Burning mouth syndrome

Burning mouth syndrome is the medical term for ongoing or recurring burning in the mouth without an obvious cause. You may feel this burning on your tongue, gums, lips, inside of your cheeks, roof of your mouth or large areas of your whole mouth. The feeling of burning can be severe, as if you injured your mouth with a very hot drink.

Burning mouth syndrome usually comes on suddenly, but it can develop slowly over time. Often the specific cause can't be found. Although that makes treatment more challenging, working closely with your health care team can help you reduce symptoms.

Symptoms of burning mouth syndrome may include:

• A burning or scalding feeling that most commonly affects your tongue, but also may affect your lips, gums, roof of your mouth, throat or whole mouth.
• A feeling of dry mouth with increased thirst.
• Taste changes in your mouth, such as a bitter or metallic taste.
• Loss of taste.
• Tingling, stinging or numbness in your mouth.

The discomfort from burning mouth syndrome can have several different patterns. It may:

• Happen every day, with little discomfort when waking up, but become worse as the day goes on.
• Start as soon as you wake up and last all day.
• Come and go.

Whatever pattern of mouth discomfort you have, burning mouth syndrome may last for months to years. In rare cases, symptoms may suddenly go away on their own or happen less often. Sometimes the burning feeling may be briefly relieved during eating or drinking.

Burning mouth syndrome usually doesn't cause any physical changes to your tongue or mouth that can be seen.

When to see a doctor

If you have discomfort, burning or soreness of your tongue, lips, gums or other areas of your mouth, see your health care provider or dentist. They may need to work together to help pinpoint a cause and come up with an effective treatment plan.

The cause of burning mouth syndrome may be primary or secondary.

Primary burning mouth syndrome

When the cause can't be found, the condition is called primary or idiopathic burning mouth syndrome. Some research suggests that primary burning mouth syndrome is related to problems with the nerves involved with taste and pain.

Secondary burning mouth syndrome

Sometimes burning mouth syndrome is caused by an underlying medical condition. In these cases, it's called secondary burning mouth syndrome.

Underlying problems that may be linked to secondary burning mouth syndrome include:

• Dry mouth, which can be caused by some medicines, health problems, problems with the glands that make saliva or the side effects of cancer treatment.
• Other oral conditions, such as a fungal infection of the mouth called oral thrush, an inflammatory condition called oral lichen planus or a condition called geographic tongue that gives the tongue a maplike appearance.
• Not getting enough nutrients, such as a lack of iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12).
• Allergies or reactions to foods, food flavorings, other food additives, fragrances or dyes, dental materials, or mouth care products.
• Reflux of stomach acid that enters your mouth from your stomach, also called gastroesophageal reflux disease (GERD).
• Certain medicines, especially high blood pressure medicines.
• Oral habits, such as pushing your tongue against your teeth, biting the tip of your tongue, and grinding or clenching your teeth.
• Endocrine disorders, such as diabetes or an underactive thyroid known as hypothyroidism.
• A very irritated mouth, which may result from brushing your tongue too much or too hard, using abrasive toothpastes, overusing mouthwashes, or having too many acidic foods or drinks. Dentures that don't fit well may cause irritation that can make symptoms worse.
• Psychological issues, such as anxiety, depression or stress.

Burning mouth syndrome is uncommon. However, your risk may be greater if you're:

• Female.
• In perimenopause or you're postmenopausal.
• Over the age of 50.
• A smoker.

Burning mouth syndrome usually starts suddenly, for no known reason. But certain factors may increase your risk of developing burning mouth syndrome, including:

• Recent illness.
• Some long-term medical conditions such as fibromyalgia, Parkinson's disease, autoimmune disorders and neuropathy.
• Previous dental work.
• Allergic reactions to food.
• Certain medicines.
• Traumatic life events.
• Stress.
• Anxiety.
• Depression.

Complications that burning mouth syndrome may cause are mainly related to discomfort, such as problems falling asleep or difficulty eating. Long-term cases involving a lot of discomfort also could lead to anxiety or depression.

There's no known way to prevent burning mouth syndrome. But you may be able to reduce your discomfort by not using tobacco, limiting acidic or spicy foods, not drinking carbonated beverages, and using stress management methods. Or these measures may prevent your discomfort from feeling worse.

There's no one test that can tell if you have burning mouth syndrome. Instead, your health care team will try to rule out other problems before diagnosing burning mouth syndrome.

Your health care provider or dentist likely will:

• Review your medical history and medicines.
• Examine your mouth.
• Ask you to describe your symptoms.
• Discuss your habits and routine for keeping your teeth and mouth clean.

