Patients usually experience it on the tongue, but some patients feel burning in multiple areas of the mouth, including the lips, top, or bottom of the mouth. As many as 15 percent of the population can experience symptoms at some point in their life, but less than one percent of patients report continuous burning symptoms. It is more common in females and in middle-aged or older patients. Typically, the oral cavity appears normal.
Patients with burning mouth syndrome may experience symptoms including:
The cause of primary burning mouth syndrome is unknown but thought to be due to an issue with the nerves, called a neuropathy. There may be a hormonal link as almost 90 percent of patients are post-menopausal women. However, the exact link between estrogen and burning mouth syndrome is unknown. Patients with burning mouth syndrome are also more likely to have a psychiatric comorbidity, such as depression or anxiety, but this is not thought to be the cause of the disorder.
It is important to rule out other causes of mouth pain, such as thrush, vitamin deficiencies, medications, and growths or lesions. Some patients with burning in the mouth have a vitamin deficiency so your doctor may recommend lab work for certain vitamins, such as vitamin B, folate, iron, and zinc. Some blood pressure medications, antiretrovirals, and antidepressants can cause oral pain.
Other diseases like oral lichen planus and Sjogren’s disease, which are autoimmune diseases, may be confused with burning mouth syndrome. Uncontrolled diabetes, thyroid problems, and reflux may also worsen burning mouth sensations. It can also be caused by Ill-fitting dentures or teeth grinding. Oral allergies from foods, dental work, or oral care products can also cause burning in the mouth.
Treatment depends on whether a secondary cause is found. Thrush should be treated with antifungal medication, and any vitamin deficiency should be treated with vitamin supplementation. If a medication is suspected to be the cause, an alternative medication may be recommended. However, never stop a medication without consulting with your prescribing doctor first.
Your ENT (ear, nose, and throat) specialist, or otolaryngologist, may need to work with your primary care provider to treat any uncontrolled diabetes or thyroid issues. Switching oral care products can help some patients, and food avoidance may be recommended if a food allergy is suspected. Your doctor may recommend seeing a dentist to make sure there are no issues with dentures or teeth grinding. Reflux medications may be recommended. If dry mouth syndrome is the cause, there are many different treatment options.
Lifestyle changes can help alleviate some of the symptoms of burning mouth syndrome, such as reducing or eliminating alcohol and tobacco products. Certain foods such as spicy or acidic foods can make symptoms worse and should be avoided. Frequent sips of cold water can also help.
If no underlying cause is found, there are some medications that have been found to be effective. Clonazepam, which helps depress the nervous system, is often a “first-line” therapy. Antidepressants, such as paroxetine or sertraline, and gabapentin, a medication that also depresses the nervous system, are sometimes used for burning mouth syndrome. There is disagreement in medical literature if alpha-lipoic acid is beneficial for burning mouth syndrome, but some patients have found it to be beneficial. Certain topical medications such as anesthetics, anti-inflammatory medications, sucralfate, and capsaicin have been used with varying success in patients and may be recommend in certain patients.
Even though there is a hormonal link to burning mouth syndrome, hormone replacement therapy is usually not recommended. Cognitive behavioral therapy or psychotherapy has been shown to be very beneficial in patients with burning mouth syndrome. Your doctor may recommend a consultation with a psychiatrist in certain cases. Fortunately, data suggest that up to 50 percent of patients have some resolution of symptoms without any treatment within a few years of diagnosis.
Minor JS, Epstein JB. Burning mouth syndrome and secondary oral burning. Otolaryngol Clin North Am. 2011 Feb;44(1):205-19, vii. doi: 10.1016/j.otc.2010.09.008. PMID: 21093630
Zakrzewska J, Buchanan JA. Burning mouth syndrome. BMJ Clin Evid. 2016 Jan 7;2016:1301. PMID: 33830201
Last reviewed February 2022.
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