Burning Mouth Syndrome (BMS)

Symptoms

Burning mouth syndrome symptoms can include:

• A burning or scalding sensation that mostly affects the tongue, though it can also occur on the gums, lips, roof of the mouth, throat, or the entire mouth.
• A sensation of dry mouth accompanied by increased thirst.
• Changes in taste, such as a metallic or bitter taste in the mouth.
• Loss of taste.
• Stinging, numbness, or tingling sensation in the mouth.

The discomfort caused by BMS can follow varying patterns and might:

• Occur daily, with mild discomfort upon waking that worsens as the day progresses.
• Begin as soon as you get up and persist throughout the day.
• Be intermittent.

Regardless of the pattern of discomfort you experience, BMS can last for months or even years. In rare instances, symptoms may suddenly resolve on their own or become less frequent. Sometimes, eating or drinking might temporarily relieve the burning sensation.
Generally, BMS does not result in any visible physical changes to the mouth or tongue.

Causes

The cause of burning mouth syndrome can be either primary or secondary:

Primary burning mouth syndrome

When the underlying cause is unidentified, the disorder is referred to as primary or idiopathic burning mouth syndrome. Studies indicate that primary BMS might be linked to issues with the nerves responsible for taste and pain.

Secondary burning mouth syndrome

In some cases, BMS can result from an underlying health condition and is referred to as secondary burning mouth syndrome. Possible underlying issues associated with secondary BMS include:

• Dry mouth: Health conditions, medications, issues with the salivary glands, or side effects of cancer treatment may contribute to dry mouth.
• Other oral problems: These include oral thrush (mouth fungal infection), oral lichen planus (an inflammatory condition), or geographic tongue, which makes the tongue look like a map.
• Nutritional deficiencies: Lack of essential nutrients such as zinc, iron, folate (vitamin B9), riboflavin (vitamin B2), thiamine (vitamin B1), pyridoxine (vitamin B6), or cobalamin (vitamin B12).
• Allergic reactions to foods, flavourings, additives, fragrances, dyes, dental materials, or oral care products.
• Gastroesophageal reflux disease (GORD): Stomach acid reflux entering the mouth from the stomach.
• Medications: Particularly those prescribed for high blood pressure.
• Oral habits: These include pressing the tongue against teeth, biting the tip of the tongue, or teeth grinding or clenching.
• Endocrine disorders: Including diabetes or hypothyroidism (an underactive thyroid).
• Mouth irritation: Caused by excessive tongue brushing, abrasive toothpaste, overuse of mouthwash, or consuming a lot of acidic foods or beverages. Improperly fitted dentures can also worsen symptoms.
• Psychological conditions: Such as depression, anxiety, or stress.

Risk Factors

Although burning mouth syndrome is relatively rare, you may be at high risk if:

• You are female.
• You are in the perimenopause or postmenopause stage.
• You are over 50 years old.
• You smoke.

BMS often starts suddenly and without an obvious cause. However, the following factors are likely to heighten the risk:

• Recent illness.
• Chronic medical conditions such as Parkinson’s disease, fibromyalgia, autoimmune disorders, or neuropathy.
• Previous dental work.
• Allergic reactions to certain foods.
• Certain medications.
• Traumatic life events.

Diagnosis

There isn’t a specific test that can be used to confirm burning mouth syndrome. Therefore, healthcare providers focus on ruling out other possible causes before diagnosing the condition.

Your dentist or physician will likely:

• Evaluate your medical history and current medications.
• Examine your mouth for any visible signs.
• Ask about your symptoms in detail.
• Ask about your routine and habits to keep your teeth and mouth clean.

In addition, the dentist may conduct a medical examination and check for signs of other health problems. You may therefore undergo tests such as:

• Blood tests: Used to assess complete blood count, blood sugar levels, thyroid function, immune system functionality, and nutritional factors. The results may provide clues about the cause of your burning mouth.
• Oral cultures or biopsies: During this test, the dentist uses a cotton swab to collect a sample for an oral culture to determine if a fungal, bacterial, or viral infection is present in the mouth. With a biopsy, small tissue samples are obtained from the mouth and taken to the lab for cell analysis.
• Allergy tests: These can be done to determine if you’re allergic to particular foods, additives, dental materials, or oral care products.
• Salivary measurements: Since burning mouth syndrome can cause a dry mouth, salivary tests help determine if saliva flow is reduced.
• Gastric reflux tests: Providers use these tests to find out if stomach acid is flowing back from the stomach into the mouth.
• Imaging: MRI, CT scans, or other imaging tests may be recommended to look for other medical conditions.
• Medicine change: If a medication you’re taking is suspected of causing mouth discomfort, your provider may adjust the dosage or prescribe a different drug.  Alternatively, they might suggest temporarily stopping the medication (if possible) to determine if the symptoms improve. However, you should never attempt this option on your own, as stopping certain medicines could be dangerous.
• Mental health assessment: Your provider may ask you to answer a range of questions to help determine if anxiety, depression, or other mental health issues could be contributing to your BMS.

Treatment Options

Burning mouth syndrome treatment aims to ease symptoms and treat underlying health conditions. The available options include:

Medications:

• Painkillers: Over-the-counter pain medications or prescription drugs for nerve pain, such as amitriptyline or gabapentin.
• Antidepressants and anxiolytics: These drugs help manage anxiety, stress, or depression contributing to BMS.
• Saliva substitutes: These products are designed to alleviate dry mouth and stimulate saliva flow.
• Nutritional supplements: Vitamins and minerals supplements help address deficiencies.

Lifestyle and home remedies:

• Oral hygiene: Use non-irritating toothpaste and mouthwash and maintain proper oral hygiene.
• Dietary adjustments: Avoid acidic, spicy, or irritating foods and drinks.
• Hydration: Drink plenty of water to keep your mouth moist.
• Stress management: Use techniques such as yoga, meditation, or counselling.

Therapies:

• Cognitive behavioural therapy (CBT): This helps manage discomfort and related psychological factors.
• Physical therapy: Exercises for the jaw and mouth can help ease symptoms.

Complications

Burning mouth syndrome isn’t life-threatening, but it can have a significant impact on a person’s quality of life. Some of the complications associated with the condition include:

• Chronic pain or discomfort: Constant pain can interfere with day-to-day activities and general well-being.
• Nutritional problems: Difficulty eating can result in nutritional deficiency and unintentional weight loss.
• Emotional impact: Continuous discomfort can contribute to anxiety, stress, and depression.

Prevention

Because the cause is unclear, preventing burning mouth syndrome can be difficult. However, these measures can help lower the likelihood or severity:

• Maintain proper oral hygiene: Frequently brush and floss your teeth and attend regular dental check-ups.
• Healthy diet: Consume a balanced diet full of essential minerals and vitamins.
• Hydration: Drink enough water to maintain salivary flow.
• Stress management: Practise methods of reducing stress and improving mental well-being.
• Avoid irritants: Refrain from foods, drinks, and products that irritate the mouth.

Knowing the potential causes, symptoms, and treatment options for BMS helps you take the necessary measures to manage the issue and enhance your quality of life. Generally, it’s important to see a doctor if you have an ongoing burning sensation in your mouth for an accurate diagnosis and proper treatment.

Takeaway

Burning mouth syndrome is a distressing condition causing persistent pain. Although it can be challenging to diagnose, consulting a healthcare provider is the most effective way to manage and ease the discomfort. It’s also important to discuss your symptoms with the doctor so that they can help you find relief.