BURNING MOUTH SYNDROME (GLOSSODYNIA): SYMPTOMS, DIAGNOSIS, TREATMENT AND MORE

Medically Reviewed by Dr. Shilpy Bhandari - August 8, 2024

Burning mouth syndrome (BMS), or glossodynia, is a chronic condition causing a burning, tingling, or scalding sensation in the mouth. Often, with no apparent cause identified, BMS can significantly impact daily life. This uncomfortable sensation frequently disrupts eating, speaking, and overall well-being. With proper management, it can be controlled. This condition is found to be present in 1.73% of the general population, worldwide. While anyone can develop BMS, it is three times more common in middle aged, peri and postmenopausal women than in men. Other risk factors may include being female, over 50, and smoking.

The constant discomfort of BMS can make it difficult to focus on daily activities. Understanding the symptoms and potential management strategies for this condition is essential. If you are experiencing BMS, seeking a consultation with a medical professional is necessary for receiving a proper diagnosis and treatment.

This article will cover the types, causes, symptoms, diagnosis, and treatment options for burning mouth syndrome.

Types and Causes of Burning Mouth Syndrome

There are two known types of burning mouth syndrome: primary and secondary.

Primary burning mouth syndrome is when the burning sensation is the only symptom and not associated with any underlying medical condition. In contrast, secondary burning mouth syndrome is when the burning sensation results from an underlying medical condition or medication.

Primary Burning Mouth Syndrome

The exact cause of primary burning mouth syndrome is unknown, yet experts theorize it stems from damage or dysfunction of nerves that control pain and taste sensation. It is more common in women and typically occurs after menopause. Other risk factors for primary burning mouth syndrome include nutritional deficiencies, hormonal changes, and psychological factors such as stress and anxiety.

Secondary Burning Mouth Syndrome

Secondary burning mouth syndrome can be caused by a variety of factors, including^[1]:

• Nutritional deficiencies, particularly of vitamin B12, iron, and zinc
• Allergies to certain foods (e,g., peanuts, sorbic acid, chestnuts, and cinnamon) or dental products (e,g., mercury, amalgam, methyl methacrylate, benzoyl peroxide, cobalt, chromium)
• Acid reflux
• Dry mouth and oral habit of jaw clenching or teeth grinding
• Oral infections frequently arise from fungal and bacterial strains such as Enterobacter, Fusospirochetal, Candida, Helicobacter pylori, and Klebsiella^[2]
• Neuropsychiatric conditions such as depression, prolonged anxiety, and mood disorders
• Certain medications, such as those used to treat high blood pressure, depression, and anxiety
• Hormonal changes experienced during pregnancy or menopause
• Hormone replacement therapy
• Underlying medical conditions including diabetes, thyroid disorders, thrush or other fungal infections, and autoimmune diseases like Sjogren’s syndrome and oral lichen planus
• Chemo and radiotherapy

Symptoms of Burning Mouth Syndrome

A burning feeling in the mouth is the hallmark of burning mouth syndrome, which can affect the tongue, lips, gums, palate, or entire mouth. From moderate to severe, this sensation can be chronic or come and go^[3]. For some individuals pain may reduce on eating and drinking and for many it interferes with their sleep cycle.

Other symptoms may include:

• Changes in taste perception, such as a metallic or bitter taste in the mouth
• Dry mouth
• Increased thirst
• Sore or tender mouth
• Tingling or numbness in the mouth
• Difficulty eating or speaking

How Long Does Burning Mouth Syndrome Last?

About 50-67% of patients may see symptom improvement within weeks to months of treatment. Long-term cases may last 6-7 years or more, and the burning sensation typically remains stable at a manageable level for many, and some may fully recover. Those responding well to treatment can expect long-term symptom control, and there is no link between BMS and oral cancer.^[4]

Diagnosis of Burning Mouth Syndrome

Due to its complex nature, diagnosing Burning Mouth Syndrome (BMS) can be challenging. There is no single, specific test to confirm BMS. Instead, doctors and dentists rely on:

• Comprehensive Medical History: Your healthcare provider will ask detailed questions about your symptoms, general health, medications, and habits.
• Physical Exam: They will thoroughly examine your mouth, teeth, and throat to identify any signs of infection, dental problems, or other abnormalities.
• Ruling Out Other Causes: Several medical conditions and medications can mimic BMS symptoms.

To arrive at a clear diagnosis, your doctor might need to order the following tests^[5]:

• Blood Tests: These tests are used to check nutritional deficiencies, hormonal imbalances, thyroid problems, or underlying infections.
• Oral Swab Tests or Biopsy: To rule out oral infections or uncommon conditions affecting the mouth lining.
• Allergy Tests: To identify potential allergens from food or dental materials.
• Salivary Flow Test: To measure saliva production and diagnose dry mouth.
• Trial Change of Medications: Your doctor might change current medications to see if symptoms improve.
• Imaging Exams: This may be used to investigate related issues in rare cases.
• Gastric Reflux Tests: If acid reflux is suspected.

What Kind of Doctor Treats Burning Mouth Syndrome?

If you are experiencing any symptoms of burning mouth syndrome, you should see an ENT or a dentist.

A dentist is essential in the diagnosis process. They can identify and address dental problems like misaligned teeth, teeth grinding, or ill-fitting dentures that might contribute to BMS. They may refer you to an ENT or a neurologist for further evaluation and treatment.

