Burning Mouth Syndrome

Burning mouth syndrome is a painful condition where your mouth feels like it’s burning, even though there are no visible changes. It most commonly affects women after menopause and can last for months or years, making everyday activities like eating and talking challenging.

glossodynia, oral dysesthesia, burning tongue

Table of contents

• What is Burning Mouth Syndrome?
• Types of Burning Mouth Syndrome
• Symptoms and Pain Patterns
• What Causes This Condition?
• Who Is Most Affected?
• How Doctors Diagnose Burning Mouth Syndrome
• Treatment Options
• Self-Care Tips
• Living With Burning Mouth Syndrome

What is Burning Mouth Syndrome?

Burning mouth syndrome is a condition that causes a burning, scalding, or tingling feeling in the mouth, even when there is no obvious cause^[1]. The burning can affect your tongue, lips, gums, roof of your mouth, throat, or large areas throughout your whole mouth^[2]. The medical term for this condition is glossodynia (pronounced “glaa-sow-DI-nee-uh”)^[2].

The sensation can be severe, as if you injured your mouth with a very hot drink^[1]. Although some parts of your mouth may feel like they are burning, they will not be hot to the touch, and you might not be able to see any soreness or redness in the areas that are hurting^[5]. This is what makes the condition particularly frustrating for people who experience it.

Burning mouth syndrome usually comes on suddenly, but it can also develop slowly over time^[1]. The burning sensation often occurs in more than one site in the mouth, with the front two-thirds of the tongue, the front hard palate, and the mucosa of the lower lip most frequently involved^[6].

Types of Burning Mouth Syndrome

There are two main types of burning mouth syndrome^[2]:

• Primary burning mouth syndrome is when your mouth feels like it’s burning, but there’s no clear reason why. When the cause cannot be found, experts believe that primary burning mouth syndrome is caused by damage to the nerves that control pain and taste^[3].
• Secondary burning mouth syndrome is when your mouth burns because of another condition. If you treat that underlying condition, the burning mouth sensation usually goes away too^[2].

Doctors have also identified three symptom patterns based on when the burning occurs during the day^[4]:

1. No or little burning upon waking in the morning, with burning developing as the day progresses and becoming worst by evening
2. Continuous symptoms throughout the day from the time you wake up
3. Intermittent symptoms with some symptom-free days (this is the least commonly observed pattern)

Symptoms and Pain Patterns

The main symptom of burning mouth syndrome is pain in the mouth that feels like burning, scalding, or tingling^[3]. For many people, the burning sensation begins in late morning, builds to a peak by evening, and often subsides at night^[7]. However, some feel constant pain throughout the day, while for others, the pain comes and goes^[7].

Along with the burning feeling, you may experience^[1][2]:

• A feeling of dry mouth with increased thirst
• Taste changes, such as a bitter or metallic taste
• Loss of taste
• Tingling, stinging, or numbness in your mouth that comes and goes

Some patients also report a “draining” or “crawling” sensation in the mouth^[4]. The discomfort can last for months or even years^[1][3]. Patients often report that the pain interferes with their ability to fall asleep^[6].

The pain can range from moderate to severe and has been described as similar in intensity to toothache pain^[6]. Sometimes the burning feeling may be briefly relieved during eating or drinking^[1][3].

An important characteristic of burning mouth syndrome is that it usually doesn’t cause any physical changes to your tongue or mouth that can be seen during an examination^[1][2].

What Causes This Condition?

No one really knows exactly what causes burning mouth syndrome^[4][5]. However, researchers believe the cause of primary burning mouth syndrome is nerve damage affecting the area of your tongue that controls taste and pain^[2]. This makes your mouth feel like it’s burning and changes how things taste to you.

It is believed to be a form of neuropathic pain, which means that nerve fibers in the mouth are functioning abnormally and transmitting pain despite the fact that there is no actual painful stimulus^[4]. Recent studies have pointed to dysfunction of several nerves associated with taste sensation as a possible cause^[6].

When burning mouth syndrome is secondary to another condition, several medical conditions might cause it^[3][5]:

• Dry mouth, which can be caused by certain disorders (such as Sjögren’s syndrome) and treatments (such as certain drugs and radiation therapy)
• Acid reflux, when acid from your stomach comes up into your mouth
• Oral infections, such as thrush (a fungal infection in your mouth, also called candida)
• Nutritional deficiencies, such as low levels of iron, zinc, or vitamins B6 and B12
• Diabetes
• Thyroid problems
• Hormonal changes, particularly during menopause
• Allergies to certain foods or dental products
• Teeth grinding or jaw clenching
• Stress, anxiety, or depression
• Poorly fitting dentures or being allergic to denture materials
• Certain medicines, such as those that reduce blood pressure

Contributing factors may also include adverse life events such as loss of a job or death of a family member or spouse, as well as conditions like chronic fatigue syndrome and fibromyalgia^[4].

In some cases, burning mouth syndrome may have more than one cause^[5].

Who Is Most Affected?

Burning mouth syndrome affects around 2% of the population, with women being up to seven times more likely to be diagnosed than men^[4]. The condition is most common in postmenopausal women, particularly those over 60^[2]. The peak age of onset is from three years before to 12 years after menopause^[6].

Lower estrogen levels during and after menopause cause decreased taste bud sensitivity^[2]. Your genetic ability to taste also plays a role. Many people with burning mouth syndrome are “supertasters” who taste things really strongly, but who don’t taste things as strongly as they used to^[2].

