Overview
Burning mouth syndrome is a medical condition characterized by a persistent or recurring burning sensation in the mouth without an obvious cause. The feeling of burning can affect various parts of the mouth, such as the tongue, gums, lips, roof of the mouth, or the entire mouth. This syndrome usually begins suddenly but can develop over time. Although the specific cause is often unknown, working closely with a healthcare team can help manage the symptoms.
Understanding the disease
Symptoms
The symptoms of burning mouth syndrome may include a burning or scalding feeling that affects the tongue, lips, gums, roof of the mouth, throat, or the entire mouth. The individual may also experience dry mouth with increased thirst, taste changes, such as a bitter or metallic taste, loss of taste, tingling, stinging, or numbness in the mouth. The discomfort may follow different patterns, such as happening every day with little discomfort upon waking, starting as soon as one wakes up and lasting all day, or coming and going. Complications may include problems sleeping or eating, as well as anxiety or depression.
Risk Factors
The risk factors for developing burning mouth syndrome include being female, being in perimenopause or postmenopausal, being over the age of 50, and being a smoker. Other risk factors include recent illness, long-term medical conditions like fibromyalgia, Parkinson's disease, autoimmune disorders, and neuropathy, previous dental work, allergic reactions to food, certain medicines, traumatic life events, stress, anxiety, and depression.
Development
Burning mouth syndrome can develop due to a combination of factors, including medical, dental, and psychological issues. In some cases, the specific cause cannot be found, making treatment more challenging. Some common underlying causes and risk factors associated with burning mouth syndrome include:
- Dry mouth: A lack of saliva can cause a burning sensation in the mouth. Dry mouth can be caused by certain medications, health issues, gland problems, or side effects of cancer treatment.
- Oral conditions: Conditions like oral thrush, oral lichen planus, or geographic tongue can lead to burning mouth syndrome.
- Nutrient deficiencies: A lack of essential nutrients, such as iron, zinc, folate, thiamin, riboflavin, pyridoxine, and cobalamin, can contribute to burning mouth syndrome.
- Allergies or reactions: Reactions to foods, food additives, fragrances, dyes, dental materials, or mouth care products can cause burning mouth syndrome.
- Gastroesophageal reflux disease (GERD): Stomach acid reflux can cause burning sensations in the mouth.
- Certain medications: High blood pressure medications are a common culprit, but other medications can also contribute to the development of burning mouth syndrome.
- Oral habits: Habits like tongue thrusting, biting the tongue, and teeth grinding can irritate the mouth.
- Endocrine disorders: Diabetes, hypothyroidism, or other endocrine disorders can lead to burning mouth syndrome.
- Irritation: Overbrushing the tongue, using abrasive toothpaste, overusing mouthwash, consuming excessive acidic foods or drinks, or wearing poorly fitting dentures can cause mouth irritation and contribute to burning mouth syndrome.
- Psychological issues: Anxiety, depression, and stress can exacerbate the symptoms of burning mouth syndrome. It's important to work closely with a healthcare team to identify the specific underlying cause and develop an appropriate treatment plan.
Assessment and Diagnosis
Triage
You should see a doctor or dentist if you experience discomfort, burning, or soreness in your tongue, lips, gums, or other areas of your mouth. This is especially important if the symptoms persist or worsen over time. The healthcare provider may need to work together to help identify the cause and develop an effective treatment plan.
Diagnosis
To diagnose burning mouth syndrome, your health care team will review your medical history and medications, examine your mouth, and ask you to describe your symptoms. They may also discuss your habits and routine for keeping your teeth and mouth clean. Your health care provider will likely perform a medical exam and may order various tests such as blood tests, oral cultures or biopsies, allergy tests, salivary measurements, gastric reflux tests, and imaging to rule out other conditions and provide clues about the source of your mouth discomfort.
Management and Treatment
Complications
Burning mouth syndrome can cause various complications related to discomfort, such as problems falling asleep or difficulty eating. In cases involving significant discomfort, individuals may also experience anxiety or depression as a result of the condition.
Treatment
Treatment for burning mouth syndrome depends on whether it is primary or secondary. For primary burning mouth syndrome, there is no known cure, and treatment is focused on controlling symptoms. Possible treatment options may include using saliva replacement products, specific oral rinses or lidocaine for pain relief, capsaicin for pain relief, alpha-lipoic acid to relieve nerve pain, clonazepam (Klonopin) to control seizures, certain antidepressants, or medications that block nerve pain. Cognitive behavioral therapy may also be recommended to help manage anxiety, depression, stress, and ongoing pain. For secondary burning mouth syndrome, treatment depends on the underlying cause. Addressing the underlying condition should help relieve symptoms. Some self-help measures that may help reduce symptoms include drinking plenty of fluids, avoiding acidic or irritating foods and products, using mild or flavor-free toothpastes, practicing relaxation exercises, and engaging in activities that bring pleasure. Remember that it may take time for treatments to help manage symptoms, and it's important to work closely with your healthcare provider to find the most effective treatment plan.
Preparing for medical consultation
To prepare for an appointment for burning mouth syndrome, you should:
- Ask if there's anything you need to do before the appointment, such as limiting your diet.
- Make a list of your symptoms, including any that may seem unrelated to your mouth discomfort.
- Make a list of key personal information, including any major stresses or recent life changes.
- Make a list of all medicines, vitamins, herbs, or other supplements you're taking, including the doses.
- Bring a copy of any medical or dental records, including test results, that are related to this problem.
- Take a family member or friend with you, if possible, for support and to help you remember everything.
- Prepare questions ahead of time to ask your healthcare provider or dentist. Some questions to consider asking include:
- What's likely causing my symptoms?
- Other than the most likely cause, what are other possible causes?
- What kinds of tests do I need?
- Is my mouth discomfort likely temporary or long-term? Remember to share all relevant information with your healthcare provider during the appointment, and follow their guidance on the next steps for diagnosis and treatment.