Also called: Scalded Mouth Syndrome, BMS, Stomatodynia
Andrew M. Sicklick, D.D.S.
Burning mouth syndrome (BMS) causes pain that occurs on the tongue, lips or other areas of the mouth. This symptom is often intense, and patients may feel as though they have been scalded with a hot liquid. The source of BMS is often very difficult to determine.
The pain itself unfolds differently from patient to patient. Some people experience pain that gradually intensifies during the day, whereas others experience pain that is intermittent or constant. Pain may occur for months or even years. Other symptoms associated with BMS include dry mouth (xerostomia), sore mouth, tingling and numbness in the mouth, and a taste disorder.
In many cases, no distinct cause of BMS can be identified. In other cases, the disorder may be caused by a combination of several different factors. Causes of BMS include various illnesses, medications, allergies, hormonal imbalances and psychological factors. BMS is far more likely to affect women than men, especially those who are menopausal or post-menopausal.
Diagnosis of BMS usually begins by ruling out other conditions. A physician or dentist will pay particular attention to the patient’s mouth and ask about the patient’s oral habits and oral hygiene routine. Tests such as blood tests, allergy tests, and an oral swab or biopsy, may also be ordered.
Treatment for BMS varies significantly depending on the cause of the disorder, and may include medications, dietary changes and/or psychological counseling.
Patients can best prevent symptoms by avoiding certain irritants, including alcohol-based mouthwashes, products containing cinnamon or mint, cigarette smoke and acidic liquids.
About burning mouth syndrome
Burning mouth syndrome (BMS) is a condition in which a patient experiences persistent pain that occurs on the tongue, lips or other areas of the mouth. The burning may occur for months or even years. More than 1 million adults in the United States suffer from BMS, according to the Academy of General Dentistry.
BMS is also known by many other names, including scalded mouth syndrome, burning tongue syndrome, burning lips syndrome, glossodynia and stomatodynia. It is sometimes accompanied by physical changes in the tongue (e.g., glossitis). However, the relationship between the two conditions is not fully understood.
The source of BMS is often very difficult to determine. In many cases, no distinct cause can be identified. In other cases, the disorder may be caused by a combination of several different factors. Various illnesses can cause BMS, including diabetes, Sjogren’s syndrome, thyroid problems and other conditions.
BMS is also closely associated with several other factors, including:
- Acid reflux. People who reflux acid into their mouths may experience a bitter or sour taste that resembles BMS.
- Allergies. Reactions to foods, food flavorings and other additives, fragrances, dyes and other substances may cause BMS.
- Cancer therapy. Treatments such as radiation and chemotherapy may trigger BMS.
- Hormonal imbalances. Changes in hormones, such as those associated with menopause, may trigger BMS. This may be due to how hormonal changes affect the composition of saliva.
- Medications. Drugs such as angiotensin-converting enzyme (ACE) inhibitors used to control high blood pressure may cause BMS. In addition, many medications can cause dry mouth (xerostomia), which may trigger or exacerbate BMS.
- Mouth disorders and habits. Conditions such as thrush and dry mouth can cause BMS, as can dentures that irritate the mouth, clenching and grinding of teeth (bruxism) and tongue-thrusting. Excessive irritation of oral tissues may also cause BMS. Examples of such irritation include brushing the tongue too hard, overusing mouthwashes and drinking acidic beverages.
- Nerve disturbances or damage. Damage to nerves that regulate taste and pain in the tongue may result in BMS.
- Nutritional deficiencies. A lack of certain vitamins appears to be closely associated with BMS. Such nutrients include iron, zinc, and the B vitamins folate, thiamin, riboflavin, pyridoxine and cobalamin.
- Psychological problems. Depression has been closely associated with cases of BMS. General anxiety and fear have also been reported to be associated with BMS. In some cases, these symptoms appear to trigger BMS, but in other cases they appear to result from the condition.
BMS is far more likely to affect women than men. Although all age groups are affected, the condition most often occurs in adults who are middle-aged or older. Women who are menopausal or post-menopausal are particularly likely to be affected. Patients who experience persistent pain, including burning or soreness in any area of the mouth are urged to consult their dentist or physician.
What causes burning mouth syndrome?
Ongoing research has linked burning mouth syndrome to autoimmune disease and hormonal change. For instance, the syndrome is more common in women after menopause. Another theory points to overstimulation of the nerves that supply the mouth. Acid reflux, nutritional deficiencies, and an oral infection called thrush are also strongly related. When an underlying medical condition, such as one of these, is linked to symptoms, the condition is called secondary burning mouth syndrome.