Although female patients are predominately postmenopausal, men and pre/peri-menopausal women may also be affected^[4].

You’re more likely to develop burning mouth syndrome if you^[2]:

• Are in postmenopause
• Have certain health conditions like diabetes or Sjögren’s syndrome
• Have chronic anxiety and/or depression
• Have geographic tongue
• Have nutritional deficiencies
• Take certain medications prescribed for depression or high blood pressure
• Are female

How Doctors Diagnose Burning Mouth Syndrome

Burning mouth syndrome is a diagnosis of exclusion, meaning there is no single test that can tell if you have it^[3][8]. Instead, your health care team will try to rule out other problems before diagnosing burning mouth syndrome.

Burning mouth syndrome can be difficult to diagnose, and your dentist or doctor will rule out other conditions before confirming the diagnosis^[3]. Your health care provider or dentist will likely^[10]:

• Review your medical history and medicines
• Examine your mouth thoroughly to try to find the cause
• Ask you to describe your symptoms
• Discuss your habits and routine for keeping your teeth and mouth clean
• Do a medical exam, looking for signs of other conditions

You may have some of the following tests^[10]:

• Blood tests to check your complete blood count, blood sugar level, thyroid function, nutritional factors, and how well your immune system works. These can look for infection, nutritional deficiencies, and disorders associated with burning mouth syndrome such as diabetes or thyroid problems
• Oral cultures or biopsies to check for fungal, bacterial, or viral infections in your mouth
• Allergy tests to see if you may be allergic to certain foods, additives, dental materials, or mouth care products
• Salivary measurements to tell if you have a reduced salivary flow
• Gastric reflux tests to tell if stomach acid flows back into your mouth from your stomach
• Imaging tests such as an MRI or CT scan to check for other health problems

About one-third of people with burning mouth syndrome have an oral habit such as tooth grinding or jaw clenching that can lead to the condition^[3]. Dentists are familiar with oral habits and can help you manage them.

Your dentist may refer you to a specialist in oral surgery, oral medicine, or oral pathology who can assist with diagnosing or treating burning mouth syndrome. Ear, nose, and throat specialists can also treat this condition^[3].

Treatment Options

There is no cure for burning mouth syndrome, but treatment can help you manage painful symptoms^[2]. Treatment should be tailored to your individual needs^[7].

If secondary burning mouth syndrome has an identifiable cause, treating the underlying medical problem will usually cure it^[3]. Depending on the cause of your symptoms, possible treatments may include^[7]:

• Adjusting or replacing irritating dentures
• Treating existing disorders such as diabetes, Sjögren’s disease, or a thyroid problem
• Recommending supplements for nutritional deficiencies
• Switching medicine if a drug you are taking is causing your burning mouth
• Prescribing medications to relieve dry mouth or treat oral infections

For primary burning mouth syndrome, when no underlying cause can be found, treatment is aimed at the symptoms to try to reduce the pain^[7]. The following treatments have been suggested, though evidence for their effectiveness varies^[8]:

• Clonazepam (low-dose) dissolvable wafers
• Alpha-lipoic acid
• Topical capsaicin
• Cognitive behavioral therapy and relaxation techniques
• Tricyclic antidepressants
• Anticonvulsants

Research has shown that cognitive behavioral therapy, topical capsaicin and clonazepam, and laser therapy demonstrated favorable outcomes in both short-term and long-term assessment^[17].

Some doctors may prescribe a course of counseling and low-dose anti-depressants, because burning mouth syndrome can wear people down and cause depression due to the daily battle with pain^[5]. Other therapies can include relaxation, yoga, meditation, and hypnotherapy, as they have been found to help some people cope with anxiety^[5].

It’s important to note that hormone replacement therapy is generally not effective in managing burning mouth syndrome in postmenopausal women^[4].

Self-Care Tips

You can help to ease the symptoms yourself at home by^[5][7]:

• Sipping water often to help keep your mouth moist
• Sucking on ice chips or chewing sugarless gum to help you produce more saliva
• Avoiding things that irritate your mouth, such as hot, spicy foods; mouthwashes that contain alcohol; and products high in acid, like citrus fruits and juices
• Avoiding tobacco and alcohol products
• Brushing your teeth with baking soda and water

Patient-initiated pain relief measures can also include cold beverages^[9].

Living With Burning Mouth Syndrome

Burning mouth syndrome can last for months to years^[1][3]. In rare cases, symptoms may suddenly go away on their own or happen less often^[1]. Spontaneous partial recovery within six to seven years after onset has been reported in up to two-thirds of patients^[6].

The burning can get so bad that it causes people to feel depressed or anxious^[2]. Perhaps because of sleep disturbances, constant pain, or both, patients with burning mouth syndrome often have mood changes, including irritability, anxiety, and depression^[6].

It’s frustrating to have pain and not know why^[2]. Advocating for yourself and forming a partnership with a dentist or doctor you trust can be helpful throughout the process of getting a diagnosis^[3]. Working closely with your health care team can help you reduce symptoms^[1].

Many patients ask “Who else has this?” but there are many others like them^[8]. Although treatment can’t cure burning mouth syndrome, it can help manage symptoms, and learning more about possible triggers can help reduce the frequency of flare-ups^[2].