Burning mouth is a hot feeling or sensation of burning (moderate to severe burning feeling) which can affect your tongue, lips, palate (the roof of the mouth), gums or inside your cheek. It also may involve a general sensation of discomfort of the whole mouth or throat.
It starts out of the blue for no apparent reason and persists for months or even years.
For some people the feeling starts in the morning and builds up to a peak by the evening, often easing by night time. The next morning the cycle recurs. Some people have the burning feeling all the time. For others, the pain comes and goes.
Whatever pattern of mouth discomfort you have, it may last for months to years. In rare cases, symptoms may suddenly go away on their own or become less frequent. Some sensations may be temporarily relieved during eating or drinking.
Other symptoms may include numbness or tingling of your mouth or tongue, a bitter or metallic taste at the same time as the burning sensation, alterations in the taste sensation or a dry or sore mouth. At times, the burning pain may be very severe and lead to depression and anxiety from the chronic pain.
Burning mouth usually begins spontaneously, with no known triggering factor. However, certain factors may increase your risk of developing burning mouth, including recent illness, previous dental procedures, wearing dentures, allergic reactions to food, medications, traumatic life events, stress, anxiety, depression etc.
People often describe it as a feeling like you have scalded your mouth with hot food or drink.
You get this feeling when there are changes in the way the nerves in your mouth send messages to your brain – for example, about taste and temperature. When your brain doesn’t understand these messages properly it can cause the feeling of pain or burning.
Although some parts of your mouth may feel like they are burning, they will not be hot to the touch. You might not be able to see any soreness or redness in the areas that are hurting.
Burning mouth is more common in post-menopausal women. It is likely related to reduced estrogen levels, which causes the decline in the sensitivity of the taste buds.
What causes burning mouth?
It’s hard to say. No one knows exactly what causes BMS.
Research has revealed that there is a relationship between burning mouth and taste (gustatory) changes. Research has shown that many people with burning mouth have a loss of bitter taste buds at the tip of the tongue. So someone with normal taste for sweet, sour and salty has a reduced sensitivity for bitter taste. Here is the interesting part. The theory is that taste inhibits pain but when the ability to taste bitter is lost, pain fibers begin to “fire” spontaneously. This pain is felt as a burning sensation in the mouth.
Some experts believe it may be caused by damage to the nerves that control pain and taste. In some patients, herpes has been detected by saliva tests as a possible cause of burning mouth in dental clinics in Delhi.
Sometimes burning mouth is caused by an underlying medical condition. These include:
- Dry mouth (xerostomia), which can be caused by various medications, health problems, problems with salivary gland function or the side effects of cancer treatment
- Other oral conditions, such as a fungal infection of the mouth (oral thrush), an inflammatory condition called oral lichen planus or a condition called geographic tongue that gives the tongue a map-like appearance
- Nutritional deficiencies, such as a lack of iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12) can mimic the sensation of burning mouth.
- Dentures, especially if they don’t fit well, which can place stress on some muscles and tissues of your mouth, or if they contain materials that irritate mouth tissues
- Allergies or reactions to foods, food flavorings, other food additives, fragrances, dyes or dental-work substances
- Reflux of stomach acid (gastroesophageal reflux disease or GERD) when acid from your stomach comes up into your mouth
- Certain medications, particularly high blood pressure medications
- Underlying diseases such as diabetes or liver problems or herpes viral infection
- Oral habits, such as tongue thrusting, biting the tip of the tongue and teeth grinding (bruxism)
- Endocrine disorders, such as diabetes or underactive thyroid problem(hypothyroidism)
- Excessive mouth irritation, which may result from overbrushing your tongue, using abrasive toothpastes, overusing mouthwashes or having too many acidic drinks
- Psychological factors, such as anxiety, depression or stress.
- Tobacco and alcohol use are also considered as potential causes of mouth pain.
Dentists in Delhi are counseling patients on burning mouth symptoms. Symptoms may include:
- A burning,tingling or scalded sensation that most commonly affects your tongue, but may also affect your lips, gums, palate, throat or whole mouth
- Or the pain may be a feeling of numbness
- A sensation of dry mouth with increased thirst
- Taste changes, such as a bitter or metallic taste
- Loss of taste
How can I ease the symptoms myself?
You can help to ease or improve or reduce the discomfort by:
- sipping water often
- sucking on crushed ice
- chewing sugar-free gums – this helps you produce more saliva which helps to stop your mouth getting dry
- Vitamin supplements(B, folate, zinc and iron)
- avoiding things that irritate your mouth – such as hot and spicy foods, mouthwashes that contain alcohol, or acidic fruits and juices
- avoiding tobacco and alcohol products.
As no one knows the exact cause of burning mouth, it is hard to plan a correct course of treatment.
Treatments can vary depending on the causes. No specific treatment works for all people. Because burning mouth is a complex pain disorder, the treatment that works for one person may not work for another.
However, your doctor can prescribe medicine to help you manage mouth pain, dry mouth, or other symptoms.
If it has been brought on by a poor diet, then your dentist may recommend supplements for you. Sometimes symptoms go away when the underlying medical condition, such as diabetes or yeast infection, is treated. If a drug is causing burning mouth, then your doctor may switch you to a new medicine. Dentists in India have been counseling patients for the anxiety problems which result in burning mouth as a symptom.
It is important to keep a record of how your symptoms are affected by the different types of treatment. Your doctor will then have a better idea of what treatment is best for you – after all, everybody is different.
Continued follow-up is also likely help patients with management of symptoms.
The following treatments for burning mouth have been suggested-
- Discontinuation of medications that may cause xerostomia, such as anticholinergics or psychotropics
- Substitution of medications that may cause oral burning
- Adjustment of levothyroxine dosing
- Oral nystatin
- Abstinence from smoking and oral tobacco use
- Avoidance of allergens
- Adjustment of dentures (refitting and/or substituting materials)
- Chewing sorbitol-containing gum to stimulate saliva
- Pyridostigmine, Pilocarpine, or other sialogogues
- B vitamin supplementation
- Zinc supplementation
- Iron supplementation
- Folate supplementation
- Neuropathic analgesics
- Clonazepam (low-dose) dissolvable wafers (may be better than tablets) 
- Alpha-lipoic acid
- Psychotherapy (cognitive behavioral modification, relaxation)
- Hormone replacement therapy
- Tricyclic antidepressants
- Oral lidocaine
- Near infrared irradiation of the stellate ganglion, to inhibit sympathetic discharge and improve blood flow to the tongue in glossodynia (still experimental)
- Acupuncture (uncontrolled studies)
Some medications seem to help but they are not currently or specifically approved for burning mouth. These medications include certain antidepressants, an antiseizure medication, and gabapentin (a drug used to treat seizures and the pain associated with herpes) and others may include:
Clonazepam (oral or wafers), Diazepam, Amitriptyline,Nortriptyline, Doxepin, Fluoxetine, Paroxetine, Sertraline, Chlordiazepoxide, Capsaicin (oral or topical), Olanzapine (case report with low dose), Topiramate (case report).
Discuss treatment options with your doctor. Burning symptoms in the mouth is being treated routinely by the dental clinics in India.
If you have discomfort, burning or soreness of your tongue, lips, gums or other areas of your mouth, see your doctor or dentist for a checkup. They may need to work together to help pinpoint a cause and develop an effective treatment plan. They may advise you to go for some tests including saliva test or blood tests to try to find the cause of your burning mouth.
Posted by- Dr Suprriya and Dr Shriya