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Burning mouth syndrome

Overview

Burning mouth syndrome is the medical term for ongoing (chronic) or recurrent burning in the mouth without an obvious cause. This discomfort may affect the tongue, gums, lips, inside of your cheeks, roof of your mouth or widespread areas of your whole mouth. The burning sensation can be severe, as if you scalded your mouth.

Burning mouth syndrome can appear suddenly or develop gradually over time. Unfortunately, the cause often can't be determined. Although that makes treatment more challenging, you can often get burning mouth syndrome under better control by working closely with your health care team.

Symptoms

Symptoms of burning mouth syndrome may include:

  • A burning or scalded sensation that most commonly affects your tongue, but may also affect your lips, gums, palate, throat or whole mouth
  • A sensation of dry mouth with increased thirst
  • Taste changes, such as a bitter or metallic taste
  • Loss of taste

The discomfort from burning mouth syndrome typically has several different patterns. It may:

  • Occur every day, with little discomfort when you wake, but become worse as the day progresses
  • Start as soon as you wake up and last all day
  • Come and go

Whatever pattern of mouth discomfort you have, burning mouth syndrome may last for months to years. In rare cases, symptoms may suddenly go away on their own or become less frequent. Some sensations may be temporarily relieved during eating or drinking.

Burning mouth syndrome usually doesn't cause any noticeable physical changes to your tongue or mouth.

When to see a doctor

If you have discomfort, burning or soreness of your tongue, lips, gums or other areas of your mouth, see your doctor or dentist. 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 no clinical or lab abnormalities can be identified, 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. 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, health problems, problems with salivary gland function or the side effects of cancer treatment
  • Other oral conditions, such as a fungal infection of the mouth (oral thrush), an inflammatory condition called oral lichen planus or a condition called geographic tongue that gives the tongue a map-like appearance
  • Nutritional deficiencies, such as a 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, especially if they don't fit well, which can place stress on some muscles and tissues of your mouth, or if they contain materials that irritate mouth tissues
  • Allergies or reactions to foods, food flavorings, other food additives, fragrances, dyes or dental-work substances
  • Reflux of stomach acid (gastroesophageal reflux disease or GERD) that enters your mouth from your stomach
  • Certain medications, particularly high blood pressure medications
  • Oral habits, such as tongue thrusting, biting the tip of the tongue and teeth grinding (bruxism)
  • Endocrine disorders, such as diabetes or underactive thyroid (hypothyroidism)
  • Excessive mouth irritation, which may result from overbrushing your tongue, using abrasive toothpastes, overusing mouthwashes or having too many acidic drinks
  • Psychological factors, such as anxiety, depression or stress

Risk factors

Burning mouth syndrome is uncommon. However, your risk may be greater if:

  • You're a woman
  • You're postmenopausal
  • You're over the age of 50

Burning mouth syndrome usually begins spontaneously, with no known triggering factor. However, certain factors may increase your risk of developing burning mouth syndrome, including:

  • Recent illness
  • Previous dental procedures
  • Wearing dentures
  • Allergic reactions to food
  • Medications
  • Traumatic life events
  • Stress
  • Anxiety
  • Depression

Complications

Complications that burning mouth syndrome may cause or be associated with are mainly related to discomfort. They include, for example:

  • Difficulty falling asleep
  • Difficulty eating
  • Depression
  • Anxiety

Diagnosis

There's no one test that can determine if you have burning mouth syndrome. 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, oral habits and oral care routine. In addition, your doctor will likely perform a general medical exam, looking for signs of other conditions.

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 discomfort.
  • Oral cultures or biopsies. Taking and analyzing samples from your mouth can determine whether you have a fungal, bacterial or viral infection.
  • 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.
  • Gastric reflux tests. These tests can determine if you have GERD.
  • Imaging. Your doctor may recommend an MRI, CT scan or other imaging tests to check for other health problems.
  • Temporarily stopping medication. If you take medications that may contribute to mouth discomfort, your doctor may suggest temporarily stopping them, if possible, to see if your discomfort goes away. Don't try this on your own, because it can be dangerous to stop some medications.
  • 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.

Treatment

For secondary burning mouth syndrome, treatment depends on any underlying conditions that may be causing your mouth discomfort.

For example, replacing poorly fitting dentures or taking supplements for a vitamin deficiency may relieve your discomfort. 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.

There's no known cure for primary burning mouth syndrome and no one sure way to treat it. Solid research on the most effective methods is lacking. Treatment depends on your particular symptoms and is aimed at controlling them. You may need to try several treatment methods before finding one or a combination that helps reduce your mouth discomfort.

Treatment options may include:

  • Saliva replacement products
  • Specific oral rinses or lidocaine
  • Capsaicin, a pain reliever that comes from chili peppers
  • An anticonvulsant medication called clonazepam (Klonopin)
  • Certain antidepressants
  • Medications that block nerve pain
  • Cognitive behavioral therapy

Preparing for an appointment

You're likely to start by first seeing your family doctor or dentist for mouth discomfort. Because burning mouth syndrome is associated with such a wide variety of other medical conditions, your doctor or dentist may refer you to another specialist, such as a skin doctor (dermatologist), a doctor who specializes in ear, nose and throat problems (ENT) or another type of doctor.

What you can do

Here's some information to help you get ready for your appointment:

  • Ask if there's anything you need to do before the appointment, such as restrict 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 medications, vitamins, herbs or other supplements that you're taking, and the doses
  • Bring a copy of all previous consultations and tests you've had about this problem
  • Prepare questions ahead of time to help make the most of your time with your doctor or dentist
  • Take a family member or friend with you, if possible, for support and to help you remember everything

Some basic questions to ask your doctor or dentist include:

  • What's likely causing my symptoms or condition?
  • 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 chronic?
  • What's 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 printed materials that I can have? What websites do you recommend?

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your doctor or dentist is likely to ask you a number of questions, such as those below. Be ready to answer them to make the most of your time.

  • 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?
  • Do you use tobacco or drink alcohol?
  • Do you frequently eat acidic or spicy foods?
  • Do you wear dentures?

Lifestyle and home remedies

In addition to medical treatment and prescription medications, these self-help measures may reduce your symptoms and your mouth discomfort:

  • Drink plenty of fluids to help ease the feeling of dry mouth, or suck on ice chips
  • Avoid acidic foods and liquids, such as tomatoes, orange juice, carbonated beverages and coffee
  • Avoid alcohol and products with alcohol, as they may irritate the lining of your mouth
  • Don't use tobacco products
  • Avoid spicy-hot foods
  • Avoid products with cinnamon or mint
  • Try different mild or flavor-free brands of toothpaste, such as one for sensitive teeth or one without mint or cinnamon
  • Take steps to reduce stress

Coping and support

Burning mouth syndrome can be uncomfortable and frustrating. 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 the chronic discomfort of burning mouth syndrome:

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

Prevention

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

Last updated: February 11th, 2017

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