Diagnosing and Understanding Burning Mouth Syndrome: Causes, Symptoms, and Treatments

Diagnosing Burning Mouth Syndrome can be challenging. One of the discouraging things about diagnosing burning mouth syndrome is it can take a very long time. People often see multiple specialists.

I had somebody tell me that she had burning for a year and was really depressed. She had a history of depression previously. It got worse with the development of her burning tongue. The tip of her tongue burns, and her taste sensation is abnormal. And we will get into that. In addition, she told me she had spent $12,000 on treatments that were unsuccessful. I had somebody contact me about this webinar who said, “I’ve seen every kind of doctor you can imagine from A to Z, I have pain 24 seven. And when I got so discouraged and felt like I couldn’t stand the pain anymore, they admitted me to a psych hospital for seven days. It didn’t help my pain, and it was a humiliating experience.

We know patients go from doctor to doctor

So, we know that patients go from doctor to doctor, to doctor to make a diagnosis of burning mouth. I had one patient tell me her primary care doctor said, “Well, I’ve got good news for you and bad news for you. The good news is I know what you’ve got. It’s Burning  Mouth Syndrome. The bad news is I don’t know what to do to help you.”

And this is what patients confront over and over. So, because it’s in the mouth, many people go to see dentists, oral surgeons, ear, nose, and throat specialists. Wondering if it’s an allergic problem. Seeing allergy doctors, seeing their usual family practice doctors, internal medicine doctors, and alternative health practitioners as well.

The course of the disease

How does the disease go? Well, some people remember the month it happened. Or, it was pretty sudden onset. They connect it with something that’s gone on in their lives. They had dental work done. They had a traumatic experience. They were on steroid hormones. A whole variety of different kind of precedent, that they remember pretty specifically when it started. Other people kind of start having burning. It feels like their tongue was scalded, not all the time. And then as time goes on, it becomes more distinct, more progressive.

Half of patients have onset of pain and can’t connect it to anything. And like it says here, a number of people will relate it to dental work, to an illness, or medication. And so far, we really don’t know of the connection that any of these things actually cause burning mouth. We all certainly desire to try to figure out what caused it. So, we will often put it together with something else that happened at the time. I can tell you stress and trauma definitely are connected. There’s been a lot of work done to see if dental work causes burning mouth. Or if people are allergic to certain dental, composites. So far, that really hasn’t panned out as a reason for Burning Mouth Syndrome.

How does disease go? Well, symptoms usually go on for months or years. One of the articles that I read said that there is spontaneous and partial recovery in 20% of patients after six to seven years. That recovery usually, is not that it goes away, but the symptoms become more intermittent. However, for the bulk of people, it doesn’t usually get better on its own. We certainly don’t see the people for whom it’s gotten better on its own. We see the people who have seen all the doctors from A to Z and take in months and years to get diagnosed and not found a solution.

There are other associated symptoms

There are other symptoms that are associated with burning mouth. 70% of people have altered taste perceptions, which can be really distressing a feeling of a metallic taste in their mouth or a salty taste. Also, food doesn’t taste, right? The sensation of dry mouth. And I say a sensation of dry mouth because when studies have been done in burning mouth syndrome patient’s saliva is actually measured. Tests find saliva production is normal production, but the feeling is that your mouth is dry, uncomfortable, difficult to eat. and difficult to process food in your mouth. Sometimes it is difficult to swallow. And we certainly see anxiety, depression, and stress. I’ll get into these as we go. So how do we make the diagnosis?

Here are some things to look out for

If you’re having a problem with pain in your mouth, burning on your tongue, here’s some things that you can take a look for. Try to see if there a white coating on your tongue. This may be Thrush which is also yeast infection of the tongue. It can also give you an off white or gray coating. And there can be a lot of discomfort with that. Are there little blisters? Blisters can mean herpes, or shingles infections. If you have a lot of pain and burning that show up either on the tongue, inside the mouth, or on the lips are there white or purplish gray patches? It is discrete little patches. That might be the size of a diameter of a pencil eraser or smaller. This is something called lichen planus. Lichen planus is, an autoimmune, or partially autoimmune that may be caused by a virus. No one is completely sure what lichen planus is, but it creates pain in the mouth.

Then is their low salivary flow, which is something that is hard to measure yourself, but dentists who specialize in these kinds of problems can evaluate salivary flow. I’ll explain why that’s an important distinction in a little while. You want to rule out that there is something going on in the mouth causing an irritation or burning. So, a dental prosthesis, a bridge, a crown, that’s rubbing and causing pain with contact. Also, hypersensitivity to dental materials, which hasn’t in fact been shown to be a cause of burning mouth syndrome, but some people might possibly have that as a cause of irritation in their mouth.

Allergies and reflux can cause burning mouth

You want to look at whether you have allergies to foods, the flavorings, additives, or fragrances that you’re using on your body. Is there anything caustic that you’re using? Are you eating a lot of acidic foods? Do you have a kind of chronic habit of biting your cheek? What is gastrointestinal reflux? So gastrointestinal reflux happens when stomach acid comes up your esophagus and sometimes can even come into the mouth. Not only do we see, reflux coming into the mouth, it also can go, the back of the mouth, the pharynx, the larynx, which is your voice box.

A lot of times this kind of reflux can be caused by problems during sleep with oxygenation and the structure of your mouth and throat. This causes problems with low oxygenation and a collapsed airway during sleep and with the alterations and the pressure between your mouth, your stomach, and your lungs. Acidic stomach fluid gets pulled up into the back of the mouth and throat and can be a cause of burning. So, you want to rule out whether you have a problem with gastrointestinal reflux. That is reflux of acidic stomach contents into the back of your throat and mouth, which will cause burning.

Vitamin deficiencies, diabetes, and autoimmune diseases

There are other things that can cause burning. Vitamin deficiencies, such as the B vitamins like vitamin B12 and thiamine B1 can cause nerves to malfunction. We see that, in people who have certain chronic illnesses where they have low B vitamins. Sjogren’s is an autoimmune disorder with true dry mouth and people with Sjogren’s syndrome can have a burning tongue. We try to distinguish. Is it Sjogren’s auto immune or is it burning mouth syndrome? One of the big distinguishing features is that people with Sjogren’s have not only dry mouth, but they also have dry eyes. So, if you’re somebody with dry eyes, as well as dry mouth, this can be a distinguishing factor in whether you have Sjogren’s, which is autoimmune. Sjogren’s requires somewhat different type of treatment from Burning Mouth Syndrome.

Diabetics are known for having neuropathy or a malfunction of their nerves and it’s possible. It’s usually the nerves on the feet and the legs. It could also be hands, and it also can end up showing up in people’s mouth. So, you want to rule out whether you’re diabetic or prediabetic. If you are having problems with regulating blood sugar, blood sugars being too high that may be the cause. Medications can cause burning in the mouth. There’s one particular class of medications called the, ACE inhibitors or angiotensin converting enzyme inhibitors. They have names that ended P R I L like lisinopril and captopril. And for some people changing from this type of medication to another blood pressure medication will give some relief of burning.