Burning Mouth Syndrome

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Burning Mouth Syndrome (BSM):

Burning Mouth Syndrome is characterized by a burning pain in the tongue, lips, or other oral sites, usually without any known source. About 1.3 million American adults suffer from burning mouth syndrome, most being pre-menopausal women. Symptoms that are also experienced by affected patients are dry mouth and taste alterations. Most patients will awaken without pain or symptoms, but note increasing sensations throughout their day. In addition to the symptoms experienced, chronic anxiety or depression, nutritional deficiencies, type 2 diabetes, and changes in salivary function are other conditions that have been reported. However, according to the February 2002 article written by Grushka, Epstein, and Gorsky of the American Academy of Family Physicians, these conditions have not been consistently linked to the syndrome and their treatment has had little impact on burning mouth symptoms. Studies have pointed to the dysfunction of several cranial nerves associated with taste sensation as a possible cause of burning mouth syndrome. Some effective treatments for patients include low dosages of benzodiazepines, tricyclic antidepressants, or anticonvulsants, and topical capsaicin (American Family Physician 2002;65:615).

Etiologic Factors of BSM:

Psychologic Dysfunction: Anxiety and depression have been consistently reported in patients with burning mouth syndrome. Personality and mood changes; however, is common in patients suffering from chronic pain which suggests that the conditions maybe a result of pain rather than the burning mouth syndrome. The use of tricyclic antidepressants and some benzodiazepines as pain coping treatments have proven effective due to their analgesic and anticonvulsant properties (American Family Physician 2002;65:616-617).

Hormonal Changes: Hormonal changes are considered to be a prominent source of burning mouth syndrome, even though significant evidence of the effectiveness of hormone replacement therapy in women with the disorder has yet to be founded (American Family Physician 2002;65:617). However, it is known that changes in hormone levels can affect the composition of one’s saliva (Mayo Foundation for Medical Education and Research, 2006).

Dry Mouth: Dry mouth (Xerostomia) has often been suggested as an etiologic factor of burning mouth syndrome due to its high occurrences in suffering patients. Although studies have shown alterations in salivary components, salivary flow rate tests have shown no decrease in neither stimulated nor unstimulated salivary flow (American Family Physician 2002;65:617). Dry mouth can also be related to the use of certain medications, including tricyclic antidepressants, central nervous system depressants, lithium, diuretics, and medications used to treat high blood pressure. The condition can also occur with aging or Sjogren’s syndrome, and autoimmune disease that causes both dry mouth and dry eyes (Mayo Foundation for Medical Education and Research, 2006).

Taste Function: Although there is an increased prevalence of so-called “supertasters” (persons with enhanced abilities to detect taste) among patients with burning mouth syndrome, the role of taste is not straightforward. Supertasters are more likely to be affected by the burning sensations because of their higher density of taste buds, each of which are encased by pain neurons of the trigeminal nerve. (American Family Physician 2002;65:617) According to Grushka, Epstein, and Gorsky of the American Academy of Family Physicians, it has been suggested that damage to taste may also be associated with loss of central inhibition of trigeminal-nerve afferent pain fibers, which can lead to oral burning symptoms (American Family Physician 2002;65:618).

Other Possible Causes: Nutritional deficiencies-lack of nutrients such as iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12), may affect one’s oral tissue and cause burning mouth syndrome (Mayo Foundation for Medical Education and Research, 2006).

Endocrine disorders: Oral tissues often react to high blood sugar levels that occur with conditions such as diabetes and under active thyroid (hypothyroidism). Angiotensin-converting enzyme (ACE) inhibitors which are used to treat high blood pressure can also cause the burning sensation (Mayo Foundation for Medical Education and Research, 2006).

Allergies: The burning sensation may be a result of an allergic reaction to foods, food flavorings, and other food additives such as dyes and fragrances (Mayo Foundation for Medical Education and Research, 2006).

Oral habits: Oral irritation can be a result of unconscious activities such as tongue thrusting or teeth grinding (bruxism) (Mayo Foundation for Medical Education and Research, 2006).

Most often more than one cause is present.