Most people can relate
to the uncomfortable feeling that occurs after scalding their mouth on hot soup
or coffee. It's a relief when that burnt feeling subsides after several days.
But imagine experiencing that burning sensation all day, every day. The
condition is called burning mouth syndrome (BMS), and damage to the nervous
system during menopause may be to blame, according to an article published in
the May/June 2011 issue of General Dentistry, the peer-reviewed clinical
journal of the Academy of General Dentistry (AGD).
Although BMS can affect
both sexes, the study confirms by a 7:1 ratio that women in their menopausal
and post-menopausal years are more likely to be affected by BMS.
What is
Burning Mouse Syndrome?
Burning mouth
syndrome causes chronic burning pain in your mouth. The pain from burning mouth
syndrome may affect your tongue, gums, lips, inside of your cheeks, roof of
your mouth, or widespread areas of your whole mouth. The pain can be severe, as
if you scalded your mouth. Other names for burning mouth syndrome include
scalded mouth syndrome, burning tongue syndrome, burning lips syndrome,
glossodynia and stomatodynia.
Symptoms
Unfortunately, the
cause of burning mouth syndrome often can't be determined, since it is
characterized by a burning sensation in the tongue or other oral sites, usually
in the absence of clinical and laboratory findings. Affected patients often
present with multiple oral complaints, including burning, dryness and taste alterations.
Burning mouth complaints are reported more often in women, especially after
menopause.
In many patients
with the syndrome, pain is absent during the night but occurs at a mild to
moderate level by middle to late morning. The burning may progressively
increase throughout the day, reaching its greatest intensity by late afternoon
and into early evening. Patients often report that the pain interferes with
their ability to fall asleep. Perhaps because of sleep disturbances, constant
pain, or both, patients with oral burning pain often have mood changes,
including irritability, anxiety and depression. Earlier studies frequently
minimized the pain of burning mouth syndrome, but more recent studies have
reported that the pain ranges from moderate to severe and is similar in
intensity to toothache pain.
Typically, patients
awaken without pain but note increasing symptoms through the day and into the
evening. Conditions that have been reported in association with burning mouth
syndrome include chronic anxiety or depression, various nutritional
deficiencies, type 2 diabetes (formerly known as non–insulin-dependent
diabetes) and changes in salivary function. However, these conditions have not
been consistently linked with the syndrome, and their treatment has had little
impact on burning mouth symptoms.
Symptoms of burning
mouth syndrome include:
- A burning sensation that may affect your
tongue, lips, gums, palate, throat or whole mouth
- A tingling or numb sensation in your
mouth or on the tip of your tongue
- Mouth pain that worsens as the day
progresses
- A sensation of dry mouth
- Increased thirst
- Sore mouth
- Loss of taste
- Taste changes, such as a bitter or metallic taste
Little information
is available on the natural course of burning mouth syndrome. Spontaneous
partial recovery within six to seven years after onset has been reported in up
to two thirds of patients, with recovery often preceded by a change from
constant to episodic burning. No clinical factors predicting recovery have been
noted.
Causes
"The cause of BMS is currently unknown, but our findings support the
theory that this is a neuropathic condition," says lead study author Gary
D. Klasser, DMD. "For reasons unknown, it seems that the BMS patient's
nerves are not sending and/or processing information correctly—there's a short
circuit in the nervous system and the brain can't turn off the pain
receptors."
Other recent studies
have pointed to dysfunction of several cranial nerves associated with taste
sensation as a possible cause of burning mouth syndrome.
In general, the
cause of burning mouth syndrome can be classified as either primary or
secondary. When the cause of burning mouth syndrome isn't known, the condition
is called primary or idiopathic burning mouth syndrome. Some research suggests
that primary burning mouth syndrome is related to problems with taste and
sensory nerves of the peripheral or central nervous system, and most of the
menopause related conditions fall in this category. However, in some cases the
triggers for the burning mouse syndrome can be found in patients’ diet,
lifestyle, or medications list, so that falls in the secondary burning mouse
syndrome category.
Underlying problems
that may be linked to secondary burning mouth syndrome include:
- Dry
mouth (xerostomia), which can
be caused by various medications or health problems.
- Other
oral conditions, such as oral
yeast infection (thrush), oral lichen planus or geographic tongue.
- Psychological
factors, such as anxiety,
depression or excessive health worries.
- Nutritional
deficiencies, such as 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).
- Dentures. Dentures can place stress on some of
the muscles and tissues of your mouth, causing mouth pain. The materials
used in dentures also can irritate the tissues in your mouth.
- Nerve
damage to nerves that control
taste and pain in the tongue.
- Allergies
or reactions to foods, food
flavorings, other food additives, fragrances, dyes or other substances.
- Reflux
of stomach acid (gastroesophageal reflux disease) that enters your mouth from your upper
gastrointestinal tract.
- Certain
medications, particularly high
blood pressure medications called angiotensin-converting enzyme (ACE)
inhibitors.
- Oral
habits, such as tongue
thrusting and teeth grinding (bruxism).
- Endocrine
disorders, such as diabetes
and underactive thyroid (hypothyroidism).
- Hormonal
imbalances, such as those
associated with menopause.
- Excessive mouth irritation, which may result from overbrushing of your tongue, overuse of mouthwashes or having too many acidic drinks.
Treatments and drugs
There’s no one sure
way to treat primary burning mouth syndrome, and solid research on the most
effective methods is lacking. Treatment depends on your particular signs and
symptoms, as well as any underlying conditions that may be causing your mouth
pain. That’s why it is important to try to pinpoint the cause. Once any
underlying causes are treated, your burning mouth syndrome symptoms should get
better.
If a cause can’t be
found, treatment can be challenging. There is no known cure for primary burning
mouth syndrome. You may need to try several treatment methods before finding
one or a combination that is helpful in reducing your mouth pain. Treatment
options may include:
- A lozenge-type form of the
anticonvulsant medication clonazepam (Klonopin)
- Alpha-lipoic acid, a strong antioxidant
produced naturally by the body
- Oral thrush medications
- Certain antidepressants
- B vitamins
- Cognitive behavioral therapy
- Specific oral rinses or mouthwashes
- Saliva replacement products
- Capsaicin, a pain reliever that comes
from chili peppers
Surgery is not
recommended for burning mouth syndrome.
Lifestyle and home remedies
In addition to medical
treatment and prescription medications, self-help measures may help improve
your symptoms. You may find these self-help measures beneficial for reducing
chronic mouth pain:
- Drink more fluids, to help ease the
feeling of dry mouth.
- Don’t use tobacco products.
- Minimize alcohol intake to avoid the
oral tissue irritation.
- Avoid products with cinnamon or mint.
- Avoid spicy-hot foods.
- Avoid acidic foods and liquids, such as
tomatoes, orange juice, soft drinks and coffee.
- Chew
sugarless gum to increase saliva flow.
- Try different brands of toothpaste.
- Take steps to reduce excessive stress.
"BMS is not a matter of life or death, but it is a matter of quality
of life," says Dr. Antenucci. "Patients who believe they suffer from
any of these symptoms should speak with their general dentist and seek out a
health practitioner who has experience with this condition."
Sources and Additional
Information:
