What You Need to Know About This Painful Problem
Burning mouth syndrome (BMS) is a painful and often frustrating condition. Some patients compare it to having burned their mouth with hot coffee. The burning sensation may affect the tongue, the roof of the mouth, the gums, the inside of the cheeks and the back of the mouth or throat or widespread areas of your whole mouth. The burning sensation can be severe, as if you scalded your mouth. Other symptoms include dry mouth or a bitter or metallic taste also may be present. This condition can afflict men or women and affects up to 7 percent of the general population, but it is especially common in women during or after menopause.
The pain can last for months or years. Some people feel constant pain every day. For others, pain increases throughout the day. They may have difficulty falling asleep. The discomfort and restlessness may cause mood changes, irritability, anxiety and depression. For many people, the pain is reduced when eating or drinking.
Causes
The exact cause of burning mouth syndrome often is difficult to pinpoint. The disorder has long been linked to a variety of other conditions: menopause, diabetes, nutritional deficiencies, tongue thrusting, disorders of the mouth (oral thrush and dry mouth), acid reflux, cancer therapy (irradiation and chemotherapy) and psychological problems.
BMS 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.
Side Effects of Medicine
Look up the side effects of any medications you are taking (such as those used to treat high blood pressure). You can ask a pharmacist, check a Physicians’ Desk Reference at the library or go to the Internet for this information. If any of your medications are reported to cause a burning sensation in the mouth, ask your physician to consider prescribing a substitute medication. Also, some medications can cause dry mouth, which might aggravate the condition.
Diagnosis
Doctors and dentists do not have a specific test for BMS, which makes it hard to diagnose. The dentist or doctor will review your medical history and examine your mouth. A lot of tests may be needed. Tests may include:
- Blood tests to check for certain medical problems
- Oral swab tests
- Allergy tests
- Salivary flow test
- Biopsy of tissue
- Imaging tests
Primary and Secondary BMS
Primary BMS: If tests do not reveal an underlying medical problem, the diagnosis is primary BMS. Experts believe that primary BMS is caused by damage to the nerves that control pain and taste.
Secondary BMS: Certain medical conditions can cause BMS. Treating the medical problem will cure the secondary BMS. Common causes of secondary BMS include:
- Hormonal changes (such as from diabetes or thyroid problem)
- Allergies to dental products, dental materials (usually metals), or foods
- Dry mouth, which can be caused by certain disorders (such as Sjogren’s syndrome) and treatments (such as certain drugs and radiation therapy)
- Certain medicines, such as those that reduce blood pressure
- Nutritional deficiencies (such as a low level of vitamin B or iron)
- Infection in the mouth, such as a yeast infection
- Acid reflux
Treatment
Your dentist can confirm the diagnosis and develop an appropriate treatment plan. The dentist will review your medical history and ask you to describe your symptoms. First, any oral conditions causing the burning sensations should be investigated. For example, if you have dry mouth, your dentist may advise that you drink more fluids or may suggest saliva replacement products that can be purchased at a pharmacy. An oral swab or biopsy may be used to check for thrush, which is a fungal infection; thrush can be treated with oral antifungal medications. Any irritations caused by sharp or broken teeth or by a removable partial or full denture should be eliminated.
If your dentist determines that no oral conditions are causing the burning sensation and the steps listed above do not resolve the problem, disorders such as diabetes, abnormal thyroid conditions, Sjogren’s syndrome (a rheumatological disorder), mineral deficiencies or food allergies should be investigated. This usually involves referral to your family physician and the use of blood tests.
Helpful Tips
To help ease the pain of BMS, sip a cold beverage, suck on ice chips, or chew sugarless gum. Avoid irritating substances, such as:
- Tobacco
- Hot, spicy foods
- Alcoholic beverages
- Mouthwashes that contain alcohol
- Products high in acid, such as citrus fruits and juices
Summary
Because BMS is a complex pain disorder, the treatment that works for one person may not work for another. Start with the simple and eliminate various possibilities. Even if a cause cannot be found, your dentist working with your physician may recommend medications to provide relief of symptoms.
Sources: National Institute of Dental and Craniofacial Research, Mayo Clinic, American Dental Association
