Burning Mouth Syndrome (Burning Tongue Syndrome/Scalded Mouth Syndrome/Glossodynia/ Burning Lips Syndrome/Stomatodynia) is a medical condition where the patient experiences recurrent or persistent (chronic) burning in the mouth for which there is not obvious cause seen. This burning sensation or discomfort can involve the tongue, lips, gums, inside of the cheeks, palate (roof of the mouth) and can also affect the widespread region of the entire mouth. Burning mouth syndrome is not a disease in itself, but commonly occurs as a result of some other condition. Patient experiences Burning Mouth Syndrome quite suddenly and severely as if he/she has scalded their tongue or mouth.
Till now the cause of burning mouth syndrome is not clear making it difficult to treat; although not impossible. Burning mouth syndrome occurs abruptly without any clear cause. Burning mouth syndrome can be controlled by working closely with your physician. Treating the underlying cause can relieve burning mouth syndrome.
Causes of Burning Mouth Syndrome
Primary/Idiopathic Burning Mouth Syndrome is a condition in which the patient does not have any clinical or lab abnormalities. According to research, primary burning mouth syndrome is also related to problems or damage to the sensory and taste nerves of the central/peripheral nervous system.
Secondary Burning Mouth Syndrome occurs from an underlying medical condition such as:
- Xerostomia (dry mouth) can occur as a result of certain medications, health problems, dysfunction of the salivary glands. Patient can also experience dry mouth as a side effect from cancer treatment, such as radiation.
- Other oral conditions, such as oral thrush which is a fungal infection of the mouth, oral lichen planus and geographic tongue can also cause burning mouth syndrome.
- Nutritional deficiencies, such as lack of zinc, iron, folate (vitamin B-9), riboflavin (vitamin B-2), thiamin (vitamin B-1), cobalamin (vitamin B-12) and pyridoxine (vitamin B-6) can cause burning mouth syndrome.
- Dentures, especially ill-fitting dentures, put stress on the tissues and muscles of the mouth causing burning mouth syndrome. Some dentures can have materials which irritate the tissues of the oral cavity resulting in burning mouth syndrome.
- Reactions/allergies to certain foods, flavorings, food additives, dyes, fragrances, dental-work substances can cause burning mouth syndrome.
- GERD (gastroesophageal reflux disease) in which there is reflux of stomach acid into the mouth can also cause burning mouth syndrome.
- Certain medications like anti-hypertensives, such as ACE (angiotensin-converting enzyme) inhibitors can also result in a burning sensation in the mouth.
- Bad oral habits like tongue biting, tongue thrusting, and bruxism (teeth grinding) can also cause burning mouth syndrome.
- Certain medical conditions, such as endocrine disorders like hypothyroidism and diabetes can also produce burning sensation in the oral cavity.
- Irritation to the oral cavity, such as occurring from over-brushing of the tongue, use of strong abrasive toothpastes, excessive use of the mouthwash or drinking too many acidic drinks; all these can cause burning mouth syndrome.
- Psychological conditions, such as stress anxiety and depression, can also result in burning sensation in the oral cavity.
Risk Factors for Burning Mouth Syndrome
- Postmenopausal women who are in their 50s to 70s are at an increased risk for having burning mouth syndrome than men.
- Having previous dental procedures increases the risk of burning mouth syndrome.
- Individuals with an upper respiratory tract infection are more prone to developing burning mouth syndrome.
- Use of certain medications increases the risk of burning mouth syndrome.
- Having a history of allergy to certain foods and other substances increases the risk of burning mouth syndrome.
- Patients who suffer from psychological conditions, such as depression, anxiety and undergo stressful life events, are at an increased risk for having burning mouth syndrome.
Signs & Symptoms of Burning Mouth Syndrome
- Patient has a painful or burning/tingling/scalding sensation in the oral cavity, commonly in the tongue.
- Burning sensation can also be felt in the gums, lips, palate, throat, or in the entire mouth.
- Patient can also have a numb sensation in the tongue or other regions of the mouth.
- Patient experiences mouth dryness with an increase in thirst.
- There are changes in the taste, such as a metallic or bitter taste.
- Patient can also have complete loss of taste sensation.
- There are different patterns to the burning mouth syndrome. Sometimes, the patient may have mild discomfort upon waking up and the burning sensation increases as the day progresses.
- Sometimes patient may have burning sensation in the mouth as soon as he/she wakes up and this can last the whole day or decrease also.
- Sometimes the discomfort comes and goes the whole day.
- There are no obvious physical changes seen in the tongue or in the mouth.
- Patient can have burning sensation in the mouth for months and years.
- In rare case there is complete resolution of the burning sensation.
- Patient should consult a doctor/dentist if there is excessive burning, soreness, discomfort in the tongue, gums, lips and other regions of the mouth.
Investigations for Burning Mouth Syndrome
There are no specific tests for diagnosis of burning mouth syndrome. Tests done to find out other medical conditions which cause burning mouth syndrome are:
- Blood tests, such as complete blood count, thyroid function, glucose levels, immune functioning and nutritional factors, to find out the source of the oral discomfort.
- Oral cultures/ biopsies where samples are taken from the oral cavity to find out if there is any infection and what type of infection it is (fungal, bacterial, viral).
- Allergy tests to find out the specific additives, foods and substances in the dentures to which the patient is allergic.
- Gastric reflux tests to assess for GERD.
- Salivary flow test to measure the saliva and to find out if there is any decrease in the saliva production causing the patient to have a dry mouth.
- Imaging tests, such as MRI and CT scan, to look for other underlying health problems.
- Psychological questionnaires are given to the patient for filling out to determine if the patient is suffering from stress, anxiety and depression or other such mental health conditions.
Treatment & Lifestyle Modifications for Burning Mouth Syndrome
- Treating the underlying medical conditions, such as infections of the mouth or treatment of psychological conditions, can make the burning mouth syndrome go away.
- If certain medications are causing burning mouth syndrome, then after consulting a doctor, those medicines need to be changed or stopped.
- If the patient is having any pain, then medicines are given to control the pain.
- Drinking cool fluids or sucking on a piece of ice helps in relieving any pain.
- Patient is advised to drink plenty of fluids to alleviate mouth dryness.
- Carbonated beverages and tobacco products should be strictly avoided.
- Patient should stop drinking alcohol, as it can cause irritation to the lining of the oral cavity.
- Products which contain mint or cinnamon should be avoided.
- Spicy foods and acidic foods/liquids, such as orange juice, tomatoes, coffee and soft drinks, should be avoided.
- Patient should try changing his/her toothpaste and use a flavor-free or mild type of toothpaste.
- If patient is prone to stress, then he/she should take up relaxation techniques, such as yoga, meditation etc.