Risk Factors, Prevention, and Treatment of Burning Mouth Syndrome

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Condition

Burning Mouth Syndrome

Scalding, burning, and/or tingling in the mouth that may be accompanied by a metallic taste, dry mouth, thirst, and more

Prevalance: Very rare (under 20,000 cases each year in the US)

Ages Affected: All, most common in women over 50

    • Burning/scalding sensation in the mouth
    • Metallic taste
    • Dry mouth
    • Heightened thirst
    • Chronic pain
    • Loss or changes in sense of taste
    • Foods/supplements
    • Mouth Rinses
    • Lifestyle changes (quitting smoking & more)

Burning mouth syndrome, also called glossodynia or stomatodynia, can sound mysterious and concerning. While only two percent of the general population suffers from this, certain stages in life, conditions, and other factors may be putting you at risk.

How can you prevent yourself from this diagnosis, and how can you treat the discomfort if it does occur? Here, we discuss the burning questions of BMS.

What is burning mouth syndrome?

The National Institute of Dental and Craniofacial Research defines burning mouth syndrome as feeling of burning, tingling, or scalding in the mouth. Other symptoms of BMS can be dry mouth and changed taste.

Clearly, this difficult and distressing condition that can affect many areas of life. This uncomfortable sensation can last for days, weeks, or even years in more serious cases.

While BMS may have a specific set of sensations, there is a distinction that doctors must make between primary and secondary burning mouth syndrome.

Primary BMS is the diagnosis when no clinical or lab irregularities are found. In this case, issues in taste or the central or peripheral nervous system may be to blame.

 

Secondary burning mouth syndrome occurs when another condition is the underlying cause. Dry mouth, acid reflux, hormonal imbalances, psychological factors like stress and depression, and certain medications can cause this burning or scalding pain.

Oral habits, such as tongue thrusting, tongue biting, and bruxism can also be culprits. Nutritional deficiencies are also known to cause secondary BMS.

The prevalence of burning mouth syndrome is fairly low. In one study, no men under 40 were affected, and less than 1% of those under 50 experienced the syndrome. The incidence raised to 3.7% by seventy years old.

Women are much more likely to experience BMS, and there was a .6% incidence in women under 40. However, this number grew to a much higher statistic of 12% in postmenopausal women. In fact, burning mouth syndrome is five times more likely in women than men by age 70.

Symptoms of Burning Mouth Syndrome

No two people experience the sensation of burning mouth precisely the same way. These are some of the most common symptoms:

  • Burning/scalding sensation in the mouth
  • Metallic taste
  • Dry mouth
  • Heightened thirst
  • Chronic pain
  • Loss or changes in sense of taste

Though the symptoms of BMS can vary from person to person, one in particular stands out. A burning sensation or scalding feeling through in the mouth is very common, and can be accompanied by a metallic taste. This may occur in one part of or the whole mouth.

Burning mouth symptoms can happen in different patterns, like worsening as the day progresses, coming and going, or ongoing symptoms from when you wake up. Though geographic tongue, a condition marked by raised “map-like” appearance of the tongue, may accompany the syndrome, it generally does not cause changes to the mouth.

Unfortunately, these symptoms can last for days, months, or even years.

Diagnosing BMS can be done in a number of ways. Blood tests or taking a swab of the oral biome are two common methods. Your health care provider may also order an allergy test, salivary or gastric tests, or even imaging services.

The type of testing you need will depend on your symptoms, medical history, and conversation with your doctor.

Causes & Risk Factors

There are several conditions that can cause the sensations also experienced during burning mouth syndrome. These can include: Sjogren’s syndrome, cancer treatments like chemotherapy or radiation, some low blood pressure medications, or a deficiency of the B vitamins or iron.

Also on the list are diabetes, acid reflux, thyroid issues, an oral fungal infection, ill-fitting dentures, or allergic reactions.

All of these are possible causes of burning sensations in the mouth. Even if scalding or burning feelings in the mouth occur, BMS may not be to blame.

In order to make a diagnosis and differentiate between primary and secondary burning mouth syndrome, physicians must rule out other conditions first.

Primary BMS has several identifiable risk factors. Women are more likely to experience the condition, especially postmenopausal women and those over the age of fifty. The same goes for patients who have recently experienced dry mouth, traumatic life events, high stress, or anxiety and depression that has gone undiagnosed. The sensation from acidic foods can also occasionally be mistaken for BMS.

