Burning mouth syndrome (BMS), or stomatopyrosis, is a perplexing condition characterized by a persistent burning sensation in the tongue or oral mucous membranes, despite no apparent clinical or laboratory findings. It can cause discomfort, pain, and distress, leading to difficulties in eating, speaking, and sleeping.
Moreover, the chronic nature of BMS can also have emotional and psychological repercussions, including increased anxiety and depression.
While BMS itself is not considered a life-threatening condition, it can have a significant impact on a person’s quality of life and well-being. That said, this syndrome does not typically lead to serious complications or physical harm.
It is not associated with the development of oral cancer or other severe health conditions. BMS is primarily a symptom rather than a disease itself, and its impact is mainly on the individual’s day-to-day comfort and quality of life. However, you should keep in mind that the exact nature of BMS and its potential dangers are still subjects of ongoing research and discussion.
Who is at risk of burning mouth syndrome?
Burning mouth syndrome primarily affects 0.7 to 2.6 percent of postmenopausal women. It has also been observed in a significant percentage of women seeking treatment for menopausal symptoms.
The onset of oral pain in most patients is spontaneous, and the burning sensation can persist for years, potentially interfering with daily activities and sleep. The intensity of the pain can vary from mild to severe, resembling toothache pain.
Symptoms of BMS
Burning Mouth Syndrome is characterized by a range of signs and symptoms that primarily affect the mouth and oral tissues, including:
- Persistent Burning Sensation – The hallmark symptom of BMS is a persistent burning or scalding sensation in the mouth, particularly on the tongue, lips, gums, palate, or throat. This burning sensation may vary in intensity throughout the day.
- Dry Mouth (Xerostomia) – Many individuals with BMS experience a subjective feeling of dryness in the mouth, even though saliva production may be normal. This sensation of oral dryness can contribute to further discomfort and difficulty in speaking, swallowing, or tasting food.
- Altered Taste Sensation (Dysgeusia) – BMS can cause changes in taste perception, leading to a metallic, bitter, or otherwise abnormal taste in the mouth. This can affect the enjoyment of food and beverages.
- Tingling or Numbness – Some individuals may experience a tingling or numb sensation in the mouth, adding to the overall discomfort.
- Oral Soreness or Pain – Along with the burning sensation, individuals with BMS may experience oral soreness or pain, which can be localized or spread across multiple areas of the mouth.
- Increased Sensitivity – The oral tissues may become more sensitive to certain substances, such as spicy or acidic foods, hot or cold temperatures, or even oral care products like toothpaste or mouthwash.
- Psychological Impact – BMS can have a significant psychological effect, leading to anxiety, depression, irritability, or difficulty concentrating due to the chronic discomfort and frustration it causes.
Generally, the severity and combination of symptoms tends to vary among people suffering from BMS. If you experience persistent oral discomfort or any of the mentioned symptoms, it is recommended to seek evaluation and diagnosis from a healthcare professional or dentist who can provide appropriate guidance and management options.
Causes of BMS
The exact cause of burning mouth syndrome remains elusive, which in turn poses challenges in its successful management.
That said, there are several factors that are believed to be possible causes, including:
- Xerostomia (dry mouth)
- Candidiasis
- Chronic infections
- Reflux of gastric acid
- Medications
- Blood dyscrasias
- Nutritional deficiencies
- Hormonal imbalances
- Allergic or inflammatory disorders
- Psychological factors and mood changes may also play a role
Although a dry mouth or decreased salivary flow rates do not appear to be a significant factor in burning mouth syndrome, studies have revealed qualitative changes in salivary components such as mucins, IgA, phosphates, and pH, which can disrupt the oral microbial balance, leading to an increased risk of gum inflammation and periodontal disease.
Diagnosis of Burning Mouth Syndrome
Diagnosing Burning Mouth Syndrome (BMS) can be challenging since there are no specific tests or markers that definitively confirm the condition. Instead, the diagnosis is usually made by ruling out other potential causes of mouth discomfort (like oral candidiasis or ulcerative lesions) and evaluating the patient’s symptoms.
Here are some diagnostic approaches commonly used:
- Comprehensive blood tests can be conducted to assess various factors such as complete blood count, blood sugar levels, thyroid function, nutritional status, and immune system function. Abnormalities in these tests may provide insights into underlying causes or contributing factors related to the mouth discomfort.
