The main symptom of burning mouth syndrome is pain in the mouth that is of burning, scalding, or tingling type. Burning mouth syndrome does not cause any noticeable changes in the physical appearance of your tongue or mouth.
Alterations in your taste perception such as a bitter or metallic taste
Loss of taste
The pain and discomfort occurring from burning mouth syndrome typically has several different patterns. It may:
Feel as constant pain every day, with little discomfort when you wake up, which slowly becomes worse as the day progresses
Occur as pain that starts increasing as soon as you wake up and lasts all day
Come and go
Whatever is the pattern of your mouth discomfort, burning mouth syndrome can last for months to years. Rarely, symptoms disappear suddenly on their own or may recur less frequently. Sometimes, the pain may get temporarily relieved while eating or drinking.
When to see a doctor
If you feel any burning sensation or soreness in your tongue, lips, gums or other areas of your mouth, consult your doctor or dentist. Often, a multidisciplinary approach is required to find out the exact cause and develop an effective treatment plan.
The causes of burning mouth syndrome are classified as either primary or secondary.
Primary burning mouth syndrome
If tests do not show any clinical or lab abnormalities that reveal an underlying medical problem, the condition is called primary or idiopathic burning mouth syndrome. Some studies suggest that primary burning mouth syndrome is caused by damage to the taste and sensory nerves of the peripheral or central nervous system.
Secondary burning mouth syndrome
When burning mouth syndrome is caused by an underlying medical condition, it is called secondary burning mouth syndrome. Common causes of secondary burning mouth syndrome include:
Dry mouth (xerostomia), which can be caused by disorders such as Sjögren’s syndrome, problems with salivary gland function or the side effects of various medications or cancer treatment such as certain drugs and radiation therapy
Other oral conditions, such as yeast 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 low levels of iron, zinc, folate (vitamin B9), thiamin (vitamin B1), riboflavin (vitamin B2), pyridoxine (vitamin B6), and cobalamin (vitamin B12)
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 products (metals)
Reflux of stomach acid (gastroesophageal reflux disease or GERD) that enters your mouth from your stomach
Certain medicines, particularly those that reduce high blood pressure
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, overuse of abrasive toothpastes and mouthwashes or having excess amounts of acidic drinks
Psychological diorders, such as anxiety, depression or stress
4 Making a Diagnosis
There is no single test that can diagnose whether you have burning mouth syndrome. You may consult your family doctor or dentist for mouth discomfort. For a diagnosis of burning mouth syndrome to be made, your doctor or dentist will refer you to another specialist, such as a skin doctor (dermatologist), a doctor who specializes in ear, nose and throat problems (ENT) or another specialist if required as burning mouth syndrome is associated with a wide variety of other medical conditions.
Here is some information that helps you get ready for your appointment:
What you can do
When you make your appointment, ask if there is something you need to do before the appointment, such as dietary restrictions. Make a list of the following information:
Your symptoms, including those that may seem unrelated to your mouth discomfort
Key personal information, including any major stresses or recent life changes
Regular medications, vitamins, herbs or other supplements that you take, and their doses
Carry a copy of all previous test results you have had about this problem
Ask a family member or friend to come with you, if possible, for support and help you remember everything the doctor says.
Preparing questions in advance gives you more time to discuss treatment options with your doctor or dentist.
Some basic questions to ask your doctor or dentist include:
What is the most likely cause of my symptoms?
What are other possible causes?
What kind of tests do I need?
Is my condition a temporary or chronic?
What is the best course of action?
What are the alternatives to the primary approach that you're suggesting?
How can I best manage my other medical conditions together?
Are there any restrictions that should be followed?
Should I see a specialist?
Is there a generic alternative to the medicine you prescribing?
Are there any printed materials or websites that you recommend?
What to expect from your doctor
Your doctor or dentist may ask you a number of questions, such as:
When did you first begin experiencing symptoms?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
Is there anything that seems to improve or worsen your symptoms?
Instead, your doctor or dentist will try to preclude other conditions before diagnosing burning mouth syndrome.
Your doctor or dentist will review your medical history and previous medications, examine your mouth, and ask you to describe your symptoms, oral habits, and oral care routine. In addition, your doctor will also perform a general medical examination to check for signs of other conditions. You may need some of the following tests:
Blood tests that include complete blood count, glucose level, thyroid function, nutritional factors and immune functioning may be done. These may provide clues about the underlying cause of your mouth discomfort.
Oral cultures or biopsies:
Taking a oral swab and analysis of these samples can determine whether you have a fungal, bacterial or viral infection.
Allergy testing may be done to check whether you are allergic to certain foods, additives or even to materials from which dentures are made.
