Burning Mouth Syndrome: Causes, Symptoms, and Relief Options

Introduction

Burning Mouth Syndrome (BMS) is a chronic condition characterized by a persistent burning or scalding sensation in the mouth, often without an identifiable cause. This discomfort can affect various areas, including the tongue, lips, gums, or other parts of the mouth, and may last for months or even years. BMS can significantly impact a person’s quality of life, making it difficult to eat, drink, or speak comfortably. Although first described in medical literature in the early 20th century, the exact causes of BMS remain unclear. However, recent research has identified potential risk factors and treatment options.

This article provides a comprehensive overview of Burning Mouth Syndrome, covering its risk factors, symptoms, diagnostic tests, medications, procedures, and home remedies that may help alleviate discomfort. By understanding these aspects, patients can collaborate with their healthcare providers to manage their symptoms effectively.

Definition of Burning Mouth Syndrome

Burning Mouth Syndrome is a condition marked by a burning sensation in the mouth, often without a clear cause. This article will explore its risk factors, symptoms, diagnostic tests, medications, procedures, and home remedies that may help manage the condition.

Description of Burning Mouth Syndrome

Burning Mouth Syndrome (BMS) is a complex, chronic pain disorder that primarily affects the mouth and tongue. It is often described as a burning, tingling, or scalding sensation, similar to the feeling of burning your mouth with hot food or drink. Some individuals may also experience dry mouth, altered taste, or a metallic taste. BMS can be classified as either primary or secondary. Primary BMS occurs without an identifiable medical cause, while secondary BMS is linked to underlying conditions such as nutritional deficiencies, hormonal changes, or allergic reactions.

The progression of BMS varies from person to person. Some individuals experience worsening symptoms throughout the day, while others have constant discomfort. The condition can persist for months or years, and in some cases, it may resolve on its own. However, for many, BMS becomes a long-term issue requiring ongoing management.

Research suggests that BMS affects approximately 1-5% of the population, with a higher prevalence in postmenopausal women. It is most commonly seen in individuals over the age of 50, though it can occur in younger adults. Despite its prevalence, BMS is often underdiagnosed, as its symptoms can be mistaken for other oral health conditions.

Risk Factors for Developing Burning Mouth Syndrome

Lifestyle Risk Factors

Certain lifestyle habits can increase the likelihood of developing Burning Mouth Syndrome. Smoking or using tobacco products can irritate the mouth and contribute to BMS. Excessive alcohol consumption is another risk factor, as alcohol can dry out the mouth and exacerbate burning sensations. Additionally, frequent consumption of spicy or acidic foods may lead to or worsen BMS symptoms.

Stress and anxiety are also significant lifestyle-related risk factors. High stress levels can affect the nervous system, potentially triggering or worsening BMS symptoms. Similarly, individuals who grind their teeth (bruxism) may experience increased oral irritation, contributing to BMS.

Medical Risk Factors

Several medical conditions and treatments can increase the risk of developing Burning Mouth Syndrome. Individuals with dry mouth (xerostomia), often caused by medications or autoimmune disorders like Sjögren’s syndrome, are more likely to experience BMS. Hormonal changes, particularly in postmenopausal women, have also been linked to BMS, as fluctuations in estrogen levels can affect oral tissues.

Other medical conditions that may contribute to BMS include nutritional deficiencies, such as low levels of vitamin B12, iron, or folate. These deficiencies can alter the mouth’s mucous membranes, increasing the likelihood of burning sensations. Additionally, individuals with diabetes are at higher risk due to the impact of high blood sugar levels on nerve function and oral health.

Genetic and Age-Related Risk Factors

Age is one of the most significant risk factors for Burning Mouth Syndrome. The condition is most commonly seen in individuals over the age of 50, with postmenopausal women being particularly susceptible. This may be due to hormonal changes during menopause, which can affect the nerves and tissues in the mouth.

While there is limited evidence of a direct genetic link to BMS, some studies suggest that individuals with a family history of chronic pain conditions may be more likely to develop the syndrome. Additionally, genetic factors affecting how the body processes certain nutrients, such as vitamin B12, may also play a role in BMS development.