When no underlying problems are found, its called primary burning mouth syndrome, and may be harder to treat.
Signs and symptoms of BMS
The major symptom associated with burning mouth syndrome (BMS) is a burning sensation on the tongue, lips, gums, palate, insides of the cheeks or throat. This symptom is often intense, and patients may feel as though they have been scalded with a hot liquid. The pain itself unfolds differently from patient to patient. Some people experience pain that gradually intensifies during the day, whereas others experience pain that is intermittent or constant.
Other symptoms associated with BMS include dry mouth (xerostomia), thirst, mouth soreness, tingling and/or numbness, and a taste disorder.
Patients who experience BMS often report discomfort or restlessness and may experience mood changes, irritability, anxiety and depression.
Diagnosis methods for burning mouth syndrome
There is no test that can definitively diagnose burning mouth syndrome (BMS). A dentist or physician may suspect that BMS is present based on a patient’s symptoms and a lack of visible signs of irritation. Diagnosis of BMS usually begins by ruling out other conditions.
A dentist or physician will perform an examination of the mouth area and compile a thorough medical history. A physician may also perform a complete physical examination. Patients may be asked about their oral habits and oral hygiene routine.
Blood tests, such as a complete blood count and other tests designed to detect nutritional deficiencies or abnormal blood sugar levels that can cause BMS, may be ordered. Allergy testing can help determine if a patient’s reaction to foods, additives or substances in dentures is the cause of BMS.
Finally, an oral swab or biopsy can help detect conditions such as oral thrush that may be responsible for the patient’s symptoms. In many cases, diagnosis and treatment of BMS will require the participation of other medical experts, such as dentists, dermatologists, mental health professionals and others.
Treatment and prevention of BMS
Treatment for burning mouth syndrome (BMS) varies significantly depending on the cause of the disorder. For example, treatment for thrush, dry mouth (xerostomia) or other conditions that cause BMS may also relieve BMS symptoms.
On the other hand, BMS that results from depression or anxiety is often best treated by having the patient seek mental health counseling. Certain medications that treat these conditions, such as benzodiazepines (e.g., clonazepam, chlordiazepoxide) and tricyclic antidepressants, may also alleviate BMS symptoms. Nutritional deficiencies can be treated with supplements or changes in diet, whereas allergies may be treated by avoiding foods and additives that trigger symptoms.
Other techniques that can help relieve symptoms associated with BMS include:
- Ask about alternative medications. Patients whose BMS is triggered by use of certain medications are urged to ask their physician about any alternative drugs or therapies that may be less likely to cause BMS.
- Avoid potential irritants. Substances such as alcohol-based mouthwashes, products with cinnamon or mint, and cigarette smoke can exacerbate BMS. Acidic liquids such as some fruit juices, sodas and coffee can worsen BMS.
- Smooth sharp edges on teeth or fillings. Rough areas of teeth or dental restorations can be smoothed by a dentist so they do not irritate the mouth.
- Suck on ice chips or chew sugar-free gum. These substances often reduce symptoms associated with BMS. It is important to note that gum with sugar may make BMS worse.
- Brush with baking soda instead of toothpaste. Patients should not use this approach without first consulting their dentist.
- Remove dentures from the mouth at night.
Topical anesthetics appear to be of limited value in alleviating BMS symptoms. Some research has indicated that use of capsaicin (a natural chemical found in cayenne pepper) in pill form is effective in the short term. However, significant gastrointestinal side effects may prohibit its long-term use. This chemical is also available in lozenge, cream or mouth rinse forms. However, more studies are needed to verify its effectiveness in treating BMS.
Questions for your doctor regarding BMS
Preparing questions in advance can help patients to have more meaningful discussions with their physicians and dentists regarding their conditions. Patients may wish to ask their doctor the following questions related to burning mouth syndrome:
- How can you tell if I have burning mouth syndrome?
- What is the likely cause of my burning mouth syndrome?
- What happens if the cause of my burning mouth syndrome cannot be identified?
- What are my treatment options? What are the side effects of these treatments?
- What other steps can I take to prevent symptoms of burning mouth syndrome?
- Are there alternative drugs or therapies available to me so that I can avoid taking medication that might trigger symptoms?
- Should I switch from toothpaste to baking soda? If so, will I need fluoride supplements?
- Should I seek treatment for my depression or anxiety (e.g., medications, psychological counseling) as a means of reducing my BMS symptoms?
- What changes should I make to my diet that may reduce symptoms?
- If my dentures are causing symptoms, what are my treatment options?