Having a certain illness or medical condition can also contribute to the risk of burning mouth syndrome. Things to watch for in your medical history include fibromyalgia, Parkinson’s disease, neuropathy, and some autoimmune disorders. Many of these come with nervous system issues, which can play into the syndrome as discussed below.

While we have yet to find a single, precise cause of BMS, there are a few factors to consider. The nervous system, both peripheral and central, may be the most decisive factor.

Nerve disturbance or damage in the mouth may spark this syndrome. Some of these phantom sensations may also result from damage to the taste system.

Potential Complications

Unfortunately, burning mouth syndrome doesn’t just affect your oral health. Due to taste and pain issues, patients with BMS may experience difficulty eating, and therefore, weight loss. Since the syndrome can occur anytime, they may also experience poor sleep quality.

Even if they weren’t a contributing factor to primary BMS, the accompanying discomfort can take a mental and emotional toll on patients. Some may develop depression, anxiety, and irritability as a result of the syndrome.

While the syndrome and complications sound dire, there is hope for burning mouth syndrome. Preventative measures are available, and there are many natural treatments that can provide sweet relief.

How to Prevent Burning Mouth

Burning mouth prevention is not only possible, but even simple in some cases.

The immediate step to take to avoid this painful phenomenon is to avoid smoking. Smoking can dry out the mouth and cause a host of other dental issues, not to mention oral cancer.

Alcohol is also wise to avoid, as are mouthwashes that contain it. Staying away from spicy foods and carbonated beverages may also help to prevent burning mouth.

There is also a host of oral medicine that may put you at higher risk for BMS. If you’re concerned about developing burning mouth, let your doctor know so they can tailor any medical advice and prescriptions. Here are some medications that can cause burning mouth:

  • High blood pressure medications that are ACE inhibitors and angiotensin receptor blockers, such as:
  • Antiretrovirals, or drugs used to manage HIV/AIDS:
    • Nevirapine
    • Efavirenz

If you are prescribed any of these, a simple medication adjustment may be able to help calm your burning mouth symptoms.

Traditional & Home Treatment

In both primary and secondary BMS, it’s important to treat the underlying causes to provide relief. In the interim, your healthcare team may prescribe:

  • Painkillers specially formulated to block nerve pain
  • Saliva replacement products
  • Certain oral rinses and mouthwashes
  • Tricyclic antidepressants like Elavil, Amitriptyline, and Nortriptyline
  • Sedatives like Klonopin (brand name Clonazepam)
  • Anticonvulsants like Neurontin or Gabapentin

While these prescriptions can help in some cases, they can also make matters worse. Many of them come with side effects that can be moderate to severe. Some even cause dry mouth, or xerostomia, which can exacerbate BMS symptoms.

Thankfully, there are many home treatments that can also bring relief. The American Academy of Oral Medicine states that up to two thirds of BMS patients will experience at least partial relief within three months of treatment.

Foods and Supplements

Vitamin B-12 can significantly reduce symptoms as well. This vitamin can be taken as a supplement or found in foods like organic yogurt, beef and chicken liver, or fish like wild-caught salmon, tuna, and sardines.

Iron-rich foods can also help. In one study, 53% of patients with BMS had an iron deficiency, and foods like many of the B12 foods mentioned above, dark chocolate, lentils, pistachios, raisins, spinach, and spirulina.

Alpha lipoic acid supplementation made an improvement in 64% of patients. Foods with a high level of alpha lipoic acid include broccoli, Brussels sprouts, tomatoes, peas, and beets.

Rinses

A capsaicin rinse can improve symptoms in 80% of patients. Capsaicin is a chemical found in chili peppers, and has been shown to treat peripheral nerve pain.

Baking soda rinse. This cost-effective solution is easy to whip up when burning mouth hits. Just grab a mug and combine one third of a cup of water with a teaspoon and ½ teaspoon of baking soda.

Lifestyle Changes

Reducing stress. Stress and any resulting depression or anxiety can be risk factors for burning mouth syndrome. Reducing this stress can reduce the symptoms of burning mouth syndrome. Implementing calming practices like yoga, journaling, or even cognitive behavioral therapy can regulate symptoms and improve quality of life.

Stay hydrated. Sucking (not chewing!) on ice chips, taking frequent sips of water, and chewing on sugarless gum can all keep the mouth hydrated and saliva production at helpful levels.

Burning Mouth: A Gut Problem?

I often say that the mouth is an indicator of overall health, and can show us issues happening in other parts of the body. While burning mouth syndrome certainly feels like an oral issue, it may start somewhere else entirely.

