Burned Mouth Syndrome (BMS)

Overview

Burning tongue syndrome (BMS) has many different alternative names including scalded mouth syndrome, burning lips syndrome, glossodynia, glossopyrosis, stomatodynia, stomatopyrosis, and oral galvanism. Regardless of the name, the condition involves chronic, burning pain in the tongue, gums, lips, and inside of the mouth.

While there aren’t any visible signs or lesions to observe, the very real pain can range from moderate to severe, and some have compared its intensity to that of a toothache.

BMS usually begins without any recognizable trigger, and may last for a few weeks, months, or even years.

Diagnosis is usually a process of ruling out other possible conditions, and treatment varies from lifestyle changes in diet and behavior to the administration of traditional drugs.

Two thirds of those reporting BMS will have recovered in 6-7 years as constant pain and discomfort becomes more episodic. There is no known prevention for this problem at present.

Symptoms

The most obvious symptom of BMS is an unpleasant to painful burning sensation on the tongue, lips, gums, palate, throat, or even in the whole mouth. It is also possible to have a numbing or tingling sensation in the mouth or on the tip of the tongue.

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Interestingly, most patients report that they awake with little or no pain and the intensity increases as the day progresses, peaking by bedtime. They experience little or no pain during the night hours, starting the cycle anew each day. Some report having a very dry mouth and increased thirst. Another symptom may be a loss of taste or a change from normal to a bitter or metallic one that lingers in the mouth. These evidences of BMS may be continuous or periodic.

Causes

While the actual causes of BMS have yet to be been clearly established, it seems that the condition can be divided into two general categories. When the outbreak has no identifiable cause, it is treated as “primary” or “idiopathic” BMS. Researchers suspect that there is a dysfunction of the sensory and taste nerve of the peripheral and/or the central nervous systems.

The cranial nerves are also associated with the taste sensations. “Supertasters,” those people with a really high density of the small papillae that contain the taste buds seem to be slightly more prone to BMS, possibly because all those extra taste receptors are surrounded by basket-like clusters of pain neurons that may fire up if the taste buds stop functioning, as often happens during menopause.

Secondary BMS

If an underlying problem is identified and BMS becomes a symptom of the greater illness, the term “secondary” BMS is used. As mentioned previously menopause seems to be a key player in this health issue. As a woman’s estrogen levels drop in pre-menopause, it fades from her saliva as well.

With the loss of function of her bitter taste buds, it would appear that the pain neurons are activated and BMS may be the result. The fact that 40% of menopausal women suffer from this condition that starts about 3 years before menopause and lasts as long as 12 years after, seems to support this theory.

Other Possible Causes

• Oral candida (yeast infection of mouth)
• Hormonal deficiencies or abnormalities
• Diabetes (specifically Type 2)
• Dry mouth
• Blood abnormalities (anemia, dyscrasias)
• Medications (especially those given for high blood pressure)
• Endocrine disorders (hypothyroidism)
• Nutritional deficiencies (B vitamins, niacin, folic acid, iron, zinc)
• Allergies (food, gum, toothpaste, mouthwash)
• Gastric acid reflux
• Dental procedures
• Dental disease
• Unhealthy oral habits (biting tongue, thrusting tongue, grinding teeth)
• Chronic infection
• Inflammatory disorders
• Tobacco use
• Oral cancer
• Nerve damage
• Too many acidic drinks
• Mouth irritation (excessive tongue brushing)
• Use of ACE inhibitors (angiotensin-converting enzymes)
• Dentures (stressing muscles and tissues or causing allergic reaction in surrounding tissues)

Risk Factors

Most sufferers of BMS are middle-aged women between the ages of fifty and seventy years. They are seven times more likely to be affected than men, which may support the argument for hormonal imbalance experienced during menopause as the most frequent underlying condition.

There doesn’t appear to be an identifiable trigger, and the onset is usually spontaneous. Approximately 30% of those diagnosed with BMS report recent dental procedures, illnesses, or newly prescribed medications in their history intake.

Other important factors seem to be stress or a traumatic life event, allergic reactions, upper respiratory infections, and excessive taste bud loaded papillae.

Tests and Diagnosis

Because there is no present consensus on the origins or causes of BMS, most doctors will try to diagnose this condition by process of elimination, ruling out all other possibilities. The patient can typically expect a review of personal medical history and current medications being taken. The mouth will be thoroughly examined and cultures taken.

The doctor will want to know about the symptoms being presented as well as the oral habits and mouth care of the patient. Most doctors will want to do a complete general medical examination while they search for an underlying condition that may have triggered this attack. Blood tests will be part of that process as well. It may be necessary to have an imaging test such as an MRI or CT scan.

Allergy tests and saliva measurements are often included, as is a test for gastric reflux. Finally, the last item will probably be a psychological questionnaire to analyze the levels of stress the patient may be experiencing.

Complication

While each person who suffers from BMS is unique, some associated problems seem to be held in common. It is not unusual for patients to express difficulty in sleeping. Whether this insomnia is caused by increased levels of evening pain or the stress associated with having this illness is uncertain. In a similar fashion, it is not always clear whether the accompanying depression is a cause of the BMS or a result of trying to deal with this illusive illness.

