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Burning Mouth Syndrome

A Painful Puzzle

A Consultation with Dr. Tanya S. Rouleau

Dear Doctor,
I am a 55-year-old woman. I have an uncomfortable burning and dry sensation in my mouth most of the time. My dentist says it's probably “burning mouth syndrome” but he's not sure what's causing it. Please explain?

Burning mouth syndrome.

Dear Cheryl,
Burning mouth syndrome (BMS) is a sensation of the mouth feeling scalded, on fire, or burnt. In addition dryness, tingling or numbness may exist and taste sensation may be altered or diminished. BMS may be generalized (throughout the mouth) or localized to certain areas. The lips, tongue, inside of cheeks, gums, throat, or roof of the mouth can be affected. It is most common in women around the age of menopause.

What Causes Burning Mouth Syndrome?

The exact cause of BMS is often difficult to pinpoint. It has long been linked to a variety of other conditions: diabetes, nutritional deficiencies (of iron and B vitamins, for example), acid reflux, cancer therapy (irradiation and chemotherapy) and psychological problems. Hormonal changes associated with menopause are believed to be important factors, though hormone replacement therapy has not proven to be an effective treatment.

Once BMS begins, it may persist for many years. Those who have it may awaken with no pain only to find that the burning sensation becomes progressively worse as the day goes on. The discomfort may cause mood changes, irritability, anxiety and depression.

Some scientists believe BMS is caused by a neurological (nervous system) defect; others have focused on the circulatory (heart and blood vessel) system. While medical research continues, there are many pieces of the puzzle still missing. In fact, a diagnosis of BMS is often made by process of elimination; in other words, figuring out what you don't have.

Unraveling The Mystery

The first step is for your dentist to take a complete medical history including all medications being used, and conduct a thorough oral examination.

Many prescription and over-the-counter (OTC) drugs (even illegal drugs) have oral side effects, including mouth dryness. In older people, dryness from diminished saliva flow can lead to yeast (fungal) infections. Additionally, poor lubrication causes sticking of the tongue, cheeks and palate, also sometimes leading to a burning sensation.

Some denture wearers may have an allergic reaction to the denture materials, resulting in oral burning. Habitual smoking, alcohol use, and very hot and spicy foods may also cause mouth dryness and occasional burning, as well as changes to the skin of the mouth. Toothpastes containing the foaming agent sodium lauryl sulfate (SLS), whiteners, and/or flavorings such as cinnamon can cause peeling of tissues that line the mouth leading to BMS symptoms.

If adjusting medications or curing an existing infection provide no relief, it may be necessary to rule out illnesses that exhibit similar symptoms. Systemic disease, such as diabetes, gastric reflux, and hypothyroidism can cause symptoms of oral burning. Blood testing may be necessary to look at Vitamin B12, iron, folate, and zinc levels.

One condition worth noting is Sjogren's syndrome (pronounced SHOW-grins), which primarily affects middle-aged women. Sjorgren's is an autoimmune disorder (“auto” – self; “immune” – resistance), in which the body destroys its own tissues, ceasing to be self-protective. It affects the salivary glands causing drying of the mouth and throat, among other symptoms. The syndrome can also cause an inflammatory condition of the joints producing arthritis-like symptoms and fatigue.

If your dentist cannot fully diagnose the cause of your BMS he/she may refer you to an oral pathologist, a dentist who has specialized in diseases of the mouth. This specialist may in turn collaborate with an appropriate physician, depending upon the cause of your particular condition.

Finding Relief

In some cases, BMS simply resolves itself over time. While there is no single proven treatment, there are some things you can try to relieve your symptoms:

Stop habits that can cause dry mouth such as chronic smoking, alcohol and/or coffee drinking, and frequent eating of hot and spicy foods.

Keep your mouth moist by drinking lots of water. OTC products that replace or stimulate production of saliva, including Biotene products, might also help. Chewing gum containing xylitol will help increase saliva production, while the xylitol will reduce the risk of tooth decay, a major consequence of chronic mouth dryness.

Try different brands of toothpastes — look for “plain” varieties that don't contain SLS, whiteners, or strong flavoring such as cinnamon.

Keep a food diary of everything that you put into and around your mouth (including food, makeup and personal care products). This may reveal a correlation to BMS.

Check with your physician or dentist if you are taking prescription drugs that can cause dry mouth or oral burning; see if they can be substituted. Additionally there are prescription medications that can promote and increase salivation. Other medications used to treat nerve pain can be recommended to treat BMS.

Reduce stress in your life. Try relaxing forms of exercise, such as yoga. Join a support group for people dealing with chronic pain. Seek comfort from sympathetic friends and family members, or consider seeing a psychotherapist.

Above all, don't give up hope that you will one day be pain-free.