Burning Mouth Syndrome: Symptoms, Causes, and Treatment

Burning Mouth Syndrome: Symptoms, Causes, and Treatment
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Burning Mouth Syndrome: Symptoms, Causes, and TreatmentClinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. What is BMS?
  2. Symptoms
  3. Causes
  4. Risk Factors
  5. Diagnosis
  6. Treatment
  7. Tips to Cope
  8. Complications
  9. Prevention
  10. When to See a Doctor
  11. Frequently Asked Questions
  12. References

Burning mouth syndrome (BMS) refers to a benign but painful medical condition characterized by a burning sensation or discomfort in the mouth with no related signs of diseases in the mouth.

When symptoms of BMS have no apparent identifiable medical or dental causes, doctors refer to it as primary BMS. Primary BMS accounts for about half of all the cases of this condition.

BMS is more prevalent in postmenopausal women, lending credence to the thought that estrogen plays a role in the condition.

BMS has no cure, although doctors treat it with antidepressants, anticonvulsants or anxiolytics.

What Is BMS?

Burning Mouth Syndrome (BMS) is a poorly understood oral condition that is rather uncommon, affecting only one in 100,000 people in the general population. BMS affects the tongue, lips and oral cavity and has no underlying known medical or dental causes.

It is one of the most challenging conditions for health care professionals to address. The International Association for the Study of Pain defines the condition as “a burning pain in the tongue or oral mucous membranes in the absence of laboratory findings or clinical signs.”

There are three general categorizations of BMS – Type 1, 2 and 3:

  • Type 1 lacks symptoms in the morning but worsens progressively during the day and has variable symptoms at night.
  • Type 2 exhibits symptoms throughout the day and is associated with depression and anxiety.
  • Type 3 presents with intermittent symptoms during the day, with periods exhibiting no symptoms.

Symptoms

Signs and symptoms of BMSvary, but typical clinical symptoms usually include a burning, scalding or tingling pain in their oral cavity. Most often, the burning sensation affects the tongue, lips and hard palate.

The onset of burning mouth syndrome is spontaneous, and symptoms can occur daily for months or longer.

The syndrome can be accompanied by three sensory reactions inside the mouth:

  • Xerostomia (dryness of the mouth that is associated with reduced salivary flow or changes in saliva composition)
  • Dysgeusia (a distortion in the sense of taste)
  • Dysesthesia (abnormal burning or prickling sensation in the mouth)

Primary and Secondary Causes

When symptoms of BMS have no apparent identifiable medical or dental causes, doctors refer to it as primary BMS. Primary BMS accounts for about half of all the cases of this condition.

Researchers have several theories — with varying degrees of evidence — but do not have a definitive cause for BMS. Many experts believe the syndrome may be caused by damage to nerves that control pain and taste.

BMS can also result from certain local or systemic factors and medical conditions. When this is the case, it is termed as secondary BMS.

Depression and anxiety are often associated with the syndrome, but researchers do not know if they are causes or results of BMS.

Other secondary causes of BMS may include:

  • Hormonal changes
  • Dry mouth syndrome
  • Certain medications
  • Mouth infections
  • Nutritional deficiencies
  • Allergies to certain foods and dental products

Risk Factors

BMS is more prevalent in postmenopausal women, lending credence to the thought that estrogen plays a role in the condition. About 90 percent of women with BMS are peri- and post-menopausal women.

The prevalence in this demographic is between 12 and 18 percent.

Females are more likely to develop BMS than males, although the condition has been strongly associated with aging in both sexes. Nonetheless, females are three to seven-time more likely to have the syndrome.

There is also a connection between BMS and individuals with neuropsychiatric conditions like major depression, chronic anxiety and other mood disorders. Recently, a strong psychological component was identified in BMS.

Diagnosis

The diagnosis of BMS is based on exclusion: Doctors rule out all other detectable causes of the symptoms to make the diagnosis. A thorough investigation of systemic and local factors associated with the condition is essential.

