The medical condition known as burning mouth syndrome (BMS) is a diagnostic puzzle, wrapped around a causation mystery, all topped off by a smorgasbord of treatment options.
In other words, the health care world knows little about the sources of burning mouth syndrome. Its symptoms are numerous and inconsistent, and the prevailing treatment methods are varied, to say the least.
Why does my mouth burn?
You may have BMS (a.k.a. glossodynia or stomatodynia) if there is a chronic burning sensation in your mouth or lips as if you just tried to swallow boiling coffee. Other symptoms include enduring altered taste, such as a bitter or metallic taste in your mouth.
That burning sensation is the primary symptom of BMS. The pain will often begin in the late morning, build to a peak by evening, and may subside at night. However, other BMS sufferers may experience a completely different cycle of discomfort.
Tingling, numbness, loss of all sense of taste, or dryness of the tongue, lips, and mouth may sometimes replace the pain. Or you may experience all of the symptoms, either simultaneously or in random groupings.
The burning pain of BMS may last for days, months, or years. BMS may suddenly disappear and then reappear without notice, even after years without symptoms.
Who is at risk of getting burning mouth syndrome?
Postmenopausal women and women in menopause are most likely to be affected by burning mouth syndrome. According to the National Institute of Dental and Craniofacial Research, women are about five times more likely than men to be afflicted.
What causes burning mouth syndrome?
When burning mouth syndrome is caused by underlying pain conditions or other abnormalities, it is known as secondary BMS. The treatment plan for secondary BMS is relatively simple: diagnose and cure the underlying condition. Some of the underlying conditions that seem to be associated with burning mouth pain are:
- Dry mouth (xerostomia), which can be caused by some medications, various health problems, or salivary gland malfunction.
- Other mouth symptoms, such as a fungal infection of the mouth (a.k.a. thrush or candidiasis), an inflammatory condition called oral lichen planus, or the aptly named geographic tongue, in which the patient’s tongue looks like a relief map of Colorado. These conditions can be identified by standard diagnostic tools, such as a biopsy or blood test.
- Nutritional deficiencies, such as a lack of iron, zinc, and/or vitamin B12.
- Allergic reactions or other responses to food, fragrances, dyes, or metallic dentures.
- Acid reflux, known as gastroesophageal reflux disease (GERD), in which stomach acid is regurgitated into the mouth.
- Some medications, particularly those known as ACE inhibitors, which are prescribed for high blood pressure.
- Endocrine disorders, such as diabetes or an underactive thyroid.
- Sjogren’s syndrome, a systemic autoimmune disease affecting the salivary glands.
- Hormonal changes due to menopause.
- The side effects of some oral medicines.
- Psychological problems, like anxiety, depression, or stress, are also linked with BMS. But whether such mental/emotional conditions cause BMS, or result from it, (or both) is yet to be determined.
Diagnosis of primary burning mouth syndrome
Burning mouth syndrome is located within an unexplored intersection between medicine and dentistry. There are currently no diagnostic tools that can reliably identify primary BMS. So, the most effective method of diagnosing primary BMS is to eliminate all other potential causes. When every other possible cause of BMS-like symptoms has been ruled out, the patient probably has BMS.
Treatment for burning mouth syndrome
As noted above, treatment of secondary BMS is straightforward: find the causative condition and cure it. Fortunately, nearly all of the more common conditions which underlie secondary BMS are amenable to available treatment plans.
Treatment of primary BMS is a different, and more perplexing problem
There is no currently available cure for primary BMS, and there is no single effective treatment method. According to the Mayo Clinic, “solid research on the most effective methods is lacking.”
Instead, treatment is aimed at identifying and controlling the most vexing symptoms. Several treatment methods may have to be tried before the most effective protocol is determined. Those methods include:
- Replacing salivary flow with saliva replacement products
- Using oral rinses containing lidocaine
- Using toothpaste that does not contain sodium laurel sulfate, which can irritate the mouth and lips
- Applying topical capsaicin – a completely counterintuitive pain reliever – derived from red-hot chili peppers
- Taking an anticonvulsant medication like clonazepam in a low-dose prescription
- Taking antidepressants
- Using medications, such as gabapentin and amitriptyline that block neuropathic pain
- Employing cognitive-behavioral therapy to develop strategies against the anxiety and depression that result from (or perhaps cause) the chronic pain of BMS.
Can BMS be prevented?
The simple, short, and accurate answer is no. But there are steps that can reduce the frequency and intensity of BMS episodes:
- Avoid alcohol (including mouthwashes containing alcohol)
- Don’t smoke tobacco (good advice in any context)
- Avoid acidic foods like tomatoes and citrus fruits
- Shun cinnamon and mint
- Practice good oral health
- Stay away from spicy foods
- Drink a lot of fluids
- Practice relaxation, meditation, yoga
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