The 100 trillion bacteria in your gut can affect many systems in the body, including mental health, nutrient deficiencies, and poor sleep—problems associated with BMS.

A study from 2016 found that a sore tongue, dry mouth, and burning could be indicators of gut imbalances, like stomach autoimmunity issues (APCA).

This autoimmune problem causes the immune system to attack and destroy the cells lining your stomach, which also produce stomach acid. This acid helps us to absorb vitamins and minerals, digest protein, and prevent parasites. It also stops the overgrowth of harmful bacteria and fungus.

This burning mouth syndrome, while difficult, may have a silver lining. Not only do fungal overgrowths and nutritional issues sometimes accompany BMS, but its symptoms may help us catch gut issues. For the full story on the stomach and burning mouth, take a look at Dr. Michael Ruscio’s comprehensive piece.

Living with Burning Mouth

For patients living with burning mouth, relief is possible. On top of the natural treatments I recommend above, you can ease other complications.

I recommend CBD oil for natural pain relief, as well as to ease sleep and anxiety.

Don’t hesitate to combine treatment methods, like CBD oil with your new nutrient-rich diet or journaling with constant sipping from a water bottle.

FAQs

Q:

Is there a cure for burning mouth syndrome?

A: There is no one cure, but the treatments and suggestions in this article can provide relief. Many patients begin experiencing relief within the first few weeks of treatment. Many cases can be resolved over time.
Q:

How long does burning mouth last?

A: Each case is different. Some cases resolve in just a few days, while others can last months or even longer. While there’s no universal timeline for BMS, the symptoms can be managed with treatment. Also, the time needed to treat conditions causing secondary burning mouth will determine how long those cases last.
Q:

Is burning mouth syndrome contagious?

A: The condition is not contagious, since it’s based on the individual’s nervous system. You cannot catch BMS from being around it.
Q:

What other oral conditions can contribute to BMS?

A: An overgrowth of fungi like oral thrush or the painful condition of oral lichen planus can cause burning mouth syndrome as a side effect. So can behaviors like tooth grinding, tongue thrusting, or tongue biting.

Key Takeaways: Burning Mouth Syndrome

Burning mouth syndrome is a painful condition that affects tens of thousands of Americans.
Primary BMS is a nervous and taste issue, while secondary BMS can result from a variety of factors and coexisting conditions.

Women, especially after menopause, and individuals under high stress or taking certain medications are at a higher risk for burning mouth syndrome.

Thankfully, there are many safe natural treatments of rinses, lifestyle changes, and dietary changes that bring relief to burning mouth. Though BMS is unpleasant to deal with, the pain and discomfort can be managed and there is hope for those suffering.