Clinical Manifestations of Burning Mouth Syndrome

Burning Sensation in the Mouth

The hallmark symptom of Burning Mouth Syndrome (BMS) is a persistent burning sensation in the mouth, affecting approximately 70-100% of patients. This burning can occur on the tongue, lips, gums, palate, or throughout the entire mouth. The intensity often increases as the day progresses, starting mild in the morning and worsening by evening. The exact cause of this burning sensation is not fully understood, but it is believed to be related to nerve dysfunction, where the nerves responsible for pain and taste become hypersensitive or misfire, sending pain signals to the brain even without injury or irritation.

Dry Mouth

Dry mouth, or xerostomia, is reported by 30-50% of individuals with BMS. Patients often describe a feeling of dryness or stickiness in the mouth, even though saliva production may be normal. This symptom may result from altered nerve function affecting the salivary glands or could be a side effect of medications or other underlying conditions. Dry mouth can exacerbate the burning sensation and contribute to difficulty speaking, swallowing, or tasting food. In some cases, patients may also experience thick or stringy saliva.

Altered Taste

Altered taste, or dysgeusia, occurs in about 60-70% of BMS patients. This can manifest as a reduced ability to taste (hypogeusia) or a complete loss of taste (ageusia). Some patients report that foods taste different, often describing a bitter or metallic taste. This alteration may be due to nerve damage or dysfunction in the taste pathways, causing the brain to misinterpret taste signals. This symptom can significantly impact a patient’s quality of life, reducing the enjoyment of eating and leading to changes in diet.

Metallic Taste

A metallic taste, also known as dysgeusia, is specifically reported by 10-15% of BMS patients. This unpleasant taste can be persistent or intermittent and may affect the entire mouth or be localized to certain areas, such as the tongue. The cause of metallic taste in BMS is thought to be related to nerve dysfunction, particularly in the taste buds or the nerves that transmit taste signals to the brain. This symptom can be distressing and may interfere with a patient’s ability to enjoy food and beverages.

Soreness in the Mouth

Approximately 50-60% of BMS patients experience soreness in the mouth, ranging from mild discomfort to significant pain. This soreness may be localized to specific areas, such as the tongue or gums, or affect the entire mouth. It is often described as a raw or irritated feeling, similar to the sensation of burning the mouth on hot food or drink. This symptom is likely related to the same nerve dysfunction that causes the burning sensation, as the nerves in the mouth become hypersensitive to normal stimuli.

Redness in the Mouth

Redness in the mouth is less common in BMS, occurring in about 10-20% of patients. This redness may be localized to the tongue, gums, or other areas and is often associated with inflammation or irritation. While redness is not a primary symptom of BMS, it can occur in patients with secondary conditions, such as oral infections or allergic reactions, that contribute to overall discomfort. Treating the underlying cause of the redness may help alleviate some BMS symptoms.

Sensitivity to Spicy Foods

Sensitivity to spicy foods is reported by 40-50% of BMS patients. This occurs because the nerves in the mouth are hypersensitive, making spicy foods feel more intense or painful than they would for someone without BMS. Patients may also find that acidic or salty foods cause discomfort. Avoiding these foods can help reduce irritation and prevent worsening of the burning sensation. In some cases, patients may need to make significant dietary changes to manage their symptoms.

Swelling of the Tongue

Swelling of the tongue, or glossitis, is a less common symptom of BMS, affecting about 5-10% of patients. This swelling may be mild or severe and can cause discomfort or difficulty speaking and eating. The cause of tongue swelling in BMS is not well understood, but it may be related to inflammation or irritation of the tongue’s tissues. In some cases, swelling may indicate an underlying condition, such as an allergic reaction or nutritional deficiency, contributing to BMS symptoms.

Oral Thrush

Oral thrush, a fungal infection caused by Candida, is seen in about 10-15% of BMS patients. Thrush presents as white patches on the tongue, inner cheeks, or roof of the mouth and can cause soreness or a burning sensation. While oral thrush is not a direct symptom of BMS, it can occur in patients with weakened immune systems or those using certain medications, such as antibiotics or corticosteroids. Treating the fungal infection with antifungal medications can help alleviate some of the discomfort associated with BMS.

