What is Burning Mouth Syndrome?
Burning mouth syndrome (BMS) is a condition where you feel a burning pain in your mouth, even though everything looks normal. This pain typically lasts for at least four to six months. The exact cause of this condition is unknown and it is often seen in women, especially those going through menopause or post-menopause. Doctors can usually diagnose this just by examining the mouth and ruling out other reasons for mouth pain and changes in taste.
Different studies have shown that burning mouth syndrome might be associated with mental health disorders, changes in the structure and function of the nervous system, and disruptions in the body’s internal 24-hour clock (circadian rhythm). Disruptions to your circadian rhythm can affect how you perceive pain, your mood, and can cause disruptions to your body’s stress response system (hypothalamic-pituitary-adrenal axis).
According to researchers Lamey and Lewis, burning mouth syndrome can be divided into three different types based on how the severity of the pain changes throughout the day:
* Type 1 usually feels no pain upon waking up, with the pain getting worse as the day goes on and often changes throughout the night. This type could be related to lack of essential nutrients or certain hormone-related conditions like diabetes.
* Type 2 is often associated with long-term anxiety and the symptoms of burning mouth syndrome are present throughout the entire day.
* Type 3 experiences inconsistent symptoms during the day and may have periods without any symptoms at all. A potential cause might be food allergy.
What Causes Burning Mouth Syndrome?
The exact cause behind burning mouth syndrome, a condition where a person feels a burning sensation in their mouth, is unclear. Several theories suggest more than one factor may contribute to its onset.
The condition is more common in peri- and postmenopausal women, which indicates that estrogen, a hormone whose levels decrease after menopause, may be involved. Reduced estrogen can cause the oral tissue to thin, potentially making it more prone to inflammation and symptoms of burning mouth syndrome.
Sometimes, an infection could happen before the symptoms start to show, with certain germs more frequently found in patients with burning mouth syndrome. These include germs like Candida, Enterobacter, Fusospirochetal, Helicobacter pylori, and Klebsiella.
People with diabetes and related nerve damage, known as peripheral neuropathy, may also experience symptoms akin to burning mouth syndrome. In this scenario, the underlying cause is nerve damage.
Certain irritants, including dental materials like mercury, amalgam, methyl methacrylate, cobalt chloride, zinc, and benzoyl peroxide can contribute. Some food allergies, including to peanuts, sorbic acid, chestnuts, and cinnamon, have also been linked to burning mouth syndrome.
The condition is also associated with mental health conditions like major depression, chronic anxiety, and mood disorders. The strongest link is with major depressive disorder, where the condition can occur with it, either following its beginning or at some point in the patient’s life.
Other potential triggers include orthodontic appliances (like braces), possible side effects from prescription drugs, an increase in bradykinin (a substance that dilates blood vessels), and concurrent skin conditions.
Risk Factors and Frequency for Burning Mouth Syndrome
Burning mouth syndrome typically affects women more than men, with women being 3 to 7 times more likely to experience it. The chance of this condition happening increases as both women and men get older. The highest number of cases in women happens around the time of menopause. It hardly ever happens in children or people younger than 30. In men, it’s rare to see before the age of 50. The exact number of people with burning mouth syndrome isn’t fully known, but it’s estimated that about 4% of people have it.
Signs and Symptoms of Burning Mouth Syndrome
Burning mouth syndrome relates to a condition where the mouth feels like it is burning all the time. It’s important to note that this diagnosis is made when no other causes of the oral pain can be identified. Doctors check chronic mouth discomfort, the presence of other health problems, and the current medications the patient is taking. It is paramount that there are no visible sores in the mouth for it to be classified as burning mouth syndrome.
Diagnosing this syndrome can be challenging due to differing views among professionals. However, certain criteria have been suggested to aid in the diagnosis, including:
- Daily intensive burning pain that can be felt on both sides of the mouth.
- The burning pain that persists for four to six months or longer.
- The severity of the condition either remains steady or worsens during the day.
- Relief from pain after eating or drinking, with no worsening of symptoms.
- The absence of sleep interruption due to the burning sensation of the mouth.
In some cases, patients with this condition may also experience changes in taste or dry mouth, sensory alterations, and mood or psychological disorders. It’s common for patients to describe their taste as metallic or bitter.
Testing for Burning Mouth Syndrome
If you’ve got a condition known as ‘burning mouth syndrome’, it means you constantly feel a burning sensation in your mouth. Doctors have a specific way to identify whether or not you have this condition, as outlined in a study by R. Aravindhan, Santhanam Vidyalakshmi and others:
1. They will start by asking you about your medical history and about the intensity and frequency of your burning sensation.
2. Next, they will carefully look inside your mouth, to see if the cause of your pain could be due to a local problem or another health condition.
3. They’ll also ask how you’re feeling in general, to understand if your psychological state might play a role.
4. Your doctor will then test your saliva production and your sense of taste. This helps determine how well your mouth is functioning.
5. They’ll perform a neurological examination, which is a check of your brain and nerves, and may use imaging tests (like CT scan, or MRI) to rule out degenerative disorders (conditions that gradually cause damage) or other problems related to the brain or nervous system.
6. They’ll take swabs from your mouth to look for harmful bacteria, fungi, or viruses which might be causing the problem.
7. If you are allergic, the doctor may use allergy patch tests. By applying small amounts of common allergens to the skin, they can see if your body has an allergic reaction to any of them.