Irritability and anxiety are understandably often part of the package too. Some patients report difficulty eating because of the persistent pain in their mouths or on their tongues or lips. Others stop or decrease their times of socializing because of the discomfort and distraction that BMS causes.

Treatment

Since there is no known cure or universal treatment for primary BMS, each patient will be dealt with according to the individual presenting symptoms. The goal will be to alleviate the pain as much as possible, or if that fails, at least to manage it.

There are several drugs currently available including Klonopin, a lozenge type form of the anti-convulsant drug clonazepam. Patients have reported some relief with this medication.

Secondary BMS Treatment

Concerning secondary BMS, the treatment protocol involves identifying the underlying cause and then addressing it as a way to eliminate the presenting burning mouth or tongue issues. Recommendations can include traditional drugs, alternative health care, and lifestyle changes. It would appear that the combination of lifestyle adjustments and alternative health practices offers the best results for many patients. However, some underlying conditions require very serious attention and become the primary focus of treatment, at least initially.

Alpha-lipoic acid is a strong antioxidant that seems to benefit BMS suffers. Oral thrush medications can be prescribed as well as saliva replacement products. There are also special oral rinses and mouthwash products that a doctor may include in the treatment regimen.

Home Remedies

Some of the simplest home remedies can actually bring almost instantaneous relief to the BMS sufferer. They are as uncomplicated as sucking on ice, keeping one’s mouth moist by sipping extra water, and increasing daily intake of certain foods. Eating “plain” food and lots of boiled vegetables is a good place to start. Foods high in Vitamin B need to be included in the menu.

Meat, brown rice, fish, wheat germ, whole grain cereals, and soybeans are all great sources of Vitamin B. Also, foods rich in iron such as red meats, liver, cashews, figs, and Special K cereal are recommended additions, especially in cases where the underlying condition may be anemia. Adding certain fresh fruits and vegetables to a healthy diet can also help.

Applying glycerin to the tongue has been reported to bring relief, as has eating honey with milk. It seems the combination increases the blood flow to the tongue which encourages a healthier response from the pain neurons.

More Homeopathic Remedies

Another homeopathic treatment involves applying lavender oil to the tongue and leaving it there over night. Lavender oil is actually a powerful antiseptic. Some doctors recommend topical Capsaicin, a cream pain reliever made from chili peppers. Its purpose is to desensitize the tongue and mouth from the burning sensations.

There are simple lifestyle choices that can also make a difference in reducing the pain from BMS. Sugar-free gums will keep the mouth and tongue moist. Avoiding alcohol and tobacco are also important. Both smoking and chewing tobacco can be problematic if BMS is diagnosed.

Ironically, while the doctor may have prescribed Capsaicin cream for your tongue, it is best not indulge in spicy foods because of added irritation within the mouth. Others to avoid include acidic foods and liquids such as some fruit juices. Eliminating soft drinks and coffee are important changes to one’s diet as well.

Toothpaste

It may be necessary to switch out a favorite toothpaste, especially if the one in question contains sodium laurylsulfate. Baking soda is always a good safe alternative. While in the bathroom, check out the mouthwash also, to make sure there is no alcohol in it.

Behavior Concerns

Although hormonal imbalances have taken first place as a plausible cause of BMS, to date there is no conclusive evidence that hormone replacement therapy has had a significant effect in successfully treating this problem. If a doctor determines that psychological factors such as stress, anxiety, or depression are the causes and not the symptoms of BMS, antidepressants may be prescribed.

Cognitive behavior therapy has also been used to treat this condition. The bottom line may be to make as many lifestyle changes as possible to reduce the negative effects of stress and anxiety in one’s life.

Cost

The expense of finding relief from the pain of BMS is directly related to the number of professionals one may visit and the amount of health insurance in place. Many sufferers first consult their dentist because they view their mouth problems as dental care issues. From there, they may consult a family physician who will probably send them on to a specialist.

Add to these visits, the cost for all the preliminary tests, and the price continues to rise. Throw in a CT scan or MRI and it’s beginning to be really costly for the person without good health insurance. Some of the drug regimens are expensive, and so is a visit to the psychologist. If the patient doesn’t already suffer from anxiety or depression, rising health costs may do it.

The best approach would seem to be to try the easiest and least expensive treatment suggestions first. It may not be necessary to seek further expensive care. To the sufferers of BMS, this is no minor problem that can be easily overlooked. Imagine a toothache that lasted for years. For some, any price is worth getting relief.

Progress

In the past, because of the lack of physical symptoms in the mouth and on the tongue, many patients’ complaints were not taken seriously. Add that to the fact that the majority of complainers were middle-aged women in the throes of menopause, and the seriousness of the ailment often came into question. It was not unusual to be told that one was imagining the discomfort.

Today, however, the medical profession is more aware and sympathetic to this problem. Increased research seeks to understand the etiology and the pathogenesis so that more effective treatments can be prescribed. The dental field is also involved since dental procedures and problems seem to sometimes precede the onset of BMS.

It is to be hoped that in the near future, much more definitive knowledge will be available and better treatment protocols in place. Until then, trial and error of both traditional drug therapies and alternative health recovery plans, when combined with relevant lifestyle changes, are the best chance one has to find relief from the pain of BMS.

Resources

nlm.nih.gov

Mayoclinic.Com

MedicineNet.Com