Also, your health care provider will likely do a medical exam, looking for signs of other conditions. You may have some of the following tests:

• Blood tests. These tests can check your complete blood count, blood sugar level, thyroid function, nutritional factors and how well your immune system works. Test results may give clues about the source of your mouth discomfort.
• Oral cultures or biopsies. A cotton swab is used to get a sample for an oral culture. This can tell if you have a fungal, bacterial or viral infection in your mouth. For a biopsy, tiny pieces of tissue are taken from your mouth and sent to a lab to look at the cells.
• Allergy tests. Your provider may suggest allergy testing to see if you may be allergic to certain foods, additives, or even dental materials or mouth care products.
• Salivary measurements. With burning mouth syndrome, your mouth may feel dry. Salivary tests can tell if you have a reduced salivary flow.
• Gastric reflux tests. These tests can tell if stomach acid flows back into your mouth from your stomach.
• Imaging. Your provider may recommend an MRI, a CT scan or other imaging tests to check for other health problems.
• Medicine change. If you take a medicine that may cause mouth discomfort, your provider may change the dose or switch to a different medicine. Another option is to stop the medicine for a short time, if possible, to see if your discomfort goes away. Don't try this on your own because it can be dangerous to stop some medicines.
• Mental health questions. You may be asked to answer a series of questions that can help decide if you have symptoms of depression, anxiety or other mental health conditions that may be linked to burning mouth syndrome.

Treatment depends on whether you have primary or secondary burning mouth syndrome.

Primary burning mouth syndrome

There's no known cure for primary burning mouth syndrome. And there's no one sure way to treat it. Solid research on the most effective methods is lacking. Treatment depends on what symptoms you have and is aimed at controlling them. You may need to try several treatments before finding one or a combination that helps reduce your mouth discomfort. And it may take time for treatments to help manage symptoms.

Treatment options may include:

• Saliva replacement products.
• Specific oral rinses or lidocaine, which causes numbness to help relieve pain.
• Capsaicin, a pain reliever that comes from chili peppers.
• Alpha-lipoic acid, an antioxidant that may help relieve nerve pain.
• A medicine used to control seizures called clonazepam (Klonopin).
• Certain antidepressants.
• Medications that block nerve pain.
• Cognitive behavioral therapy to develop practical skills to address anxiety and depression, deal with stress, and cope with ongoing pain.

Secondary burning mouth syndrome

For secondary burning mouth syndrome, treatment depends on the underlying conditions that may be causing your mouth discomfort.

For example, treating an oral infection or taking supplements for a low vitamin level may relieve your discomfort. That's why it's important to try to find the cause. Once any underlying causes are treated, your burning mouth syndrome symptoms should get better.

In addition to medical treatment and prescription medicines, these self-help measures may reduce your symptoms:

• Drink plenty of liquid to help ease the feeling of dry mouth, or suck on ice chips.
• Avoid acidic foods and liquids, such as tomatoes, orange juice, carbonated beverages and coffee.
• Avoid alcohol and products with alcohol, as they may irritate the lining of your mouth.
• Don't use tobacco products.
• Don't eat irritating foods, such as spicy-hot foods.
• Avoid products with cinnamon or mint.
• Try different mild or flavor-free toothpastes, such as one for sensitive teeth or one without mint or cinnamon.
• Take steps to reduce stress and try relaxation methods.

Coping with burning mouth syndrome can be challenging. It can reduce your quality of life if you don't take steps to stay positive and hopeful.

To help you cope with the discomfort of burning mouth syndrome:

• Practice relaxation exercises, such as yoga.
• Focus on activities that give you pleasure, such as physical activities or hobbies, especially when you feel anxious.
• Try to stay socially active by connecting with family and friends.
• Join a chronic pain support group for people who have ongoing pain.
• Practice good sleep habits, such as going to bed and getting up at about the same time each day and getting enough sleep.
• Consider talking to a mental health provider to learn strategies that can help you cope.

You'll likely start by seeing your family health care provider or dentist for mouth discomfort. Because burning mouth syndrome is linked with many other medical conditions, your provider or dentist may refer you to another specialist, such as a specialist in problems of the skin (dermatologist), or ear, nose and throat (ENT), or another type of specialist.

What you can do

Here's some information to help you get ready for your appointment:

• Ask if there's anything you need to do before the appointment, such as limit your diet.
• Make a list of your symptoms, including any that may seem unrelated to your mouth discomfort.
• Make a list of key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins, herbs or other supplements that you're taking, including the doses.
• Bring a copy of any medical or dental records, including test results, that are related to this problem.
• Take a family member or friend with you, if possible, for support and to help you remember everything.
• Prepare questions ahead of time to ask your health care provider or dentist.

Questions to ask may include:

• What's likely causing my symptoms?
• Other than the most likely cause, what are other possible causes?
• What kinds of tests do I need?
• Is my mouth discomfort likely temporary or long term?
• What's the best course of action?
• Are there options to the main approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any printed materials that I can have? What websites do you suggest?

Feel free to ask other questions during your appointment.

What to expect from your doctor

Your health care provider or dentist is likely to ask you several questions, such as:

• When did you start having symptoms?
• Do you have symptoms all the time, or do they come and go?
• How severe are your symptoms?
• What, if anything, seems to make your symptoms better?
• What, if anything, seems to make your symptoms worse?
• Do you use tobacco or drink alcohol?
• Do you frequently eat acidic or spicy foods?
• Do you wear dentures?

Your health care provider or dentist may ask other questions based on your answers, symptoms and needs. Be ready to answer questions so you have time to discuss whatever is most important to you.