Burning mouth syndrome

Burning mouth syndrome causes chronic burning pain in your mouth. The pain from burning mouth syndrome may affect your tongue, gums, lips, inside of your cheeks, roof of your mouth, or widespread areas of your whole mouth. The pain can be severe, as if you scalded your mouth.

Unfortunately, the cause of burning mouth syndrome often can't be determined. Although that makes treatment more difficult, don't despair. By working closely with your health care team, you can usually get burning mouth syndrome under control.

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

Symptoms

Symptoms of burning mouth syndrome include:

• A burning sensation that may affect your tongue, lips, gums, palate, throat or whole mouth
• A tingling or numb sensation in your mouth or on the tip of your tongue
• Mouth pain that worsens as the day progresses
• A sensation of dry mouth
• Increased thirst
• Sore mouth
• Loss of taste
• Taste changes, such as a bitter or metallic taste

The pain from burning mouth syndrome typically has several different patterns. It may occur every day, with little pain when you wake but becoming worse as the day progresses. Or it may start as soon as you wake up and last all day. Or pain may come and go, and you may even have some entirely pain-free days.

Whatever pattern of mouth pain you have, burning mouth syndrome may last for years. In some cases, though, symptoms may suddenly go away on their own or become less frequent. Burning mouth syndrome usually doesn't cause any noticeable physical changes to your tongue or mouth.

When to see a doctor

If you have pain or soreness of your tongue, lips, gums or other areas of your mouth, see your doctor or dentist as soon as possible. They may need to work together to help pinpoint a cause and develop an effective treatment plan.

Causes

The cause of burning mouth syndrome can be classified as either primary or secondary.

Primary burning mouth syndrome

When the cause of burning mouth syndrome isn't known, the condition is called primary or idiopathic burning mouth syndrome. Some research suggests that primary burning mouth syndrome is related to problems with taste and sensory nerves of the peripheral or central nervous system.

Secondary burning mouth syndrome

Sometimes burning mouth syndrome is caused by an underlying medical condition, such as a nutritional deficiency. In these cases, it's called secondary burning mouth syndrome.

Underlying problems that may be linked to secondary burning mouth syndrome include:

• Dry mouth (xerostomia), which can be caused by various medications or health problems.
• Other oral conditions, such as oral yeast infection (thrush), oral lichen planus or geographic tongue.
• Psychological factors, such as anxiety, depression or excessive health worries.
• Nutritional deficiencies, such as lack of iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12).
• Dentures. Dentures can place stress on some of the muscles and tissues of your mouth, causing mouth pain. The materials used in dentures also can irritate the tissues in your mouth.
• Nerve damage to nerves that control taste and pain in the tongue.
• Allergies or reactions to foods, food flavorings, other food additives, fragrances, dyes or other substances.
• Reflux of stomach acid (gastroesophageal reflux disease) that enters your mouth from your upper gastrointestinal tract.
• Certain medications, particularly high blood pressure medications called angiotensin-converting enzyme (ACE) inhibitors.
• Oral habits, such as tongue thrusting and teeth grinding (bruxism).
• Endocrine disorders, such as diabetes and underactive thyroid (hypothyroidism).
• Hormonal imbalances, such as those associated with menopause.
• Excessive mouth irritation, which may result from overbrushing of your tongue, overuse of mouthwashes or having too many acidic drinks.

Risk factors

Burning mouth syndrome is uncommon. Your risk may be greater if:

• You're a woman
• You're in your 50s, 60s or even 70s.

Burning mouth syndrome usually begins spontaneously, with no known triggering factor. But some research studies suggest that certain factors may increase your risk of developing burning mouth syndrome. These risk factors may include:

• Being a so-called "supertaster," or someone with a high density of the small tongue bumps called papillae, which contain taste buds
• Upper respiratory tract infection
• Previous dental procedures
• Allergic reactions to food
• Medications
• Traumatic life events
• Stress

Complications

Complications that burning mouth syndrome may cause or be associated with are mainly related to pain and include:

• Difficulty sleeping
• Irritability
• Depression
• Anxiety
• Difficulty eating
• Decreased socializing
• Impaired relationships

Preparing for your appointment

You're likely to start by first seeing your family doctor, general practitioner or dentist for mouth pain. 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 (otolaryngologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor or dentist.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment for your mouth pain, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to your mouth pain.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements that you're taking.
• Write down questions to ask your doctor.
• Take a family member or friend with you, if possible. Sometimes it can be difficult to retain all the information provided to you during an appointment. Someone who goes with you may remember something that you missed or forgot.

