Burning Mouth Syndrome

Burning mouth syndrome (BMS) is a common, but complex problem that causes patients to experience a burning or scalding pain on the lips and tongue (and sometimes throughout the mouth). There are often no visible signs of irritation, and the cause of the syndrome may be caused by various factors, ranging from the onset of menopause to psychological dysfunctions to vitamin deficiencies. BMS may affect up to 5 percent of Americans and usually occurs in people over age 60.

Though members of both sexes are susceptible to BMS, it occurs more frequently in older women (between 18and 33 percent of post-menopausal women are estimated to have BMS). The syndrome is also called glossodynia (tongue pain) and stomatodynia (mouth pain). BMS is not a form of nor can cause cancer.

There are a variety of symptoms associated with BMS. The main symptom is a burning sensation, ranging from moderate to severe, in your mouth, throat, lips and tongue. Many patients have described the feeling as "scalding." Other symptoms include dry mouth or a bitter or metallic taste. Patients with BMS often say that the pain is gradual and spontaneous, intensifying as the day moves along. It can affect a person's ability to fall asleep. The discomfort and restlessness associated with BMS may cause mood changes, irritability, anxiety and depression.

The exact cause of BMS is difficult to determine. In 30 percent of cases it is caused by a variety of existing conditions that affect the oral and systemic health. Some conditions include the onset of menopause, diabetes and deficiencies in such nutrients as iron, zinc, folate, thiamine, riboflavin vitamins B6 and B12, and complications to cancer therapy (radiation and chemotherapy).

In the majority of cases, no specific diagnosis for the symptoms can be made. BMS symptoms may occur from xerostomia (dry mouth), tongue thrusting, bruxism (teeth grinding), irritating or ill-fitting dentures and thrush (a common fungal infection characterized by a white lesion). Some research points to nerve disorders and damage; psychological factors, particularly depression and anxiety; allergies; acid reflux; and medications that cause dry mouth. It's not unusual for a patient suffering from BMS to have more than one cause attributed to the ailment or to have health care providers fail to find any cause at all.

About one-third of patients say BMS symptoms first appeared shortly after a dental procedure, recent illness or medication course.

BMS is difficult to diagnose because its cause can stem from any number of conditions, both physical and psychological. For this reason it's important to consult with your dentist and physician to develop an appropriate treatment plan. Your dentist will begin by reviewing your medical history and asking you to describe the symptoms. He or she may look for oral causes by taking an oral swab or biopsy to check for thrush. He or she may also look for signs of dry mouth. But because BMS is caused by so many conditions, your dentist may refer you to a general physician or specialist for other blood, allergy, liver or thyroid tests.

Treatment for BMS depends on the patient and the cause. If the cause is related to the oral cavity, your dentist has a variety of ways to provide relief. For dry mouth, your dentist may advise that you drink more fluids, or he or she may prescribe medicine that promotes the flow of saliva. Thrush may be treated with oral antifungal medications, such as nystatin or fluconazole. If dentures are the culprit, your dentist can make adjustments so they won't irritate the mouth or replace them with better-fitting dentures. Topical capsaicin, the natural chemical in cayenne pepper, may provide pain relief in some patients with BMS.

There are a variety of symptoms associated with BMS. The main symptom is a burning sensation, ranging from moderate to severe, in your mouth, throat, lips and tongue. Many patients have described the feeling as "scalding." Other symptoms include dry mouth or a bitter or metallic taste. Patients with BMS often say that the pain is gradual and spontaneous, intensifying as the day moves along. It can affect a person's ability to fall asleep. The discomfort and restlessness associated with BMS may cause mood changes, irritability, anxiety and depression.