Burning Mouth Syndrome Causes and Treatments
A non-infectious chronic condition, burning mouth syndrome (BMS) causes a hot or burning pain or unpleasant sensation, most typically in the lips and/or tongue, and often also elsewhere in the mouth such as the palate, the insides of the cheeks and the gums.
Some people describe it as the feeling you get when you scald your mouth by eating or drinking something very hot. However, there aren’t any visible symptoms in your mouth such as redness or inflammation, and despite the burning sensation the affected areas don’t feel hot to the touch.
Sometimes called by another name such as glossodynia, glossopyrosis or scalded mouth syndrome, BMS can be accompanied by other symptoms such as a dry mouth (subjective xerostomia), an unpleasant metallic or bitter taste (dysgeusia) or feelings of numbness.
The condition is far more common in women than in men. One study of more than 48,000 people revealed 1.6 per cent of men and 5.5 per cent of women had BMS, and that the syndrome wasn’t found at all in men under 40 or women under 30 (i). Experts at the Eastman Dental Hospital, University College London Hospitals also claim they see about two or three patients with BMS each week, and that the syndrome is more common in women who are around menopause age.
How long does it last?
BMS symptoms can vary from mild to severe, with moderate pain being the most common. You may have symptoms continuously throughout the day and even at night, which can make it difficult for you to get a good night’s sleep. Classic BMS is when you don’t have any symptoms when you wake, but the symptoms start to appear as the day progresses and are most intense by the evening. It’s also possible to have symptoms coming and going during the day and night.
BMS is usually diagnosed in people who’ve had symptoms for at least four to six months without a break. On average the symptoms last for 3 - 4 years (ii), but some people have them for 12 years or longer.
Meanwhile other features of BMS can also include the following:
• Fissured tongue (cracks and grooves on the tongue)
• Painful teeth, jaw pain, discomfort or tightness
• Neck and shoulder pain
• Teeth grinding (bruxism)
• Speaking difficulties
• Nausea and gagging
• Swallowing difficulties (dysphagia)
As with any other condition that involves dealing with chronic pain, BMS can be very distressing. You may not enjoy your food or drink as much as you did before, and if you have symptoms at night you may feel tired and irritable during the daytime. Some people also find the symptoms of BMS make them feel low, and their ability to carry on with day-to-day activities may be affected. However, not all mouth pain is a sign of BMS, as similar swelling and irritation can also be felt with mouth ulcers.
What causes BMS?
Experts are undecided on what exactly causes BMS. Some believe it could be caused by damage to the nerves in the mouth that send messages to the brain. Since these nerves are damaged the brain interprets the messages incorrectly, causing pain and a burning sensation. This is why the pain of BMS is often called neuropathic pain.
In most cases of BMS there is no known underlying medical cause – this is classed as primary BMS. Secondary BMS, on the other hand, is when there is an underlying medical condition, which may include the following:
Acid reflux (acid rising from your stomach up towards your mouth)
Oral thrush (a fungal infection also called candida)
Nutritional deficiencies (including iron, folate, vitamin B12 and zinc)
Other triggers have also been suggested, including immune system problems, reactions to ingredients in toothpaste or mouthwash (or overuse of mouthwash), badly fitting dentures or an allergy to some of the materials used in dentures. Some medicines may cause BMS too, including ACE inhibitors, which are commonly given to people following a heart attack and to treat high blood pressure.
There may also be psychological triggers such as stress, anxiety and depression – though anxiety and depression are thought to make BMS worse rather than cause it.
However, one thing experts agree on completely is that BMS is not a symptom of mouth cancer.
How is it treated?
If you suspect you have BMS, first see your dentist for a check-up. If there is a dental cause – such as badly fitting dentures or an allergy to your dentures – your dentist is the best person to give you the help you need. They can adjust your dentures, for instance, or replace them if necessary. Your dentist can also prescribe medicines to treat a dry mouth or a fungal infection. However, if there isn’t a dental cause, your dentist may suggest that you see your GP or refer you to a specialist.
If you need to see your GP they may recommend a blood test to check for an underlying condition such as diabetes or thyroid problems, or to find out if you have any nutritional deficiencies that may be causing your symptoms. They may also change any medication you’ve been taking that might trigger BMS symptoms.
Treating primary BMS
In most cases there is no known cause of BMS, which usually makes treatment more challenging. If you have primary BMS your GP or specialist may recommend a course of cognitive behavioural therapy to help you cope more effectively with pain or even prescribe low-dose antidepressants if battling with pain on a daily basis is getting you down.