An ENT (Ear, Nose, and Throat) specialist might be consulted to exclude conditions affecting the sinuses or nerves in the face and head.

Treatment Options for Burning Mouth Syndrome

While there is no cure for burning mouth syndrome, to help control symptoms and enhance quality of life, a range of therapy alternatives are available.

The primary focus is treating the medical condition responsible for BMS symptoms. This may involve:

• Managing dry mouth
• Treating infections (fungal or bacterial)
• Controlling diabetes or thyroid disorders
• Adjusting or switching medications
• Addressing nutritional deficiencies

Instant Relief

If you experience a sudden flare-up of burning mouth syndrome, there are some things you can do for instant relief. These include:

• Rinsing your mouth with cold water
• Applying a cold compress to the cheek or affected area
• Using a numbing mouthwash or spray, such as one containing benzocaine

Lifestyle Modifications

For most cases of burning mouth syndrome, lifestyle modifications are necessary to keep symptoms under control and prevent recurrence.

Stress Management: Techniques like mindfulness meditation, deep breathing exercises, or yoga can reduce stress, which may aggravate BMS.

Dietary Changes: If you have burning mouth syndrome, there are certain things you should avoid to prevent further irritation and discomfort. These include:

• Spicy, acidic, or hot foods and drinks
• Alcohol and tobacco
• Harsh mouthwashes or toothpaste
• Chewing gum or using mints with sugar^[6]

Your doctor may recommend additional lifestyle changes to assist with managing symptoms of other conditions.

Medications

Your doctor may provide a prescription to help manage your symptoms. These may include:

• Artificial saliva to relieve dry mouth
• Pain relievers, such as ibuprofen or acetaminophen
• Topical medications that numb the area, like lidocaine, can provide temporary relief
• Antidepressants, which can help with pain and improve mood
• Anticonvulsants, which can help with nerve pain
• Sedative medications that can help manage nerve pain
• Hormone replacement therapy for menopausal women
• Medications to treat underlying health issues, such as acid reflux or allergies

Other medications and supplements that may help include:

• Capsaicin, a pain reliever derived from chili peppers, can desensitize nerves over time^[7]
• Alpha-lipoic acid, a potent antioxidant may offer some benefit
• Vitamin B Complex and Zinc may be recommended if a deficiency is identified

Treatment for BMS often requires a trial-and-error approach to find what works best for each individual. Consult with an experienced healthcare professional for a tailored treatment plan and advice.

Home Remedies

There are also some home remedies that may provide relief for burning mouth syndrome, including^[8]:

• Consuming cold water or nibbling on ice chips
• Using a saliva substitute or sugar-free gum to help with dry mouth
• Using a soft-bristled toothbrush and gentle toothpaste
• Practicing relaxation techniques to help with stress and anxiety

Living with Burning Mouth Syndrome

Living with burning mouth syndrome can be difficult. However, there are strategies for managing the condition and enhancing the quality of life for people who are impacted.

Some tips for living with burning mouth syndrome include:

• Keeping a meal journal to recognize and steer clear of triggers
• Drinking enough water and, if needed, using a saliva substitute
• Practicing good oral hygiene to prevent infections
• Keeping away from irritants like acidic or spicy foods and beverages
• Managing stress and anxiety
• Getting regular check-ups and blood tests to check for nutritional deficiencies
• Taking medications as prescribed and consulting over any potential side effects with your doctor
• Seeking support from friends, family, or a therapist if necessary
• Joining a support group for others with burning mouth syndrome to share experiences and tips

Latest Advancements in Burning Mouth Syndrome Research

Research on burning mouth syndrome is ongoing, and there have been some recent advancements in understanding and treating the condition.

• Nerve Involvement: Studies focus on nerve dysfunction as a primary driver of BMS. Scientists are investigating changes in nerve sensitivity, pain signaling, and even potential structural damage to the nerves responsible for taste and sensation in the mouth.^[9]
• The Immune System: Research now suggests that BMS might be linked to localized inflammation^[10] or changes in the immune response within the mouth, leading to a heightened sense of burning and pain.
• Genetic Predisposition: There is an increasing interest in identifying whether underlying genetic factors make specific individuals more susceptible to BMS.^[11]

Some of the latest advances in treatment include:

• Nerve Stimulation Techniques: Research is underway to test whether targeted electrical stimulation of specific nerves involved in pain signaling might offer relief from BMS symptoms.^[12]
• Targeted Medications: As researchers gain insights into the potential causes of BMS, developing medications aimed at those specific processes becomes possible. For example, if inflammation is a crucial factor, anti-inflammatory medications could provide more effective relief.
• Low level laser therapy: Research suggests that receiving low-level laser therapy at the affected area in the mouth can reduce the burning sensation. This therapy is considered effective because it stimulates the production of chemicals, such as serotonin and β-endorphins, which lowers the burning pain and improves the quality of life for affected individuals. However, long-term analysis of this technique is still needed. 
• Personalized Treatment: The future of BMS management may rely on recognizing different "subtypes" of the condition based on the underlying cause for each individual. This could lead to more tailored treatments with higher success rates.

Conclusion

Burning mouth syndrome can be frustrating and uncomfortable. With proper treatment and symptom control, patients can find relief. If you are experiencing symptoms, seeing your doctor for appropriate diagnosis and treatment is essential. You can improve your quality of life and efficiently control your symptoms by taking preventative measures and seeking support.

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