Burning Mouth Syndrome, Glossodynia
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Burning mouth syndrome (BMS), or glossodynia, manifests as a sensation of burning in the tongue, mouth roof, or lips, and can occur in various oral and throat areas. It may develop suddenly or gradually over time. Those with BMS often notice the burning sensation worsening as the day progresses, akin to being scalded by a hot drink. Additionally, individuals may experience a bitter or metallic taste.
The pain typically subsides during sleep but returns the next day, establishing a recurring pattern. Despite adequate saliva production, many sufferers report a persistently dry mouth. In severe cases, the constant pain may lead to feelings of depression and anxiety.
Symptoms
Burning mouth syndrome can persist for months to years, but in rare instances, symptoms may spontaneously improve or occur less frequently. Temporary relief from the burning sensation may occur during eating or drinking.
Burning mouth syndrome can cause discomfort in various ways. It might occur daily, starting with mild discomfort in the morning but worsening as the day progresses. Alternatively, it could begin as soon as one wakes up and last throughout the entire day. Some people may experience the discomfort coming and going intermittently.
Burning mouth syndrome does not result in observable physical changes to the tongue or mouth. Common symptoms include:
- A scorching or searing sensation that might impact the lips, gums, roof of the mouth or throat, or entire mouth, but it usually affects the tongue
- Mouth numbness that comes and goes
- Loss or altered taste, such as a metallic or bitter taste
- A dry mouth sensation accompanied by increased thirst
If any of the signs and symptoms persist, consult a healthcare provider for proper diagnosis and treatment. It may be necessary to identify the underlying cause especially when an individual is experiencing discomfort, burning, or soreness in their tongue, lips, gums, or other areas of the mouth.
Causes
Burning mouth syndrome have several potential causes. It is often categorized into two:
- Primary burning mouth syndrome: Primary burning mouth syndrome is believed to result from nerve damage that impacts the tongue’s taste and pain control area. Researchers suggest that the ability to taste bitter flavors normally inhibits pain, but when this is compromised, pain fibers may unexpectedly activate, leading to a burning sensation in the mouth for those affected. This type of BMS is also known as idiopathic burning mouth syndrome in which the illness is diagnosed but the underlying cause is unknown.
- Secondary burning mouth syndrome: An underlying medical problem may occasionally be the cause of burning mouth syndrome, such as:
- Dry mouth: Side effects of cancer treatment, medications, health issues, and gland-related problems affecting saliva production are among the factors that can cause dry mouth.
- Oral habits: Clenching or grinding the teeth, biting the tip of the tongue, and pressing the tongue on the teeth are examples of oral habits that can cause BMS.
- Extremely irritated mouth: Ill-fitting dentures can contribute to irritation, exacerbating symptoms. Aggressive tongue brushing, the use of abrasive toothpaste, overreliance on mouthwashes, or consuming an excess of acidic foods or beverages can lead to excessive irritation in the mouth.
- Other oral health disorders: This include geographic tongue, which causes the tongue to resemble a map, oral lichen planus, an inflammatory disease, and oral thrush, a fungal infection of the mouth.
- Acid reflux: Also known as gastroesophageal reflux disease (GERD), this condition causes stomach acid to escape from the stomach and enter the mouth.
- Nutritional deficiency: A deficiency of vitamin B12, folate or iron can resemble the sensation of burning mouth.
- Allergies: Allergic reactions in the oral cavity can stem from various sources, including metal dental products, specific foods, food flavorings, additives, fragrances, and dyes.
- Psychological problems: This include stress, depression, or anxiety.
- Certain drugs: BMS can be associated with certain medications, including ACE inhibitors used for hypertension, specific antidepressants like fluoxetine and sertraline, and high blood pressure medications such as captopril, clonazepam, efavirenz, and enalapril. Hormonal replacement therapies may also be linked to BMS.
- Certain disorders: Conditions like Sjögren’s syndrome, characterized by dry mouth and dry eyes, as well as diabetes, thyroid disease, and liver problems can cause burning mouth syndrome.
Risk factors
Burning mouth syndrome often arises suddenly without an identifiable cause. However, certain factors may increase the risk of developing BMS, including being female and being a smoker. Women are particularly vulnerable to BMS due to their heightened sensitivity to taste.
BMS is also frequently observed in individuals over 60, especially in postmenopausal women, as decreased estrogen levels lead to reduced taste bud sensitivity.
Other risk factors include:
- Recent medical condition
- Food-related allergic responses
- A few chronic illnesses, including neuropathy, fibromyalgia, Parkinson’s disease, and autoimmune disorders
- Has geographic tongue, where red patches emerge on the tongue’s surface
- Past dental procedures
- Specific medications
- Difficult life experiences
- Tension, anxious feelings, and depressive states
Diagnosis
The diagnosis of burning mouth syndrome can be challenging because involves the elimination of other potential causes like oral yeast infections. It is recommended to consult with a dentist initially, as oral health issues contribute to a significant portion of BMS cases. Generally, no single test can diagnose BMS.
The diagnosis involves a comprehensive approach which typically includes a thorough review of the individual’s medical history and medications, a physical examination of the mouth, a discussion about the symptoms experienced, an exploration of oral hygiene habits and routines, and some tests.
Tests that may be required include:
- Blood tests: The findings of this test may provide information on what is causing mouth pain. The immune system function, thyroid function, blood sugar level, nutritional status, and full blood count can all be assessed during a blood test.
- Salivary flow test: This test can detect if the flow of saliva is decreased. Dry mouth can be an indicator of burning mouth disease.
- Oral swab test or tissue biopsies: Small pieces of tissue are removed from the mouth, usually using a cotton swab, for laboratory analysis. This can determine whether the oral cavity is infected with bacteria, viruses, or fungi.
- Imaging tests: To check for additional health issues, an MRI, CT scan, or other imaging tests.
- Allergy tests: To find out if a person might be allergic to any foods, additives, dental materials, or mouthwashes, allergy testing may be advised.
- Tests for acid reflux: If stomach acid leaks from the stomach back into the mouth, these tests can detect it.
- Adjustments in medication: Stopping the medicine temporarily may be considered. Changing the dose or switching to a different one may also be necessary. However, this requires supervision from a healthcare provider as discontinuing certain medications can be risky.
- Mental health assessment: Symptoms of depression, anxiety, or other mental health conditions associated with burning mouth syndrome may be assessed through mental health questions.
Treatment
The treatment for burning mouth syndrome typically involves medications. Although no medication is made specifically for BMS, other medications can alleviate the symptoms.
- Primary burning mouth syndrome: The treatment focuses on symptom control, and individuals may need to experiment with various options before finding a suitable combination. Treatments for primary BMS include saliva replacement products, specific antidepressants, and cognitive-behavioral therapy to address anxiety, depression, stress, and cope with persistent pain.
Other medications may be recommended, such as:- Medications targeting nerve pain
- Alpha-lipoic acid as a nerve pain reliever
- Capsaicin for pain relief
- Clonazepam for seizure control
Primary burning mouth syndrome lacks a known cure, and effective treatment methods are not firmly established due to limited research. Managing symptoms may require time, and individual responses to treatments can vary.
- Secondary burning mouth syndrome: If issues like teeth grinding or jaw clenching are the cause of burning mouth syndrome, a dentist can assist in correcting these oral problems. If it is due to issues like an oral infection or a deficiency in certain vitamins, treating these specific causes can improve the condition. Generally, if an underlying health condition is identified as the trigger for BMS, addressing and treating that specific condition is likely to lead to the alleviation of burning mouth symptoms.