Cracked Lips

Cracked lips, or cheilitis, are reported by 20-30% of BMS patients. This symptom may result from dry mouth, which can cause the lips to become dry and prone to cracking. Cracked lips can be painful and may bleed or become infected if not properly cared for. Using lip balm or other moisturizing products can help prevent cracking and reduce discomfort. In some cases, cracked lips may indicate an underlying condition, such as a vitamin deficiency, contributing to BMS symptoms.

Diagnostic Evaluation of Burning Mouth Syndrome

The diagnosis of Burning Mouth Syndrome (BMS) is primarily made through a process of exclusion, meaning other potential causes of the symptoms must be ruled out before confirming BMS. This typically involves a thorough review of the patient’s medical history, a clinical examination, and diagnostic tests to rule out conditions such as infections, nutritional deficiencies, allergies, or autoimmune disorders. Since there is no specific test for BMS, the diagnosis is often made after excluding other possible causes. Below are some diagnostic evaluations that may help identify or rule out other conditions.

Blood Tests

Blood tests are commonly used to evaluate underlying conditions that may be causing BMS symptoms. These tests measure levels of various nutrients, hormones, and other substances in the blood to check for deficiencies, imbalances, or signs of infection. For example, blood tests may check for vitamin B12, iron, or folate deficiencies, which can cause symptoms similar to BMS. Blood tests can also evaluate thyroid function, as thyroid disorders can sometimes cause burning sensations in the mouth.

If blood tests show normal levels of nutrients, hormones, and other substances, this helps rule out conditions like nutritional deficiencies, thyroid disorders, or infections as the cause of symptoms. If blood tests reveal an underlying condition, such as a vitamin deficiency or thyroid disorder, treating that condition may alleviate BMS symptoms.

Allergy Tests

Allergy tests determine if an allergic reaction is contributing to BMS symptoms. These tests identify allergies to foods, medications, or other substances that may cause irritation or inflammation in the mouth. Allergy testing can be done through skin prick tests, where small amounts of allergens are introduced to the skin to see if a reaction occurs, or through blood tests that measure specific antibodies associated with allergic reactions.

If allergy tests are negative, this helps rule out allergies as the cause of symptoms. If an allergy is identified, avoiding the allergen may help reduce BMS symptoms. If no allergies are found and other potential causes are ruled out, a diagnosis of BMS may be considered.

Salivary Flow Measurement

Salivary flow measurement evaluates the function of the salivary glands to determine if dry mouth is contributing to BMS symptoms. This test measures the amount of saliva produced over a specific period, either by collecting saliva in a container or using absorbent pads placed in the mouth. Reduced salivary flow can indicate conditions like Sjögren’s syndrome or other autoimmune disorders affecting the salivary glands.

If salivary flow is normal, this helps rule out conditions like Sjögren’s syndrome or other disorders causing dry mouth. If salivary flow is reduced, further testing may be needed to determine the underlying cause. If tests are negative and other potential causes are ruled out, a diagnosis of BMS may be considered.

Oral Mucosal Biopsy

An oral mucosal biopsy involves taking a small tissue sample from the mouth lining to examine under a microscope. This test checks for signs of infection, inflammation, or other abnormalities that may be causing BMS symptoms. The biopsy is typically performed using a local anesthetic, and the tissue sample is sent to a laboratory for analysis.

If the biopsy shows no signs of infection, inflammation, or other abnormalities, this helps rule out conditions like oral lichen planus, fungal infections, or autoimmune disorders as the cause of symptoms. If the biopsy reveals an underlying condition, such as an infection or autoimmune disorder, treating that condition may alleviate BMS symptoms.

Imaging Studies

Imaging studies, such as X-rays, CT scans, or MRIs, may be used to evaluate the structures of the mouth, jaw, and surrounding tissues. These tests help identify abnormalities, such as tumors, cysts, or other growths, that may be causing BMS symptoms. Imaging studies are typically used when other diagnostic tests have not provided a clear explanation for the symptoms.