17 References

  1. Puhakka, A., Forssell, H., Soinila, S., Virtanen, A., Röyttä, M., Laine, M., … & Jääskeläinen, S. K. (2016). Peripheral nervous system involvement in primary burning mouth syndrome—results of a pilot study. Oral diseases, 22(4), 338-344. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/26847146
  2. Bergdahl, M., & Bergdahl, J. (1999). Burning mouth syndrome: prevalence and associated factors. Journal of Oral Pathology & Medicine, 28(8), 350-354. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/10478959
  3. Grushka, M., Epstein, J. B., & Gorsky, M. (2002). Burning mouth syndrome. American family physician, 65(4). Abstract: https://www.nidcr.nih.gov/health-info/burning-mouth
  4. Aggarwal, A., & Panat, S. R. (2012). Burning mouth syndrome: A diagnostic and therapeutic dilemma. Journal of clinical and experimental dentistry, 4(3), e180. Abstract: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917644/
  5. Netto, F. O. G., Diniz, I. M. A., Grossmann, S. M. C., de Abreu, M. H. N. G., do Carmo, M. A. V., & Aguiar, M. C. F. (2011). Risk factors in burning mouth syndrome: a case–control study based on patient records. Clinical oral investigations, 15(4), 571-575. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/20440632
  6. Femiano, F. (2004). Damage to taste system and oral pain: burning mouth syndrome. Minerva stomatologica, 53(9), 471-478. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/15499299
  7. Castells, X., Rodoreda, I., Pedrós, C., Cereza, G., & Laporte, J. R. (2002). Dysgeusia and burning mouth syndrome by eprosartan. Bmj, 325(7375), 1277. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC136926/
  8. Triantos, D., & Kanakis, P. (2004). Stomatodynia (burning mouth) as a complication of enalapril therapy. Oral diseases, 10(4), 244-245. Abstract: https://www.researchgate.net/publication/8511747_Stomatodynia_burning_mouth_as_a_complication_of_enalapril_therapy
  9. Savino, L. B., & Haushalter, N. M. (1992). Lisinopril-induced “scalded mouth syndrome”. Annals of Pharmacotherapy, 26(11), 1381-1382. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/1335803
  10. Grushka, M., Epstein, J. B., & Gorsky, M. (2002). Burning mouth syndrome. American family physician, 65(4). Full text: https://www.aafp.org/afp/2002/0215/p615.html
  11. Sun, A., Lin, H. P., Wang, Y. P., Chen, H. M., Cheng, S. J., & Chiang, C. P. (2013). Significant reduction of serum homocysteine level and oral symptoms after different vitamin‐supplement treatments in patients with burning mouth syndrome. Journal of Oral Pathology & Medicine, 42(6), 474-479. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/23297780
  12. Bergdahl, J., & Anneroth, G. (1993). Burning mouth syndrome: literature review and model for research and management. Journal of oral pathology & medicine, 22(10), 433-438. Abstract: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0714.1993.tb00120.x
  13. Palacios-Sánchez, B., Moreno-López, L. A., Cerero-Lapiedra, R., Llamas-Martínez, S., & Esparza-Gómez, G. (2015). Alpha lipoic acid efficacy in burning mouth syndrome. A controlled clinical trial. Medicina oral, patologia oral y cirugia bucal, 20(4), e435. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/26034927
  14. Silvestre, F. J., Silvestre-Rangil, J., Tamarit-Santafé, C., & Bautista, D. (2012). Application of a capsaicin rinse in the treatment of burning mouth syndrome. Medicina oral, patologia oral y cirugia bucal, 17(1), e1. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/21743415
  15. Miziara, I., Chagury, A., Vargas, C., Freitas, L., & Mahmoud, A. (2015). Therapeutic options in idiopathic burning mouth syndrome: literature review. International archives of otorhinolaryngology, 19(01), 086-089. Full text: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-48642015000100086
  16. Sun, A., Chang, J. Y. F., Wang, Y. P., Cheng, S. J., Chen, H. M., & Chiang, C. P. (2016). Effective vitamin B12 treatment can reduce serum antigastric parietal cell antibody titer in patients with oral mucosal disease. Journal of the Formosan Medical Association, 115(10), 837-844. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/27474730
  17. Bookout, G. P., & Short, R. E. (2018). Burning Mouth Syndrome. In StatPearls [Internet]. StatPearls Publishing. Full text: https://www.ncbi.nlm.nih.gov/books/NBK519529/

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7 Comments

Leave a Comment

  1. Luci Kennedy-Montecinos says:

    Dr B, I have denturesdue to problems of long term multiple auto immune diseases as well as mental and female issues…I cannot get my dentist to see the corresponding issues with my dentures…I am homebound and disabled..what are my options to get my dentures to fit correctly with having to go to implants I am toothless right now. . Please help ?????

  2. Dalayna Mullins says:

    Oh my gosh! I have had a burning tongue for at least 3 years now! I told my GI doc! He did a blood test for something. I don’t remember what now though. It was negative. I have had Crohn’s disease since 1993. I’ve told my close minded thinks he knows it ALL family doc. He has no answers! This just might be my answer! I also think I have a thyroid problem. My Mom is hypo. My numbers always come back high but WNL. I’ve read that he needs to do more extensive blood work but… he knows it all and won’t listen! Thanks for this article and this website! I came here because my son has a toothache and it is a holiday weekend! So I got some good tips for keeping him comfortable until Monday. Thank you, thank you, thank you!

  3. What treatments are available for APCA?

    • Mark Burhenne, DDS says:

      It’s imperative to work on your gut health. To find out exactly what YOUR gut needs, you should find a good functional practitioner that will run some tests such as an Organic Acids Test and work with you to make a plan for your healing.

  4. Hashimoto/ gym disease/LT CARE with dentures?
    I am in need of the name of oral probiotic to help gum disease and I have Hashimoto. Secondly, will I be a denture candidate with this gum disease. Will my jar bone be jeopardize where I can not wear dentures
    Thank you
    Linda

    • Mark Burhenne, DDS says:

      Check out my store for Hyperbiotics PRO Dental. There is a coupon listed for my readers!

      Yes, you want to get your oral health under control to avoid issues down the road.

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