Everything You Need To Know About Burning Mouth Syndrome

Burning Mouth Syndrome or BMS is a painful mouth condition characterized by a burning, tingling, or scalding feeling in the mouth. This condition can exist without any obvious inflammatory signs or lesions and can continue every day for months. Other synonyms of BMS are oral dysesthesia, glossalgia, glossodynia, and stomatocytosis. 

Oral dysesthesia initially presents itself with pain in the mouth, dry mouth, or alteration in taste or salivation where there is no mucosal wound or injury. This discomfort is usually continuous in nature but the intensity increases by evening or night. 

Since there are no conspicuous signs of this syndrome, it is difficult to diagnose, and your doctor would typically try to rule out other dental problems before investigating burning mouth syndrome (as there is no one test that can tell you whether you have BMS or not.)

Around two percent of the population suffers from BMS, and women have seven times higher chances of developing this condition than men. We will look into what causes BMS, what tests your doctor will conduct to diagnose this syndrome, and other information about this condition.

Types of BMS

There are primarily two types of BMS, as described below:

• Primary BMS – When there is no underlying medical problem associated with BMS, then it is termed primary BMS. Some studies show that primary BMS is associated with nerves responsible for pain and taste.
• Secondary BMS – If BMS is a result of an underlying health condition, then it is called secondary BMS. Some of the underlying medical issues that can lead to BMS are dry mouth, fungal infection in the mouth, allergies, reflux, etc.

Primary and Secondary BMS Explained

There is no specific reason for burning mouth syndrome except that it is believed to be a kind of neuropathic pain. We will take a close look at the different types of BMS explained above:

• Primary BMS:
  • Nerve fibers in the mouth – When nerve fibers in your mouth start working abnormally, they begin transmitting pain without the presence of any painful stimulus. There are nerves in our mouths that are responsible for feeling pain, and they can get stimulated and excited very easily. 

Factors that contribute to the abnormal functioning of these fibers are menopause, psychiatric conditions (depression, anxiety, PTSD, etc.), emotional trauma (death of a family member, loss of job, etc.), chronic fatigue syndrome, TMJ problems, and fibromyalgia.

• Secondary BMS:
  • Dry mouth – This problem could occur due to medicines, salivary glands, health issues, or side effects of cancer treatments.
  • Lack of nutrients – If you do not get certain nutrients such as thiamin (Vitamin B1), folate, riboflavin (Vitamin B2), zinc, cobalamin (Vitamin B12), and pyridoxine (Vitamin B6).
  • Stomach acid reflux – When acids in your stomach come back to your mouth, it is called GERD (gastroesophageal reflux disease.)
  • Other oral problems – Oral thrush (fungal infection of the mouth), oral lichen planus (an inflammatory condition), and geographic tongue (tongue appears like a map) are some of the oral conditions that can cause BMS.
  • Medication – Some medications, especially the ones for high blood pressure, can give rise to burning mouth syndrome.
  • Allergic reactions – Your mouth could react to certain foods, food additives, food flavorings, dyes, fragrances, mouth care products, or dental materials, etc., causing BMS.
  • Endocrine disorder – Underactive thyroid (hypothyroidism) or diabetes can cause BMS.
  • Oral habits – If you have some oral habits, such as pushing your tongue against your teeth, clenching or grinding your teeth, or biting the tip of your tongue, you might develop BMS.
  • Extremely irritated mouth – You could develop extreme irritation in the mouth due to many reasons, such as brushing your tongue too hard, overusing mouthwashes, using abrasive toothpaste, or consuming lots of acidic foods or beverages. If you wear dentures that do not fit well, they could irritate and worsen symptoms.

Symptoms of Burning Mouth Syndrome

The primary symptom of BMS is a pain in the oral region that feels like scalding, burning, or tingling.

• You could have pain along with numbness that comes and goes.
• You could also develop a dry mouth and altered taste if you have BMS.
• There could be a metallic or bitter taste in your mouth.
• You could also have a loss of taste.
• People who suffer from BMS might wake up with less pain which worsens during the day or could wake up with pain that lasts all day.
• You could have BMS every day, or it may come and go. 
• BMS could last months or even years.

How is BMS Diagnosed?

BMS is hard to diagnose, and there is no one test to confirm the diagnosis. Your doctor would first try to rule out any other problem before investigating BMS. They would begin with taking your medical history, examining your mouth, taking note of your symptoms, and discussing your oral regime. They would most likely perform the following medical exams to check for other conditions:

• Blood test – This is done to check your CBC, thyroid function, blood sugar level, immune system, and nutritional factors. 
• Biopsies or oral culture – Using a cotton swab, your doctor would take an oral culture to test for bacteria, viral, or fungal infection in your mouth.
• Salivary measurements – BMS can give you a dry mouth, and by testing saliva production, your doctor can determine the saliva flow in your mouth.
• Allergy tests – Allergy testing is done to check for allergies to certain mouth care products, foods, dental materials, etc.
• Imaging – Your dentist might also get an MRI, CT scan, or other imaging test done to rule out other medical conditions.
• Medicine intake – If you are taking any medicine that can cause discomfort in oral regions, your doctor might change the medicine or reduce the dosage. S/he could even ask to stop the medication for some time to see if that is the reason for your BMS.

Treatment For Burning Mouth Syndrome

BMS does not have any specific course of medicinal treatment. Your dentist will help you manage your oral habits that might lead to BMS, for instance, jaw clenching and teeth grinding.

• Treatment for BMS is based on the underlying cause, the symptoms, and the severity.
• You might be prescribed products that can produce saliva and give you relief from dry mouth.
• Your dentist might recommend nutritional supplements such as zinc, iron, and vitamins.
• If BMS is linked with your nervous system and psychological issues such as depression and anxiety, then appropriate medicines for these symptoms might be given to you.
• Certain ointments, such as topical clonazepam or Capsaicincan, can help in relieving pain.

BMS is an uncommon disease that starts suddenly and might not have any known reasons. Some people, like menopausal women or smokers, are more disposed to this syndrome. Your dentist might conduct a few tests to confirm the reason for BMS and give you appropriate medical advice based on the underlying cause.