Burning mouth syndrome

Overview of burning mouth syndrome

Oral health is of crucial importance for the maintenance of a healthy lifestyle. Failure to do so can lead to several diseases of the oral cavity and the gums. Burning mouth syndrome is one such disease that causes a persistent burning sensation in the mouth. Most of the patients having the disease are not even aware of it, due to the negligible severity of the syndromes in the early stages. Though the global scenario of the disease is not very serious at the moment, care should be given to dental and gum health in order to avoid similar conditions.

What is burning mouth syndrome?

Burning mouth syndrome is defined as a painful, dry and burning sensation inside the mouth, which may be short-termed or persistent. The disease mainly affects the tongue, the roof of the mouth, the back of the mouth and the throat. The patients may also experience tingling or numbness inside the mouth, particularly on the tongue. This may be accompanied by a strong metallic taste in the mouth. The condition is observed in both men and women. But the symptoms are more prominent in post-menopausal women. The condition is often termed as- “scalded mouth syndrome”, “glossodynia” and “stomatodynia”.

What are the causes of burning mouth syndrome?

Burning mouth syndrome is often idiopathic in nature, that is the exact cause is not known. Research workers have performed a number of case studies and finally assembled a few causes of burning mouth syndrome. The most important ones are listed below-

Local causes: 

• Oral conditions like geographic tongue or lichen planus
• Maladaptive oral practices like bruxism and tongue thrusting
• Mouth irritation caused by an excess intake of acidic fluids, vigorous brushing and an overuse of mouthwashes.

Systemic causes: 

• Xerostomia (dry mouth) caused by Sjogren’s syndrome and radiation therapy
• Gastroesophageal reflux disease

Nutritional causes:

• Deficiency of vitamins B₁, B₂, B₆ and B₁₂
• Zinc, folate and iron deficiency

Immunological causes: 

• Raised levels of Erythrocyte Sedimentation Rate (ESR) and salivary IgA
• Dental irritants like mercury, methyl methacrylate, cobalt chloride, zinc, and benzoyl peroxide
• Food allergens like cinnamon, nicotinic acid, sorbic acid, peanuts, and chestnuts

Psychological causes: 

• Increase in salivary cortisol due to significant stress
• Existing conditions worsened by anxiety and depression

Iatrogenic causes: 

• Angiotensin-convert enzyme (ACE) inhibitors
• Angiotensin-receptor blockers
• An increased salivary concentration of kallikrein
• Drugs like antiretrovirals nevirapine and efavirenz

Infections: 

• Candida
• Enterobacter
• Fusospirochetes
• Helicobacter pylori
• Klebsiella

Endocrine disorders: 

• Menopause (surgical or physiological)
• Damage to oral mucosa due to hormonal changes
• Atrophic changes in the oral cavity due to hormonal deficiency
• Reduced functioning of the thyroid hormones, leading to hypogeusia
• Sensitive trigeminal sensation

Neurological disorder: These mainly result from abnormal interactions between the sensory functions of chorda tympani and lingual nerve in the peripheral and central nervous systems.

Did you know you can prevent burning mouth syndrome if you take care of the nutritional deficiencies that could trigger it?

What are the main symptoms of burning mouth syndrome?

Burning mouth syndrome is primarily identified by a burning and tingling sensation in the mouth. There a few other symptoms as well which are discussed below-

• Dryness and burning pain in the mouth
• Scalding, tingling and numbness in the entire mouth
• Extreme dryness and roughness of tongue
• Dryness in the lips and the roof of the mouth
• Dryness of the throat
• A bitter or metallic taste in the mouth
• Reduced ability to taste (hypogeusia)
• Pain in the tongue (glossodynia)
• Burning sensation in the tongue (glossopyrosis)
• Damaged oral mucosa
• Pain in teeth, jaw and the temporomandibular joint
• The involuntary tightness of the jaw
• Loss of a comfortable jaw position
• An increase in parafunctional activity
• Problems in speaking (dysphagia)
• Altered taste sensations (dysgeusia)
• Nausea and vomiting
• Mood swings and emotional disturbances

What are the different types of burning mouth syndrome?

Based on the symptoms, burning mouth syndrome is of three types-

• Type 1 BMS: The person does not experience any dryness on waking up in the morning. But the symptoms start growing throughout the day and become maximum in the evening. The symptoms manifested at night vary if the patients have nutritional deficiencies or metabolic diseases like Diabetes.
• Type 2 BMS: The symptoms are more or less continuous and are present throughout the day. The severity of the symptoms is the highest at night. This results in a severe lack of sleep at night. Type 2 BMS is often associated with chronic anxiety due to a markedly altered sleep pattern. Studies have shown a connection between Type 2 BMS and the antidepressant drugs that cause xerostomia.
• Type 3 BMS: Here the symptoms occur intermittently throughout the day with periods of no symptoms in between. Type 3 BMS occurs due to anxiety or allergic reactions, particularly the ones caused by food allergens.

Diagnosis

The most common diagnostic tests for burning mouth syndrome are given below-

• Blood tests: Complete Blood Cell count (CBC), immune functions, thyroid functions, glucose level and nutritional factors.
• Oral cultures: To check for bacterial, viral or fungal infections.
• Imaging: MRI and CT scan
• Patch tests: To check for allergy to certain food, additives or denture materials
• Sialometric analysis: To measure and check the salivary flow
• Gastric reflux tests: To look for GERD
• Biopsy of the tongue and oral mucosa

Treatment and prevention

Since BMS is a complex condition with unknown etiology (causing factor of the condition), treatment aims mainly towards symptomatic relief. Pain-relieving drugs can be given along with nutrient and vitamin supplements. Alcohol-free mouthwashes along with saliva replacement products or saliva stimulators can be given. Saliva can be stimulated by chewing sugar-free gums or candies. Sucking ice chips can also give symptomatic relief.

There are no methods to prevent the condition. However, reducing the number of irritants (such as hot, spicy foodstuff, tobacco, alcoholic beverages, citrus fruits, sodas etc.) can lessen the severity of symptoms.

References