What Is Burning Mouth Syndrome?

Burning mouth syndrome(BMS) is a painful mouth condition in which pain gives burning sensation. It originates most of the time on the tongue, but can be noticed in other parts of the mouth. This condition is not common in younger individuals, but noticed mostly in middle aged and elderly who are AFAB.

In spite of the scalding and burning sensation, one cannot notice any changes in the mouth. That means the oral mucosa looks normal that it can’t signify any change or burning sensation. In general, whenever one takes hot foods, the mucosa gets burned, becomes red, and is associated with a burning sensation. But in this condition, one cannot notice any of these changes. That makes the diagnosis and treatment difficult.

Overview

Burning mouth syndrome is defined as burning pain in the tongue or other oral mucous membrane associated with normal signs and laboratory findings lasting at least 4-6 months by the International Association for the Study of Pain. It is a recurring burning sensation in the mouth without any obvious cause.

The common areas of burning sensation– the tongue, lateral sides of the tongue, but it may also involve inferior aspects of the tongue, the front part of the palate, the cheek mucosa, the lip mucosa, and other mucosal regions like the anus or vagina. It is a fairly uncommon condition that is frequently detected in people who are AFAB more than in AMAB, and only in people between the ages of 38 and 78. 

Numerous social, religious, and psychological variables may influence this possibility. Not only can BMS induce burning, but in the majority of cases, it also affects taste.

Types of burning mouth syndrome

There are two types of burning mouth syndrome based on their cause: 

Primary BMS

Burning mouth syndrome is caused by damage to the nerves that transmit pain and taste, not by any other underlying medical issues. The cause for primary BMS is called idiopathic or unknown.

Secondary BMS

Many medical conditions can cause BMS secondarily to their primary effect. When these diseases are treated, BMS can be cured.¹ 

Causes of burning mouth syndrome

The main cause of BMS is still unknown. However, many conditions are found to be associated with burning mouth symptoms. They can be broadly divided into the following: 

Local

• Ill fitting dentures 
• Dental abnormalities 
• Allergic reaction 
• Oral habits- bruxism, clenching of teeth, cheek or lip biting
• Infections-bacterial, viral, or fungi
• Hyposalivation

Systemic/Generalised 

• Deficiencies of zinc, folate,  vitamin B12, or Iron deficiency anemia
• Endocrine disorders- diabetes, thyroid, menopause, hormonal imbalance
• Autoimmune conditions–Sjogren's syndrome or Sicca Syndrome
• Medications- Antihypertensive or Antiglycemic drugs

Psychological

Anxiety, depression, obsessive compulsive disorder, or psychological disorder.^¹

Signs and symptoms of burning mouth syndrome

The most common symptom is a burning sensation that can be sudden in onset, recurrent or transient in nature. In addition, patients may also have:

• Alteration in taste, metallic or bitter taste
• Some may have complete loss of taste too
• May have hyposalivation
• Tingling,numbness and stinginess can also be noticed

The discomfort may initiate soon after one wakes up or after having his first meal, may vanish soon, or can also persist throughout the day. That varies from person to person.

Management and treatment for burning mouth syndrome

Primary BMS can be treated effectively. While Secondary BMS is treated only by treating the underlying medical conditition causing it.There are various treatment options for BMS. One has to use some or combination of them to identify the best way to manage the symptoms of BMS.² 

Treatments include: 

1. Saliva replacement products
2. Medications suppressing the pain or burning sensation
3. Medications that cause local suppression of nerves, i.e numbness  that can reduce burning sensation
4. Psychological counseling and emotional assurance to relax the patient from stress and anxiety
5. Antidepressants
6. Medications that can block nerve pain
7. Antioxidants that help in relieving the nerve pain
8. Capsaicin, a derivative of chili peppers that helps in pain relieving

Diagnosis of burning mouth syndrome

Diagnosis of Burning Mouth syndrome is entirely based on symptoms as described by the patients. The medical professional takes into account your health, allergies, and dentures. In spite of all these, your doctor may conduct various investigations to rule out other underlying medical conditions that could produce the burning symptoms. Those investigations are:

1. Blood test - to rule out any other infections, (anemia), vitamin or mineral deficiencies 
2. Oral culture/biopsy - to rule out any fungal infections like candidiasis
3. Allergy test - to identify the agent causing allergy
4. Salivary measurement- reduced salivary production can also cause burning sensation and altered taste
5. Gastric reflux test - gastric juices sometimes get back back into the mouth damaging the mucosa and causing burning sensation
6. Imaging techniques - helps to find any pathologies in the head and neck region
7. Medicinal changes - sometimes, medicine changes from one composition to other or from one manufacturing company to other can also cause BMS
8. Mental health assessment - to identify psychological factors like depression and anxiety

FAQs

How can I prevent burning mouth syndrome?

There is no way one can prevent BMS, as the cause of it is still unknown. Once can reduce the risk of BMS by:

1. Reducing intake of alcohol
2. Reducing intake of hot and spicy foods
3. Not using tobacco products
4. Reducing one’s stress and anxiety
5. Being well hydrated
6. Intake of good and healthy food
7. Leading a healthy lifestyle

What are the risks factors of burning mouth syndrome?

The various risk factors associated with BMS are:

1. Alcohol intake
2. Using Tobacco products
3. Increase intake of hot and spicy foods
4. Intake of highly acidic food or drinks
5. Mouthwashes containing more alcohol content

How common is burning mouth syndrome?

The incidence of BMS is found to be 0.6-15%  in various international studies so far conducted. Most commonly seen in females with age range of 38-78 years i.e in premenopausal and menopausal stages.

When should I see a doctor?

It is crucial to get the diagnosis of BMS, as treatment depends on the type of BMS. Whenever you are facing a burning sensation in the mouth, it is important to know whether it is primary BMS or secondary BMS. The health condition which is causing secondary BMS should be  addressed, to treat BMS. BMS causes discomfort, the individual loses the intention to eat, thereby reducing the nutrition in the body. Hence it can lead to multiple other comorbidities. That is why BMS has to be managed as soon as possible.

Summary 

Burning sensation in the mouth can make the patient stressed and anxious. One can not accomplish his daily nutrient needs at that stage. Hence it can affect the overall health of the individual in the long run. Therefore, burning mouth syndrome has to be managed effectively to ensure one's intake of food and nutrients is not reduced, thereby preserving the overall immunity of the person.