Burning Mouth Syndrome – Causes And Management

Burning mouth syndrome (BMS) is a relatively uncommon condition which causes a burning sensation in the mouth, although sufferers may also describe discomfort, tingling, tenderness, and a raw feeling rather than only direct pain.  For many sufferers the typical pattern is one where pain starts in the morning and gradually gets worse throughout the day.

It is one of a small group of conditions which have poorly understood causes, no formalized treatment pathway and a neurological aspect.

Woman with burning mouth syndrome

How does it start?

Burning mouth syndrome often starts spontaneously, and although many patients report a particular event (like trauma, eating a certain food, an ulcer, dental treatment etc) which caused the problem, these can be merely coincidental, and in about half of cases no cause is found.

Where a cause can be found the possibilities include;

  • nerve damage,
  • post-menopausal hormonal changes in estrogen/progesterone levels,
  • autoimmune disease (where the body’s immune system attacks itself by mistake),
  • depression and anxiety,
  • nutritional deficiency,
  • candidal infection of the oral soft tissues,
  • acid reflux (indigestion),
  • poorly fitting dentures and
  • allergy to some dental materials.

Of these the largest single group of sufferers is post-menopausal women.

More complicated is the relationship between burning mouth syndrome and depression/anxiety.  It is common to see depression, anxiety and other psychological problems in this group, however it is often unclear which problem came first.  While depression may be a trigger for BMS, it is well established that chronic pain leads to depression and other psychiatric illness.

There are also other things which are commonly found together with burning mouth syndrome, and these include dry mouth (xerostomia), Parkinson’s Disease, and a condition where patients are much more sensitive to taste.  An alteration in the experience of taste occurs in 60% of people with burning mouth syndrome.

Due to the strong associations with other neurological conditions including increased performance of some functions, it is now assumed that burning mouth syndrome is a problem arising from within the nervous system itself.

 

What can be done about it

Traditional treatment for this condition would have been reassurance, antidepressants, anxiolytics (for calming anxious patients), anticonvulsants (for preventing seizures), etc.  A recent review of all the literature regarding treatments for this condition, however, revealed that there was no single effective treatment with a sound scientific basis currently available.1

Identifying any possible cause and treating it is useful for about half of sufferers.  For those with no obvious cause it’s necessary to find out which things which can make the condition better, which worse, and manage the symptoms accordingly.

 

Things which make the condition worse

Hot food, spicy food and acidic foods like lemon and citrus fruits can all increase the experience of pain. Speaking can increase symptoms, and tension, fatigue and stress all make the condition worse.  For this reason a slower paced lifestyle with various forms of relaxation is often beneficial.

 

Things which help

Cold is useful, and many patients are advised to suck ice cubes and sip water frequently.  Chewing sugar free gum is commonly used to reduce pain. Sleeping can improve symptoms, and drinking alcohol is said to help for some.  For others though, alcoholic mouthwashes can make things worse.  Brushing teeth and cleaning dentures with baking soda and water is sometimes useful.

One important relieving factor can be distraction.  People with burning tongue syndrome frequently find that occupying their thoughts with certain stimuli and other tasks is useful.  In addition, due to the complicated interaction between lifestyle and onset of the disease, some centres treat patients using cognitive behavioral therapy which trains patients to mentally approach certain situations which may cause pain in a way which helps them experience it less.

Due to the varied nature of the condition and response to treatment, therefore, sufferers are recommended to keep a detailed diary, including activities, foods, life events, etc, and keep this together with a note of symptoms.  Over time this can be used to gain knowledge of ways to manage the pain for a particular person.

All these things assist in coping with the condition over the long-term, and all must be tailored to the individual patient due to their subjective nature.

 

Improvement

Two-thirds of cases spontaneously resolve after six to seven years.  When the disease starts to become more intermittent it can be a sign that the condition is entering its final stages.  In about one-third of cases, however, the condition does not fully resolve.

 

Further Information

For further information the Oxford Radcliffe has a patient information document on burning mouth syndrome available in pdf format on their website.

 

References

1. Zakrzewska, JM; Forssell, H; Glenny, AM (2005 Jan 25). “Interventions for the treatment of burning mouth syndrome.” Cochrane database of systematic reviews (Online) (1): CD002779.

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