Other treatments for primary BMS include drugs usually prescribed for epilepsy, though these aren’t widely used as it’s thought they only benefit a few people. Oral anaesthetic gels can also sometimes offer relief, as can using a mouthwash containing anti-inflammatory and painkilling ingredients.
Acupuncture may be beneficial too, with one study suggesting three weeks of acupuncture therapy may reduce the burning sensation of BMS for up to 18 months (iii).
Treating secondary BMS
If you’re diagnosed with BMS caused by an underlying medical condition, treating the underlying problem will also treat your BMS.
This could, for instance, include taking supplements to treat a nutritional deficiency or hormone replacement therapy to address menopause symptoms. And if you’ve had blood tests that show you have a thyroid disorder or diabetes, getting your condition under control will also relieve your BMS symptoms.
How to help yourself
You can also do several things to ease the symptoms of BMS yourself, including the following:
If you smoke, consider giving up, since smoking can make the symptoms of BMS worse.
Avoid certain foods
Foods or drinks that irritate your mouth can aggravate the symptoms of BMS too. Try to avoid spicy foods, especially when your symptoms are at their worst. Acidic foods and juices can irritate your mouth as well, including vinegar, citrus fruits and tomatoes. It’s also thought that avoiding alcohol may help.
This can be particularly beneficial if you have a dry mouth, since chewing gum helps you produce more saliva. However, go for sugar-free gum, and avoid gum that contains mint or cinnamon (also steer clear of toothpaste or mouthwash that contains mint or cinnamon, as well as mouthwash containing alcohol).
Taking frequent sips of water may provide relief, or you could try sucking ice chips or crushed ice.
Avoid stress Since stress can make the symptoms of BMS worse, it’s a good idea to avoid situations that put you under a lot of pressure. But since this isn’t always possible or practical, you could try finding more time to relax. Anything that helps you feel calm is ideal Some people, for instance, find it helpful to do yoga or practise meditation. Exercise is also a great stress reliever.
Experts also recommend being socially active, which may help reduce stress and anxiety. Try spending time with friends and family members who understand how your condition affects you – or ask your GP if there’s a pain support group in your area that you can join.
You could also try using an online forum for people who live with chronic pain, such as the Pain Support forum or Pain Concern forum, where you can connect with others who are in a similar situation.
Natural relief for BMS
Besides acupuncture and lifestyle measures there are other natural treatments for BMS, including the following nutritional supplements:
Found in foods such as yeast, liver, kidney, spinach, broccoli and potatoes, alpha-lipoic acid (ALA) is a powerful antioxidant with neuroprotective properties, which means it helps to protect nerve cells from damage. ALA has shown promise as a treatment for diabetic neuropathy – another form of nerve pain found in diabetes patients – and has also been investigated as a treatment for BMS. Indeed, one study carried out by Italian researchers suggests taking an ALA supplement three times a day may relieve the symptoms of BMS significantly when compared with a placebo (dummy pill) (iv).
Another paper claims ALA has ‘remarkable’ benefits and minimal adverse effects in treating BMS compared with some medications sometimes used to treat the condition (v).
However, if you have a thyroid condition, using alpha-lipoic acid may interfere with any medicines you may be taking. People with diabetes should also be aware that alpha-lipoic acid may lower blood sugar levels. Always speak to your GP or specialist before taking alpha-lipoic acid if you have any medical condition or if you’re pregnant or breastfeeding.
Vitamin B12 and zinc
Deficiencies of both these nutrients, along with vitamin B1, B2, B6, folate and the mineral iron, have been suggested by various sources as causes of secondary BMS (ii) (vi). While there is no clear clinical evidence as yet that taking supplements of these nutrients has an effect on BMS symptoms, some experts recommend supplementation as a treatment for secondary BMS (vii).
The amino acid L-lysine is associated with good oral health as there is some evidence it may significantly reduce your risk of having a cold sore flare-up (viii). And while studies investigating its use as a treatment for BMS are yet to be carried out, it is often recommended by natural practitioners as a general oral health supplement.
Again, there is no clinical evidence for the use of vitamin C as a treatment for BMS. However, there is some anecdotal evidence that may suggest vitamin C deficiency may be a trigger for the condition.
In a letter published in Headache, The Journal of Head and Face Pain, published by the American Headache Society, Dr Earnest Murray writes about a patient who had been suffering from BMS so badly that it was difficult for her to eat or drink (ix). She was tested for underlying conditions, but none were found.
However, after noticing that her symptoms improved slightly whenever she drank orange juice, the patient started taking a high dose of vitamin C (3g per day). This, claims Dr Murray, resolved her symptoms completely, suggesting that vitamin C deficiency could be considered as another possible cause of BMS.
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