Burning Mouth Syndrome

What is burning mouth syndrome?

Burning Mouth Syndrome causes a burning pain in the mouth and tongue without any clear cause. It's a complex and not well-understood condition that can be treated with medication and lifestyle changes to reduce symptoms.

The main symptom is a burning or tingling sensation in the mouth, including the gums, cheeks, lips, and roof of the mouth. Other symptoms may include dry mouth, changes in taste, insomnia, headaches, and mood changes.

Treatment focuses on managing symptoms and includes things you can do at home, medication, and prevention measures.

If you're experiencing mouth pain, see your primary care doctor soon to rule out other causes. If you have Burning Mouth Syndrome, medication may help, but treatment may not always be successful.

Burning mouth syndrome symptoms

Main symptoms

The main symptoms of burning mouth syndrome include the following.

• Mouth pain: This may constantly feel like a burning, tingling pain of the roof of the mouth (palate), gums, inside of the cheeks, and lips. Some people say it feels like you have just burnt your mouth with hot coffee or tea. The skin of the face is typically not affected.
• Dry mouth (xerostomia)
• Taste changes: More than 70% of people report taste changes, such as foods tasting unusually bitter or metallic, a loss of sense of taste, or increased taste intensity.
• Insomnia: Nighttime pain often makes it difficult to fall asleep
• Headaches
• Mood changes: The discomfort of the syndrome is often associated with irritability, anxiety, and depressed mood

Other symptoms

Other details regarding symptoms include the following.

• Symptoms persist all day: For 50% of people, symptoms occur all day.
• Worse at night: Some people may experience mild symptoms in the morning and get experience them get progressively worse throughout the day.
• Symptoms occur daily: 90% of people experience some symptoms every day.

Many people, unfortunately, continue to experience symptoms for years. However, limited research suggests that within six to seven years the pain can reduce from constant to only occurring occasionally. Fortunately, several treatments (below) can be helpful in reducing symptoms.

Burning mouth syndrome causes

The exact cause of burning mouth syndrome is not well understood. It is considered a neuropathic pain syndrome, as it occurs when nerve fibers in the pathway from the sensory cells in the mouth to the brain become dysfunctional. Other neuropathic pain syndromes include painful diabetic neuropathy, post-herpetic neuralgia, trigeminal neuralgia, and complex regional pain syndrome.

Nervous system dysfunction

Although the precise area(s) causes of dysfunction in the nervous system are unknown, possible causes include:

• Dysfunction of the trigeminal nerve: This is the main sensory nerve of the head.
• Damage to sensory nerves in the tongue
• Depression or anxiety: Burning mouth syndrome often co-occurs with depression (30-50%) and anxiety (30-60%), although the directionality of this relationship is unclear. That is, we don’t know to what extent the pain and stress of burning mouth syndrome increases anxiety, if anxiety worsens burning mouth sensations, or if a common neurologic dysfunction contributes to both burning mouth and anxiety.

Other medical conditions

Burning mouth syndrome is considered a “diagnosis of exclusion” because it is diagnosed only when other causes of mouth pain have been ruled out. Other medical conditions that can be related to burning mouth symptoms include:

• Infections: Such as oral herpes and oral candida (a fungal infection)
• Nutrient deficiency: Certain B vitamin deficiencies (such as B1-thiamine, B2 riboflavin, B3-niacin, B7 pyridoxine, and B12 cobalamin) can affect mouth tissues, causing inflammation and burning.
• Low red blood count (anemia)
• Endocrine disorders: Such as type 2 diabetes and hypothyroidism
• Autoimmune conditions: Such as lichen planus, which causes mouth ulcers, and Sjogren’s syndrome, which affects salivary glands
• Gastroesophageal reflux disease (GERD): This can cause a bitter taste in the mouth.
• ACE Inhibitors: These are medications used for high blood pressure and heart failure, such as lisinopril, which can cause taste changes in some people.
• Dentures: Poor-fitting dentures can irritate the mouth.
• Cancer treatment: Radiation and chemotherapy for cancer can affect nerves, resulting in pain.
• Excessive mouth irritation: Such as from overuse of mouthwash or brushing teeth many times per day

Who is most affected by burning mouth syndrome

An estimated 1% of the adult population is affected.

• Women are affected roughly four times more than men
• Menopausal women: Burning mouth occurs more commonly in women after menopause, most commonly three to 12 years after menopause. It has been hypothesized that hormonal changes may be a cause of the disorder, but, unfortunately, hormone replacement therapy has not seemed to improve symptoms.

Treatment options and prevention for burning mouth syndrome

If your symptoms worsen or persist, you should consult your physician for a proper treatment plan.

At-home treatments

The following treatments can likely be completed at home.

• Capsaicin: The heat-producing substance in spicy chili peppers can surprisingly help reduce pain. Although capsaicin (available in medical cream) initially burns, it ultimately desensitizes nerves, providing relief from painful signals. Capsaicin treatment can be tried at home by mixing hot pepper and water in a 1:2 ratio (or as otherwise tolerated) and rinsing the mouth with the mixture.
• Mind-body techniques: Various mind-body techniques may be helpful in reducing the discomfort associated with symptoms of burning mouth syndrome, such as deep breathing, meditation, yoga, and exercise.
• Psychotherapy: Cognitive behavioral therapy (CBT) has been shown in high-quality research studies to reduce symptoms of burning mouth syndrome.

Medications

The following medications may be prescribed to you by your physician.

• Antidepressants: Tricyclic antidepressants (TCAs, such as amitriptyline or nortriptyline), an older class of antidepressants, are commonly found helpful for a variety of neuropathic pain conditions. More commonly used newer antidepressants (SSRIs, such as sertraline), while very helpful in cases of co-morbid anxiety and depression, are not as effective for this type of pain. SNRIs (such as duloxetine) can also be helpful for neuropathic pain.
• Anticonvulsants: Medications initially developed to prevent seizures also reduce the activity of nerve fibers, which can help reduce neuropathic pain. Gabapentin is an example of an anticonvulsant commonly used for burning mouth syndrome pain.
• Anxiolytics: Medications such as benzodiazepines (such as clonazepam, chlordiazepoxide) calm the nerve fibers and may also affect the taste pathway from the tongue to the brain. However, they also pose several concerns, including a high potential for addiction, uncomfortable and potentially dangerous withdrawal when discontinued, and fall risk in elderly people.

Prevention

Dry mouth can be relieved by drinking more water throughout the day and sucking on ice chips. You should also try to avoid foods that seem to irritate your mouth the most. These are individualized, but often include alcohol, citrus fruits and juices, cinnamon, and mint.

When to seek further consultation for burning mouth syndrome

If you have symptoms of burning mouth syndrome

If you experience mouth pain and taste changes on a near daily basis, report this to your primary care physician and dentist. He or she will examine your mouth and possibly order some tests to evaluate for reversible causes of mouth pain and develop an appropriate treatment plan. The best treatment may involve coordination between your primary care physician and your dentist.

If you’re on medications and have symptoms of burning mouth syndrome

Certain medications, such as ACE-Inhibitor blood pressure medications, can cause burning mouth symptoms in some people and many medications can contribute to dry mouth, further aggravating the condition. Consider asking your doctor or pharmacist if any of your medications may be the cause of your symptoms and if any more tolerable alternatives may be available.

If you have dentures and experience burning mouth syndrome

Ask your dentist how your dentures can be adjusted to reduce pain.