- Oral Cultures or Biopsies – Oral cultures involve obtaining a sample from the mouth using a cotton swab to check for fungal, bacterial, or viral infections. Biopsies, on the other hand, involve taking small tissue samples from the mouth, which are then sent to a laboratory for microscopic examination of the cells. These tests help rule out infections or detect abnormal cellular changes that could be contributing to the symptoms.
- Allergy testing may be necessary to determine if the patient is allergic to specific foods, additives, dental materials, or mouth care products. Identifying and avoiding potential allergens can help alleviate symptoms associated with BMS.
- Salivary Measurements – BMS is often associated with reduced salivary flow, leading to dry mouth. Salivary tests can measure the quantity and quality of saliva, providing information about salivary gland function and identifying any abnormalities in salivary flow that may contribute to the symptoms.
- Gastric Reflux Tests – Testing for gastric reflux can be performed to determine if stomach acid is flowing back into the mouth from the stomach. Gastric reflux can cause irritation and contribute to the discomfort experienced in BMS.
- Imaging – In some cases, imaging tests such as magnetic resonance imaging (MRI), computed tomography (CT) scans, or other imaging techniques may be recommended to evaluate the oral and surrounding structures for any underlying health issues that could be related to the symptoms.
Keep in mind that the diagnosis of BMS relies on a combination of the patient’s reported symptoms, medical history, and the exclusion of other potential causes. A thorough evaluation by a healthcare professional, often a dentist or oral medicine specialist, is essential for an accurate diagnosis of Burning Mouth Syndrome.
Management of BMS
The identification and treatment of underlying causes, if present, form an essential part of managing burning mouth syndrome. However, it is important to note that sometimes no specific cause can be identified.
Treatment options for BMS may include the following:
Systemic Medications
Certain medications have shown effectiveness in managing BMS symptoms. Low doses of medications like clonazepam (Klonopin®), chlordiazepoxide (Librium®), tricyclic antidepressants such as amitriptyline (Elavil®), and anticonvulsants like gabapentin (Neurontin®) have been used with varying degrees of success. However, the choice of medication should be tailored to the individual patient, considering their overall health and any potential contraindications.
Topical Capsaicin
Some patients with BMS have found relief with topical capsaicin, which acts as a desensitizing agent. However, it is worth noting that capsaicin may not be well-tolerated or effective for everyone.
Psychological Support
BMS can be a challenging condition to manage, and it may be beneficial for patients to receive psychological support or counseling to cope with the associated discomfort and stress. Stress management techniques, relaxation exercises, and counseling can help improve overall well-being and potentially alleviate BMS symptoms.
HRT for menopausal symptoms
Although hormone replacement therapy (HRT) has been considered a potential treatment option for BMS in postmenopausal women, the evidence supporting its efficacy in alleviating burning mouth symptoms is limited.
Change of trigger medication (ACE inhibitors)
In some cases, burning mouth symptoms have been linked to the use of angiotensin-converting enzyme (ACE) inhibitors, which is a class of medications commonly prescribed for the treatment of high blood pressure (hypertension) and certain heart conditions.
While ACE inhibitors are generally safe and well-tolerated, they can have potential side effects, including loss of taste sensation and a condition called angioedema, which is characterized by swelling of the lips, tongue, throat, or face.
Angioedema can be serious and may require immediate medical attention, as it can potentially cause difficulty breathing and throat obstruction.
Discontinuing these medications has shown to reduce or eliminate the symptoms of BMS.
Medications for BMS
In some cases, certain medications may be described to help with the management of symptoms depending on the trigger. These include tricyclic antidepressants, benzodiazepines, and anticonvulsants.
Final thoughts
While BMS may not pose a direct danger, its impact on a person’s well-being should not be underestimated.
If you are experiencing symptoms of burning mouth syndrome, it is recommended to consult with a healthcare professional for a proper evaluation and diagnosis. This is important to rule out other potential causes of oral discomfort and to develop an appropriate treatment plan to manage the symptoms effectively and improve your quality of life.
Healthcare providers, dentists, or oral medicine specialists can provide guidance and support in addressing the symptoms and improving overall oral health.