The diagnostic criteria for BMS are not well-defined and universally accepted. To evaluate BMS, physicians carefully review the use of dental prosthetics, dietary habits, mood disturbances, medication changes and nutritional deficiencies.

A physical evaluation starts with an examination of the oral cavity and a dental inspection. Lab analyses involve hematological assessments, autoimmune markers, blood sugar levels, hormonal checks and patch tests.

Treatment

BMS has no cure. A range of multi-faceted treatment options have been employed to try and alleviate the symptoms.

If an underlying cause can be detected following diagnosis, then treatment of the causative factor is a viable option.

Traditionally, doctors treated BMS with antidepressants, anticonvulsants or anxiolytics. Even though strong evidence of the effectiveness of these medications is lacking, results are promising.

Other treatment options include dopamine agonists and histamine receptor, antagonists.

The management of BMS may include cognitive behavioral therapy and vitamin complexes supplementation. Experimental and anecdotal reports have demonstrated that cognitive-behavioral therapy can alleviate BMS symptoms.

Tips for Dealing with BMS

An important aspect of dealing with BMS is reassurance. In line with cognitive behavioral therapy, reassurance that your condition is real, not fatal and manageable goes a long way.

This is part of supportive care, which serves to reduce suffering, help you bring the condition under control, and improve your quality of life.

Also, following healthy dietary practices that provide all the necessary nutrients and vitamins may help mitigate the deficiency aspects of the syndrome.

You can also mitigate factors that may exacerbate BMS symptoms. These factors include oral habits (jaw clenching and tooth grinding), eating hot, spicy, or acidic foods, tobacco, chronic fatigue and tension.

Complications

BMS is a benign condition, meaning there are minimal chances of serious medical complications. But, because it causes chronic pain that can be challenging to manage, it can significantly impact your quality of life.

The symptoms can be difficult to ignore and thus affect your work and daily activities. This can leave patients more susceptible to mood disorders like depression and anxiety, as well as sleep problems.

Prevention

Unfortunately, there is no definitive method for preventing BMS. If there is an identifiable cause for BMS, preventative measures in regard to those conditions can help prevent the onset of BMS.

When to Call a Doctor

It is advisable to see a doctor when you notice a painful burning or scalding sensation in your oral cavity that does not go away. This is more so when these symptoms interfere with your daily activities and affect your quality of life

Frequently Asked Questions

What can cause burning mouth syndrome?
While BMS may be idiopathic and have no definitive cause, certain conditions can cause the symptoms characterizing the syndrome. These conditions include psychological factors, oral conditions, endocrine disorders, certain medications, nutritional deficiencies and allergic reactions to foods and dental materials.
How do you get rid of burning mouth syndrome?
Unfortunately, a cure for BMS remains elusive. But doctors can treat and manage the condition with causative therapy, antidepressants, anticonvulsants, anxiolytics, vitamin complexes, cognitive behavioral therapy, supportive care and pain relief medication.

References

Interventions for treating burning mouth syndrome. (November 2016). The Cochrane Database of Systematic Reviews.

Burning mouth syndrome. (2012). National Center for Biotechnology Information.

Update on Burning Mouth Syndrome: Overview and Patient Management. (July 2003). Critical Reviews in Oral Biology & Medicine.

Burning Mouth Syndrome. (March 2010). International Journal of Oral Science.

Burning Mouth Syndrome. (September 2021). National Institute of Dental and Craniofacial Research.

Pathophysiology of primary burning mouth syndrome. (January 2012). National Center for Biotechnology Information.

Burning mouth syndrome. (February 2013). World Journal of Gastroenterology.

Burning Mouth Syndrome. (December 2021). StatPearls.

Burning mouth syndrome. (January 2015). The American Academy of Oral Medicine.

Interventions for the treatment of burning mouth syndrome. (October 2000). Cochrane Database of Systematic Reviews.

Burning mouth syndrome. (February 2002). American Family Physician

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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