Burning mouth is a hot feeling or sensation of burning (moderateto severe burning feeling) which can affect your tongue, lips, palate (the roofof the mouth), gums or inside your cheek. It also may involve a generalsensation of discomfort of the whole mouth or throat.It starts out of the blue for no apparent reason and persistsfor months or even years.For some people the feeling starts in the morning and builds upto a peak by the evening, often easing by night time. The next morning thecycle recurs. Some people have the burning feeling all the time. For others,the pain comes and goes.Whatever pattern of mouth discomfort you have, it may last formonths to years. In rare cases, symptoms may suddenly go away on their own orbecome less frequent. Some sensations may be temporarily relieved during eatingor drinking.Other symptoms may include numbness or tingling of your mouth ortongue, a bitter or metallic taste at the same time as the burning sensation,alterations in the taste sensation or a dry or sore mouth. At times, theburning pain may be very severe and leadto depression and anxiety from the chronic pain.Burning mouth usually begins spontaneously, with no knowntriggering factor. However, certain factors may increase your risk ofdeveloping burning mouth, including recent illness, previous dental procedures,wearing dentures, allergic reactions to food, medications, traumatic lifeevents, stress, anxiety, depression etc.People often describe it as a feeling like you have scalded yourmouth with hot food or drink.You get this feeling when there are changes in the way thenerves in your mouth send messages to your brain – for example, about taste andtemperature. When your brain doesn’t understand these messages properly it cancause the feeling of pain or burning.Although some parts of your mouth may feel like they areburning, they will not be hot to the touch. You might not be able to see anysoreness or redness in the areas that are hurting.Burning mouth is more common in post-menopausal women. It islikely related to reduced estrogen levels, which causes the decline in thesensitivity of the taste buds.What causes burning mouth?It’s hard to say. No one knows exactly what causes BMS.Research has revealed that there is a relationship betweenburning mouth and taste (gustatory) changes. Research has shown that manypeople with burning mouth have a loss of bitter taste buds at the tip of thetongue. So someone with normal taste for sweet, sour and salty has a reducedsensitivity for bitter taste. Here is the interesting part. The theory is thattaste inhibits pain but when the ability to taste bitter is lost, pain fibersbegin to “fire” spontaneously. This pain is felt as a burning sensation in themouth.Some experts believe it may be caused by damage to the nervesthat control pain and taste. In some patients, herpes has been detected bysaliva tests as a possible cause of burning mouth in dental clinics in Nagpur.Sometimes burning mouth is caused by an underlying medicalcondition. These include:· Dry mouth (xerostomia), whichcan be caused by various medications, health problems, problems with salivarygland function or the side effects of cancer treatment· Other oral conditions, such asa fungal infection of the mouth (oral thrush), an inflammatory condition calledoral lichen planus or a condition called geographic tongue that gives thetongue a map-like appearance· Nutritional deficiencies, suchas a 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)can mimic the sensation of burning mouth.· Dentures, especially if theydon’t fit well, which can place stress on some muscles and tissues of yourmouth, or if they contain materials that irritate mouth tissues· Allergies or reactions tofoods, food flavorings, other food additives, fragrances, dyes or dental-worksubstances· Reflux of stomach acid(gastroesophageal reflux disease or GERD) when acid from your stomachcomes up into your mouth· Certainmedications, particularly high blood pressure medications· Underlying diseases such as diabetesor liver problems or herpes viral infection· Oral habits, such as tonguethrusting, biting the tip of the tongue and teeth grinding (bruxism)· Endocrine disorders, such asdiabetes or underactive thyroid problem(hypothyroidism)· Excessive mouthirritation, which may result from overbrushing your tongue, using abrasivetoothpastes, overusing mouthwashes or having too many acidic drinks· Psychological factors, such asanxiety, depression or stress.· Tobacco and alcohol use are alsoconsidered as potential causes of mouth pain.SymptomsDentists in Nagpur are counseling patients on burning mouthsymptoms. Symptoms may include:· A burning,tingling or scaldedsensation that most commonly affects your tongue, but may also affect yourlips, gums, palate, throat or whole mouth· Or the pain may be a feeling ofnumbness· A sensation of dry mouth withincreased thirst· Taste changes, such as a bitter ormetallic taste· Loss of tasteHow can I ease the symptoms myself?You can help to ease or improve or reduce the discomfort by:· sipping water often· sucking on crushed ice· chewing sugar-free gums – this helpsyou produce more saliva which helps to stop your mouth getting dry· Vitamin supplements(B, folate, zincand iron)· avoiding things that irritate yourmouth – such as hot and spicy foods, mouthwashes that contain alcohol, oracidic fruits and juices· avoiding tobacco and alcoholproducts.TreatmentAs no one knows the exact cause of burning mouth, it is hard toplan a correct course of treatment.Treatments can vary depending on the causes. No specifictreatment works for all people. Because burning mouth is a complex paindisorder, the treatment that works for one person may not work for another.However, your doctor can prescribe medicine to help you managemouth pain, dry mouth, or other symptoms.If it has been brought on by a poor diet, then your dentist mayrecommend supplements for you. Sometimes symptoms go away when the underlyingmedical condition, such as diabetes or yeast infection, istreated. If a drug is causing burning mouth, then your doctor may switch you toa new medicine. Dental clinic in Nagpur have beencounseling patients for the anxiety problems which result in burning mouth as asymptom.It is important to keep a record of how your symptoms areaffected by the different types of treatment. Your doctor will then have abetter idea of what treatment is best for you – after all, everybody isdifferent.Continued follow-up is also likely help patients with managementof symptoms.The following treatments for burning mouth have been suggested-· Discontinuation of medications thatmay cause xerostomia, such as anticholinergics or psychotropics· Substitution of medications that maycause oral burning· Adjustment of levothyroxine dosing· Oral nystatin· Abstinence from smoking and oraltobacco use· Avoidance of allergens· Adjustment of dentures (refittingand/or substituting materials)· Chewing sorbitol-containing gum tostimulate saliva· Pyridostigmine, Pilocarpine, orother sialogogues· B vitamin supplementation· Zinc supplementation· Iron supplementation· Folate supplementation· Neuropathic analgesics· Clonazepam (low-dose) dissolvablewafers (may be better than tablets) · Alpha-lipoic acid· Psychotherapy (cognitive behavioralmodification, relaxation)· Hormone replacement therapy· SSRIs· Tricyclic antidepressants· Oral lidocaine· Near infrared irradiation of thestellate ganglion, to inhibit sympathetic discharge and improve blood flow tothe tongue in glossodynia (still experimental)· Acupuncture (uncontrolled studies)MedicationsSome medications seem to help but they are not currently orspecifically approved for burning mouth. These medications includecertain antidepressants, an antiseizure medication, and gabapentin (a drugused to treat seizures and the pain associated with herpes) and others mayinclude:Clonazepam (oral or wafers), Diazepam,Amitriptyline,Nortriptyline, Doxepin, Fluoxetine, Paroxetine, Sertraline,Chlordiazepoxide, Capsaicin (oral or topical), Olanzapine (case report with lowdose), Topiramate (case report).Discuss treatment options with your doctor. Burning symptoms inthe mouth is being treated routinely by the dental clinics in Nagpur.If you have discomfort, burning or soreness of your tongue,lips, gums or other areas of your mouth, see your doctor or dentist for acheckup. They may need to work together to help pinpoint a cause and develop aneffective treatment plan. They may advise you to go for some tests includingsaliva test or blood tests to try to find the cause of your burning mouth.
Dr Sanjog ChandakMDS, OMFS