Sunday, November 6, 2011

Burning Mouth Syndrome as Symptom of Menopause

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.

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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.


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.

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"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.

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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:

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