It can hit without warning and for no apparent reason, a burning sensation begins in the mouth and then slowly spreads to the insides of the cheek, roof of the mouth, lips, and tongue. It persists, despite frequently rinsing with water. These may be signs of burning mouth syndrome, also known as glossodynia, stomatodynia, scalded mouth syndrome, or burning lips syndrome.

Understanding Burning Mouth Syndrome

The pain of burning mouth syndrome may be present as soon as you wake up in the morning, or it can grow as the day progresses. The burning sensation may be intermittent some days and totally absent on others. There could be a tingling numbness on the tip of the tongue.

Other symptoms include:

• Increased thirst
• Loss of taste sensation
• Sore mouth
• Bitter or metallic taste

Often, the cause of burning mouth syndrome is unknown. This is referred to as “primary” burning mouth syndrome. Research suggests that primary burning mouth syndrome could be related to damaged sensory nerves of the peripheral and central nervous systems.

If the burning mouth syndrome occurs due to an underlying medical problem, then it is called “secondary” burning mouth syndrome. The conditions that can cause it include:

• Oral infections caused by yeast (thrush), a rash-causing oral disease known as lichen planus, or geographic tongue (inflammatory condition of tongue)
• Dry mouth or xerostomia
• Nutritional deficiencies of B complex (vitamin B-1, B-2, B-6, B-12) or zinc and iron
• Anxiety and depression
• Ill-fitting dentures that cause stress to tissues
• Allergy to food substances, flavoring agents, and additives
• Use of high blood pressure medications like angiotensin enzyme converting inhibitors
• Gastroesophageal reflux (acid from stomach goes back into esophagus)
• Bruxism (teeth grinding) and habitual tongue thrusting (a condition where the tongue pushes against or between the teeth and lips while swallowing)
• Endocrine disorders like hypothyroidism and diabetes
• Imbalance of hormones during menopause
• Irritation of mouth due to excess use of mouth washes and brushing too much

Your dentist or doctor may conduct a variety of tests to identify the cause of burning mouth syndrome. Blood tests will be run to check:

• Thyroid function
• Glucose levels high enough to cause mouth irritation
• Complete blood picture
• Functioning of the immune system
• Nutritional factors that may cause burning mouth syndrome

Imaging tests like CT and MRI scans are done to check for other health problems such as mass lesions. Samples of saliva are taken and cultured to check for viral, bacterial or fungal infection. Tests of saliva can also determine whether the flow of saliva is reduced to the point of dry mouth syndrome (xerostomia).

The doctor may also recommend tests to determine whether the patient is allergic to certain foods or to dentures. A test called gastric reflux can help the doctor learn whether the patient is suffering from gastroesophageal reflux disease, in which stomach acid goes back into the esophagus. Patients may also be given a questionnaire to help determine possible anxiety or depression.

For primary burning mouth syndrome, there is no known cure. After several years, it may subside gradually or cease suddenly. For relief in the meantime, doctors sometimes recommend a combination of treatments that include anticonvulsant medication, like clonazepam, in lozenges form. This has been shown to treat oral thrush, a yeast infection sometimes associated with burning mouth syndrome. Other treatments include antidepressants, B complex vitamins, doctor-recommended oral rinses to relieve pain, saliva replacement products, and pain relievers like capsaicin (derived from chilies). Patients may also undergo cognitive behavior therapy (positive thinking therapy) to offset the irritability that sometimes arises from the frustration of burning mouth syndrome.

For secondary burning mouth syndrome, treatment focuses on the cause of the symptoms. One example is antioxidants, like alpha lipoic acid, that have proven to be an effective treatment for patients with high glucose levels.

Management

To keep burning mouth syndrome away, it is recommended to drink plenty of fluids or suck on ice chips. You must avoid tobacco, spicy foods, cinnamon, mint, soft drinks, and acidic foods like orange juice, tomatoes, and coffee.

Change your toothpaste every month. Some research suggests a connection between specific toothpaste formulas and burning mouth syndrome. People who wear dentures should keep them clean. Stress-reduction techniques like deep breathing, yoga, and meditation may also help.

A doctor may be able to recommend support groups where you can share your experiences with people suffering from the same condition and learn new coping skills.