If imaging studies show no abnormalities, this helps rule out structural issues, such as tumors or cysts, as the cause of symptoms. If imaging studies reveal an underlying condition, such as a tumor or cyst, further treatment may be necessary to address that condition.

What if All Tests are Negative but Symptoms Persist?

If all diagnostic tests are negative but symptoms of burning, dryness, or altered taste persist, it is important to follow up with your healthcare provider. In such cases, a diagnosis of Burning Mouth Syndrome may be made based on the exclusion of other conditions. Your healthcare provider may recommend treatments aimed at managing symptoms, such as medications, lifestyle changes, or therapies to reduce discomfort and improve quality of life.

Treatment Options for Burning Mouth Syndrome

Medications for Burning Mouth Syndrome

Clonazepam

Clonazepam, commonly used to treat seizures and anxiety, belongs to a class of medications called benzodiazepines, which work by calming the brain and nerves. For Burning Mouth Syndrome (BMS), clonazepam may help relieve nerve-related pain and discomfort.

It is often prescribed when other treatments have not provided sufficient relief. Clonazepam can be taken orally or applied topically by dissolving the tablet in the mouth. Due to the potential for dependence, it is typically used for short-term treatment.

Symptom relief may occur within days to weeks, but long-term use is discouraged. The medication should be gradually tapered off under medical supervision to avoid withdrawal symptoms.

Amitriptyline

Amitriptyline, a tricyclic antidepressant, is sometimes used to manage chronic pain, including Burning Mouth Syndrome. It works by altering brain chemicals to reduce pain and improve mood.

This medication is often prescribed when BMS is linked to nerve pain or when patients also experience depression or anxiety. Taken orally, usually at bedtime, it can cause drowsiness.

Improvements may be noticed after several weeks, but full benefits can take 6-8 weeks. Common side effects include dry mouth and drowsiness, which often improve with continued use.

Gabapentin

Gabapentin, an anticonvulsant, is also used to treat nerve pain. For Burning Mouth Syndrome, it helps reduce the burning sensation by calming overactive nerves.

Gabapentin is prescribed when other treatments have been ineffective. It is taken orally, with the dosage gradually increased to minimize side effects such as dizziness or fatigue.

Relief may begin within a few weeks, but full effects can take up to a month. Long-term use may be necessary depending on the severity of symptoms.

Benzodiazepines

Benzodiazepines, including clonazepam and diazepam, calm the nervous system and are sometimes used to treat anxiety, muscle spasms, and nerve pain.

For Burning Mouth Syndrome, benzodiazepines may be prescribed when anxiety or stress contributes to symptoms. They provide short-term relief but are not a long-term solution due to the risk of dependence.

Patients may experience rapid relief, but these medications are often combined with other treatments for more comprehensive management.

Antidepressants

Antidepressants, particularly tricyclic antidepressants like amitriptyline or selective serotonin reuptake inhibitors (SSRIs), can be used to treat Burning Mouth Syndrome. These medications work by altering neurotransmitter levels in the brain, which can reduce pain and improve mood.

They are prescribed when BMS is associated with mood disorders or nerve pain. Taken orally, the dosage is adjusted based on the patient’s response.

It may take several weeks to notice improvements. Side effects such as dry mouth, drowsiness, or weight gain may occur but often diminish over time.

Topical Treatments for Burning Mouth Syndrome

Topical Anesthetics

Topical anesthetics, such as lidocaine, numb the surface of the skin or mucous membranes. For Burning Mouth Syndrome, they can be applied directly to the affected areas to provide temporary relief from burning sensations.

These medications offer short-term relief and are applied as needed. While not a long-term solution, they can help manage acute flare-ups.

Patients can expect immediate but short-lived relief, typically lasting a few hours, with repeated applications as necessary.

Capsaicin

Capsaicin, the active component in chili peppers, is used in topical creams or oral rinses to treat pain by desensitizing nerves that transmit pain signals.

For Burning Mouth Syndrome, capsaicin is sometimes used in low concentrations to reduce burning sensations. It can be applied topically or used as an oral rinse, though it may initially increase burning before providing relief.