Your time with your doctor or dentist is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important, in case time runs out before you get through them all. For burning mouth syndrome, some basic questions to ask your doctor or dentist include:

• What is likely causing my symptoms or condition?
• Other than the most likely cause, what are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my mouth pain likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor or dentist, don't hesitate to ask questions during your appointment.

What to expect from your doctor
Your doctor or dentist is likely to ask you a number of questions. Being ready to answer them may save time to go over any points you want to spend more time on. Your doctor or dentist may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, seems to worsen your symptoms?

Tests and diagnosis

There's no one test that can determine if you have burning mouth syndrome or what may be causing your mouth pain. Instead, your doctor or dentist will try to rule out other problems before diagnosing burning mouth syndrome.

Your doctor or dentist will review your medical history and medications, examine your mouth, and ask you to describe your symptoms, your oral habits and your oral care routine. In addition, your doctor will likely perform a general medical examination, looking for signs of any other conditions.

As part of the diagnostic process, you may have some of the following tests:

• Blood tests. Blood tests can check your complete blood count, glucose level, thyroid function, nutritional factors and immune functioning, all of which may provide clues about the source of your mouth pain.
• Oral cultures. Taking samples from your mouth can tell whether you have a fungal, bacterial or viral infection.
• Imaging. Your doctor may recommend an MRI, CT scan or other imaging tests to check for other health problems.
• Allergy tests. Your doctor may suggest allergy testing to see if you may be allergic to certain foods, additives or even substances in dentures.
• Salivary measurements. With burning mouth syndrome, you may feel that you have a dry mouth. Salivary tests can confirm whether you have a reduced salivary flow.
• Psychological questionnaires. You may be asked to fill out questionnaires that can help determine if you have symptoms of depression, anxiety or other mental health conditions.
• Gastric reflux tests. These can determine if you have gastroesophageal reflux disease (GERD).

In addition, if you take medications that may contribute to mouth pain, your doctor may suggest temporarily stopping those medications, if possible, to see if your pain goes away. Don't try this on your own, since it can be dangerous to stop some medications.

Treatments and drugs

There's no one sure way to treat primary burning mouth syndrome, and solid research on the most effective methods is lacking. Treatment depends on your particular signs and symptoms, as well as any underlying conditions that may be causing your mouth pain. That's why it's important to try to pinpoint the cause. Once any underlying causes are treated, your burning mouth syndrome symptoms should get better.

If a cause can't be found, treatment can be challenging. There's no known cure for primary burning mouth syndrome. You may need to try several treatment methods before finding one or a combination that is helpful in reducing your mouth pain. Treatment options may include:

• A lozenge-type form of the anticonvulsant medication clonazepam (Klonopin)
• Alpha-lipoic acid, a strong antioxidant produced naturally by the body
• Oral thrush medications
• Certain antidepressants
• B vitamins
• Cognitive behavioral therapy
• Specific oral rinses or mouthwashes
• Saliva replacement products
• Capsaicin, a pain reliever that comes from chili peppers

Surgery isn't recommended for burning mouth syndrome.

Lifestyle and home remedies

In addition to medical treatment and prescription medications, self-help measures may help improve your symptoms. You may find these self-help measures beneficial for reducing chronic mouth pain:

• Drink more fluids, to help ease the feeling of dry mouth.
• Don't use tobacco products.
• Avoid products with cinnamon or mint.
• Avoid spicy-hot foods.
• Avoid acidic foods and liquids, such as tomatoes, orange juice, soft drinks and coffee.
• Try different brands of toothpaste.
• Take steps to reduce excessive stress.

Coping and support

Burning mouth syndrome can be painful and frustrating, especially since it can take months or years to get a diagnosis and effective treatment. Because of that, it can reduce your quality of life if you don't take steps to stay positive and hopeful.

Consider some of these techniques to help cope with burning mouth syndrome:

• Practice relaxation exercises, such as yoga.
• Join a pain support group.
• Engage in pleasurable activities, such as exercise or hobbies, especially when you feel anxious.
• Make an effort to stay socially active by connecting with understanding family and friends.

Prevention

There's no known way to prevent burning mouth syndrome. But by avoiding tobacco, acidic foods and drinks, and excessive stress, you may be able to reduce the pain from burning mouth syndrome or prevent your mouth pain from getting worse.