8. They’ll also check to see if you have gastric reflux disease, a condition where stomach acid travels up towards the throat which might be causing burning sensation in mouth.
9. Lastly, they’ll conduct tests to rule out hormonal, autoimmune (when your immune system attacks healthy cells by mistake), or nutritional problems.
Keep in mind that if your tongue looks normal during the examination, there is no need for a biopsy (a test where a small sample is taken from your body for testing). A biopsy is only required if abnormal lesion is seen on the tongue.
Treatment Options for Burning Mouth Syndrome
Burning mouth syndrome is a tricky condition to manage, and it may require more than one different type of treatment. Treatment options currently include topical (applied directly to the area) and systemic (affecting the body as a whole) medications, as well as cognitive behavioral therapy, which is a type of psychological treatment. We’ve also seen positive results from laser therapy, but there’s still more work to be done to establish standardized guidelines for its use.
There are a variety of topical medications that can help manage symptoms. One such medication is capsaicin, an analgesic, or painkiller, which has been shown to improve symptoms. Despite its effectiveness, it can cause an increased burning sensation upon application, upset stomach, or other toxic effects, which can limit its use.
Clonazepam has also been seen to improve symptoms when applied topically. To use it, you suck on a tablet three times a day for two weeks. Despite its effectiveness, the symptoms may return if the medication is discontinued and it has a potential to cause addiction. Other side effects include dry mouth and fatigue.
Interestingly, some unconventional treatments have reduced symptoms as well, such as a mouth rinse with tabasco sauce and water, or hot pepper and water. Another is applying aloe vera gel three times a day, along with using a tongue protector.
While topical medications can help alleviate symptoms, systemic medications can also play a crucial role in managing burning mouth syndrome. Low doses of clonazepam are often used to manage the pain. However, while it can reduce pain, it doesn’t help with taste dysfunction, dry mouth, or mood problems. It is a decent option for short-term treatment.
Capsaicin can also be taken systemically to improve symptoms, but it needs to be used carefully due to its possible side effects like stomach pain.
Antidepressants like amitriptyline, desipramine, clomipramine, imipramine, and nortriptyline have been found to be effective in managing symptoms, even if they cause dry mouth symptoms. Moreover, other kinds of antidepressants, including sertraline, paroxetine, and duloxetine, have been found to significantly improve oral burning symptoms.
Antipsychotic drugs, like amisulpride and levosulpiride, have been seen to improve patient compliance in short-term treatments and reduce their burning symptoms.
Supplements which include a mixture of vitamins B, C, B12, folic acid, and minerals have also led to a complete resolution of symptoms in one study.
Hormone replacement therapy has also been found to reduce oral burning symptoms in women around and past their menopausal phase.
Cognitive-behavioral therapy is another treatment option that involves teaching relaxation and cognitive restructuring techniques to patients. The latter involves identifying and replacing harmful thoughts with more helpful ones.
Finally, low-level laser therapy has also shown potential in alleviating burning symptoms. It works by stimulating the production of serotonin and beta-endorphins while decreasing the secretion of bradykinin, a pain-causing substance.
What else can Burning Mouth Syndrome be?
There are several conditions that can present similar symptoms to burning mouth syndrome, such as:
- Stomatitis (inflammation of the mouth and lips)
- Atypical facial pain (unusual pain in the face)
- Atypical odontalgia (uncommon toothache)
- Idiopathic facial arthromyalgia (unexplained facial joint pain)
- Pemphigoid and pemphigus (skin diseases)
- Oral neoplastic lesions (abnormal growths in the mouth)
- Acoustic neuroma (a type of brain tumor)
- Failed denture design or tooth restoration
- Herpes simplex and herpes zoster (types of virus-caused infections)
- Post-surgical trauma to the lingual or mandibular nerve
What to expect with Burning Mouth Syndrome
The outlook for patients can vary quite a bit and largely depends on the root cause of the condition and any other existing health conditions. There are instances where symptoms are temporary and improve with treatment and time. On the other hand, in some cases, symptoms can remain for months or even years, or may never fully disappear. However, it’s important to note that this condition doesn’t worsen over time or cause further harm.
Possible Complications When Diagnosed with Burning Mouth Syndrome
Burning mouth syndrome is a long-term health problem that can sometimes get better on its own, sometimes slightly improve or even become more severe over time. People with this condition have constant burning pain in their mouth. They may also have a dry mouth and changes in their sense of taste, which can greatly affect their quality of life. Health experts do not fully understand the causes or how this condition develops, making treatment difficult. Currently, there’s no one-size-fits-all treatment that can completely get rid of the symptoms, which can be very frustrating for both the patients and their doctors.
Preventing Burning Mouth Syndrome
Burning mouth syndrome, or the feeling of a burning sensation in the mouth, typically affects women who are middle-aged or older. In particular, it frequently appears in women who are experiencing or have experienced menopause. It is very rare for the syndrome to occur in individuals under the age of 30. It has never been documented in children or teenagers.
Burning mouth syndrome cannot be confirmed as the cause of the symptoms if there are other health issues that could explain the burning sensation in the mouth. This is because it’s often diagnosed when other potential reasons for the symptoms have been ruled out.
In terms of physical examination, to determine if someone has burning mouth syndrome, their mouth needs to be free of sores or other unusual features.
Burning mouth syndrome is a complicated disease and we don’t fully understand it yet. As a result, those affected by it often need a mix of different treatments. Given this complexity, doctors should ensure that patients have realistic expectations about the results of their treatment.