Relief may occur after several days to weeks of consistent use, but the initial discomfort may discourage some patients from continuing treatment.

Supplements and Alternative Treatments for Burning Mouth Syndrome

Vitamin B Supplements

Vitamin B deficiencies, particularly B12, have been linked to Burning Mouth Syndrome in some patients. Vitamin B supplements can correct these deficiencies and reduce symptoms.

Supplements are recommended when blood tests reveal a deficiency. They can be taken orally or administered via injection, depending on the severity of the deficiency.

Patients with confirmed deficiencies may notice improvements within a few weeks. However, if BMS is unrelated to a vitamin deficiency, this treatment may not be effective.

Alpha-Lipoic Acid

Alpha-lipoic acid, an antioxidant, may reduce nerve pain and inflammation, potentially alleviating the burning sensation in Burning Mouth Syndrome by protecting nerve cells from damage.

This supplement is taken orally and is often used alongside other treatments. While generally safe, its effectiveness varies among patients.

Some may experience relief within weeks, while others may not notice significant improvements. It is typically used as a complementary treatment rather than a primary therapy.

Oral Rinses

Oral rinses containing ingredients like capsaicin, lidocaine, or corticosteroids can soothe the mouth and reduce burning sensations. These rinses work by numbing the area or reducing inflammation.

Oral rinses are a short-term solution for symptom relief. They are swished around the mouth for a few minutes and then spit out. Depending on the ingredients, they may be used multiple times per day.

Patients can expect temporary relief, but the effects are usually short-lived. Oral rinses are often combined with other treatments for more sustained relief.

Improving Burning Mouth Syndrome and Seeking Medical Help

In addition to medical treatments, several home remedies can help manage Burning Mouth Syndrome symptoms:

1. Avoiding spicy foods: Spicy foods can irritate the mouth and worsen symptoms, so it’s best to avoid them.
2. Staying hydrated: Drinking plenty of water helps keep the mouth moist and reduces discomfort.
3. Using a humidifier: A humidifier adds moisture to the air, which may help alleviate dry mouth symptoms.
4. Practicing stress management: Stress can exacerbate BMS symptoms, so relaxation techniques like meditation or deep breathing may help.
5. Avoiding alcohol: Alcohol can irritate the mouth and worsen burning sensations.
6. Quitting smoking: Smoking dries out the mouth and irritates mucous membranes, worsening symptoms.
7. Using lip balm: Lip balm protects the lips from dryness and irritation.
8. Eating smaller meals: Smaller, more frequent meals may reduce discomfort during eating.
9. Maintaining good oral hygiene: Regular brushing and flossing help prevent infections and other oral health issues that may worsen BMS.
10. Trying herbal teas: Herbal teas like chamomile or licorice root may have soothing properties that reduce discomfort.

If you experience persistent Burning Mouth Syndrome symptoms, seek medical help. Telemedicine offers a convenient way to consult healthcare providers from home. Through virtual visits, you can discuss symptoms, receive a diagnosis, and explore treatment options without needing an in-person appointment.

Living with Burning Mouth Syndrome: Tips for Better Quality of Life

Living with Burning Mouth Syndrome can be challenging, but you can take steps to improve your quality of life. In addition to following your treatment plan and trying home remedies, consider these tips:

1. Keep a symptom diary to track triggers and what helps alleviate symptoms.
2. Stay connected with your healthcare provider through regular follow-up appointments, especially if symptoms change or worsen.
3. Join a support group or online community to share experiences and learn from others managing BMS.
4. Focus on self-care, including getting enough sleep, eating a balanced diet, and engaging in activities that bring joy and relaxation.

Conclusion

Burning Mouth Syndrome is a complex condition that can significantly impact daily life. However, with the right combination of medical treatments, home remedies, and lifestyle adjustments, many patients find relief. Early diagnosis and treatment are key to managing BMS effectively and preventing complications.

If you are experiencing Burning Mouth Syndrome symptoms, don’t hesitate to reach out to our primary care telemedicine practice. Our healthcare providers are here to help you navigate treatment options and find the best approach for your needs. Schedule a virtual consultation today to take the first step toward relief.

James Kingsley

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