJ Group") 2009