Ask the Doctors: Finding Treatment for Burning Mouth Syndrome Can Take Time | Health
Dear doctor: I am a 28 year old female and have symptoms that lead me to believe that I have burning mouth syndrome. At first it wasn’t that bad, but now it’s continuous. I have not been diagnosed, but would appreciate any information or help you can offer for this condition.
Dear reader: Burning mouth syndrome, sometimes abbreviated as BMS, refers to the presence of specific pain sensations that occur inside the mouth. These can range from a slight tingling, tingling, or numbness to pain that resembles a burn or stinging, which gives the disease its name. The pain, often severe, can be intermittent or constant. In some people, the pain is generalized and affects the whole mouth. In others, it occurs in isolated areas, such as the lips, gums, tongue, inner cheeks, roof of the mouth, or soft palate.
In some cases, these mouth sensations are accompanied by a dry mouth or noticeable changes in the sense of taste. These often include the presence of bitter or metallic flavors. Some people also find that they have increased thirst. Burning mouth syndrome, which often comes on quite suddenly, can occur in anyone and at any age. However, it is most often seen in women, as well as in adults over the age of 60.
When there is no obvious cause for burning mouth syndrome, as an underlying medical condition, specific medication, or ongoing treatment, this is called primary burning mouth syndrome. When the syndrome develops as a result of a medical problem or treatment, it is called secondary BMS. The causes of primary burning mouth syndrome are not yet understood. However, researchers believe it’s associated with damage to nerve pathways that play a role in taste and pain in the oral area.
Causes of secondary BMS can include hormonal changes associated with perimenopause or menopause, allergies to metals and other products used in dental repair, oral infections, diabetes or acid reflux, or low levels of certain nutrients, especially iron or vitamin B12. The disease can be a side effect of antihypertensive drugs and can occur in people undergoing radiation therapy. The condition has also been linked to hypothyroidism, which is an underactive thyroid gland. It is possible that hypervigilant oral hygiene, such as excessive use of astringent mouthwash, abrasive toothpaste, or dental bleach, may play a role.
There are no targeted tests for the condition. Diagnosis involves a medical history, a physical exam, and the gathering of information that may reveal an underlying medical condition. Patients are also asked detailed questions about lifestyle, diet, medications and the environment. Treatment for secondary BMS focuses on the underlying conditions that cause it. For primary BMS, the goal is to alleviate existing symptoms. This may include the use of mouthwashes, saliva substitutes, pain relievers, certain antidepressants, anticonvulsants, and behavior therapy.
Patients are also advised to avoid tobacco products and alcohol, as well as spicy, acidic, or too hot foods, and switch to mild toothpaste. This is a complex condition, and finding the right treatment can take time and patience.
(Eve Glazier, MD, MBA, is internist and associate professor of medicine at UCLA Health. Elizabeth Ko, MD, is internist and assistant professor of medicine at UCLA Health. Send questions to [email protected], or write: Ask the Doctors, c / o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Due to mail volume, personal responses cannot be provided.)