Burning mouth syndrome

Depiction of a person suffering from Burning Mouth Syndrome

Chronic pain disorder causing burning sensation in the mouth

Burning Mouth Syndrome (BMS) is a chronic pain condition characterized by a persistent burning sensation in the mouth without an identifiable underlying cause. It primarily affects the tongue, lips, palate, and inner cheeks, but may also involve the entire oral cavity. The condition is often associated with taste disturbances and dry mouth, despite normal salivary flow.

BMS is classified into:

• Primary BMS – Occurs with no identifiable medical or dental cause.
• Secondary BMS – Results from an underlying medical condition such as nutritional deficiencies, diabetes, or hormonal imbalances.

Symptoms

The primary symptom of Burning Mouth Syndrome is a persistent burning sensation in the oral cavity, often described as:

• Burning or scalding pain (similar to drinking a hot beverage).
• Dry mouth (xerostomia), despite normal saliva production.
• Altered taste perception – Some patients report a metallic or bitter taste.
• Increased thirst.
• Tingling or numbness in the mouth.

Symptoms may:

• Be constant or intermittent.
• Worsen throughout the day.
• Persist for months or even years.
• Improve with eating or drinking.

Causes and Risk Factors

The exact cause of Burning Mouth Syndrome is not well understood, but multiple factors may contribute to its development.

Primary BMS (Idiopathic BMS)

• Neuropathic dysfunction – Damage or dysfunction in sensory nerves of the mouth and tongue.
• Altered pain processing in the central nervous system.

Secondary BMS (Underlying Medical Causes)

Secondary BMS may be linked to:

• Hormonal imbalances – Common in menopausal women due to estrogen changes.
• Nutritional deficiencies – Low levels of:
• Vitamin B12
• Folate
• Iron
• Zinc
• Diabetes Mellitus – Poorly controlled blood sugar may contribute to nerve dysfunction.
• Oral infections – Such as oral candidiasis (yeast infection).
• Dry mouth (Xerostomia) – Due to medications, dehydration, or autoimmune conditions like Sjögren’s syndrome.
• Allergic reactions – To dental materials, toothpaste, or mouthwashes.
• Psychological factors – Stress, anxiety, and depression are commonly associated with BMS.

Diagnosis

Burning Mouth Syndrome is a diagnosis of exclusion, meaning other potential causes must be ruled out.

Diagnostic Approach

1. Detailed Medical and Dental History 2. Clinical Examination

• Inspection of the oral cavity, tongue, and mucosa for signs of infection or irritation.

3. Laboratory Tests

• Blood tests to check for nutritional deficiencies, diabetes, and hormonal imbalances.
• Salivary flow tests to evaluate xerostomia.
• Allergy testing for possible contact hypersensitivity.

4. Neurological Testing

• Sensory nerve function tests to identify neuropathic causes.

5. Biopsy (if necessary)

• To rule out oral cancer or other mucosal diseases.

Treatment and Management

There is no single cure for BMS, and treatment focuses on symptom relief and managing underlying conditions.

1. Medications

• Neuropathic pain medications:
• Gabapentin or pregabalin – Helps modulate nerve pain.
• Tricyclic antidepressants (Amitriptyline, Nortriptyline) – Alters pain perception.
• Clonazepam – A benzodiazepine that reduces neuropathic pain.
• Saliva substitutes and oral moisturizers – Helps relieve dry mouth symptoms.
• Capsaicin oral rinses – Reduces burning sensations by desensitizing nerve receptors.

2. Lifestyle Modifications

• Avoid irritants – Such as spicy foods, acidic beverages, alcohol, tobacco, and excessive caffeine.
• Stay hydrated – Drink plenty of water to alleviate dry mouth.
• Practice stress management – Engage in relaxation techniques, such as yoga, meditation, and cognitive behavioral therapy (CBT).
• Improve oral hygiene – Use non-alcoholic mouthwash and gentle toothpaste.

3. Nutritional Therapy

If deficiencies are detected, supplementation with:

• Vitamin B12
• Iron
• Folate
• Zinc

may improve symptoms.

4. Behavioral Therapy

• Cognitive Behavioral Therapy (CBT) – May help patients cope with chronic symptoms.
• Support groups and counseling – Useful for patients with associated anxiety or depression.

Prognosis

The prognosis for Burning Mouth Syndrome varies:

• Some patients experience spontaneous resolution.
• Others have long-term symptoms requiring ongoing management.
• Secondary BMS has a better prognosis if the underlying cause is identified and treated.

Prevention Strategies

While Burning Mouth Syndrome cannot always be prevented, the following measures may reduce risk:

• Maintain good oral hygiene.
• Avoid irritating foods and beverages.
• Stay hydrated.
• Manage stress and anxiety effectively.
• Address any vitamin or mineral deficiencies early.

See Also

• Xerostomia (Dry Mouth)
• Oral candidiasis
• Neuropathic pain
• Vitamin B12 deficiency
• Sjögren’s syndrome

External Links

• NCBI - Research on Burning Mouth Syndrome
• American Academy of Oral Medicine - BMS Information

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