Salivary tests can confirm whether your dry mouth is due to a reduced salivary flow.
Gastric reflux tests:
These tests may be done to determine whether you have GERD.
Your doctor may recommend an MRI, CT scan or other imaging tests to check for other health problems.
Temporary discontinuation of your medications:
If medications are suspected to contribute your mouth discomfort, your doctor may suggest stopping them temporarily, if possible, to check if your symptoms go away. Avoid doing this unless your doctor directs, because stopping certain medications can be dangerous.
You may be asked to complete a questionnaire that helps determine whether you have symptoms such as depression, anxiety or other mental health conditions.
There is no known treatment method that can completely cure primary burning mouth syndrome, and there is no definitive way to treat it.
There is a lack of extensive research regarding the most effective methods of treatment. Treatment usually depends on your symptoms and is aimed at controlling them. As burning mouth syndrome is a complex pain disorder, the treatment that suits one person may not work for another person. You may need to try out several treatment methods before finding a combination that reduces your mouth discomfort.
The treatment of secondary burning mouth syndrome depends on any underlying medical conditions (diabetes, yeast infections) that are the cause of your mouth discomfort.
In addition, adjustment or replacement of the poorly fitting dentures or taking vitamin supplements for a deficiency condition may help ease your discomfort. That is why it is important to find out the exact cause. If any medication is the cause of secondary burning mouth syndrome, then your doctor will prescribe a different drug. Once the underlying causes are treated, the symptoms of your burning mouth syndrome go away.
Medications that block nerve pain can help control pain and relieve dryness of your mouth.
Other treatment options include:
Saliva replacement products
Stimulation of saliva release by chewing sorbitol-containing gum
Mouthwash containing lidocaine
Topical capsaicin, a pain reliever that comes from chili peppers
An anticonvulsant medication – clonazepam (Klonopin)
Certain tricyclic antidepressants
Psychotherapy (cognitive behavioral modification and relaxation)
Hormone replacement therapy
There are no known measures that help you prevent burning mouth syndrome.
But, avoiding irritants such as
reducing your stress
can help reduce the pain and discomfort caused by burning mouth syndrome or prevent your discomfort becoming worse.
7 Lifestyle and Coping
Lifestyle modifications are necessary in order to cope with burning mouth syndrome.
In addition to the medical treatment and prescription medications, here are a few self-help measures that may reduce your symptoms and ease your oral discomfort:
Drink lots of fluids to help ease the feeling of dry mouth
Sip on a cold beverage, suck on ice chips or chew sugarless gum to help ease the pain
Avoid irritating substances such as acidic foods and liquids, such as tomatoes, citrus fruits and juices, carbonated beverages, and coffee
Avoid alcoholic beverages and products such as moutwashes containing alcohol, as they further irritate the mucosal lining of your mouth
Avoid use of tobacco products
Avoid eating hot-spicy foods
Avoid products containing cinnamon or mint: Try a different mild or flavor-free brand of toothpaste, such as one made for sensitive teeth or one without mint or cinnamon
Take steps to manage your daily stress effectively
Coping and support
Burning mouth syndrome is a frustating and an uncomfortable condition that can seriously affect your quality of life when no measures are taken to stay positive and hopeful.
Here are some techniques that help cope with the chronic discomfort of burning mouth syndrome:
Practice relaxation exercises, such as Yoga and meditation
Engage yourself in enjoyable activities, such as your favorite hobbies or physical activities, especially when you feel anxious
Be socially active and try being close to understanding family and friends
Consider joining a chronic pain support group
8 Risk and Complications
There are several risks and complications associated with burning mouth syndrome.
Burning mouth syndrome, sometimes occurs due to an underlying medical condition.
The problems linked to secondary burning mouth syndrome include the following:
Dry mouth (xerostomia), which can be caused by salivary gland problems, other health problems, or as a side effect of various medications and cancer treatment
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
Deficiencies of iron, zinc, folate (vitamin B9), thiamin (vitamin B1), riboflavin (vitamin B2), pyridoxine (vitamin B6), and cobalamin (vitamin B12)
Ill-fitting dentures, which can place stress on some tissues of your mouth, or if they contain components that irritate mouth tissues
Allergic reactions to certain foods, food flavoring substances, other food additives, fragrances, dyes or dental restorative substances
Chronic reflux of stomach acid (gastroesophageal reflux disease or GERD) that enters your mouth from your stomach
Certain medications such as 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 irritation to mouth tissues resulting from overuse of abrasive toothpastes or mouthwashes, overbrushing of your tongue, or drnking large amounts of acidic drinks
Psychological factors, such as anxiety, depression or stress
Complications of burning mouth syndrome are mainly related to discomfort. These include:
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