Gastrointestinal

What is burning mouth syndrome?

You’ve probably have heard of PMS, but what about BMS? Burning Mouth Syndrome (BMS) is a little-known condition that affects some 1.3 million Americans. It most commonly affects the tongue, although the problem can occur in any part of the oral area.

BMS typically occurs with no precipitating factors, although some patients report their symptoms began following a dental procedure or recent respiratory infection. The main symptom is a burning sensation in the mouth that feels as if one had just scalded their tongue on hot coffee. The pain is usually not present on awakening but starts by late morning and becomes most severe in the evening, making falling asleep difficult. Patients can become depressed and anxious from the chronic pain. No relief is noted with the use of over-the-counter analgesics. Some patients have been known to have a spontaneous partial recovery 6 to 7 years after onset.

What causes BMS?

What could be the cause of such an unusual condition? There are many suggested possibilities but no single answer. Most sufferers are postmenopausal women, which has led some to believe hormonal changes cause the problem. However, BMS is also seen in men and some younger patients. Possible causes include the following:

  • Allergies (food or drug)
  • Anemia
  • Anxiety/depression
  • Cranial nerve injury
  • Diabetes
  • Drug reaction
  • Gastroesophageal reflux disease (GERD)
  • Hypothyroidism
  • Hormonal imbalances
  • Oral thrush
  • Medications such as angiotensin-converting enzyme (ACE) inhibitors
  • Neuropathy to nerves that control taste and pain to the tongue
  • Nutritional/vitamin deficiencies (especially B vitamins)
  • Poor fitting dentures or poor dental work
  • Poor oral habits/bruxism, excessive brushing of tongue, overuse of mouthwash
  • Sjogren’s syndrome
  • Smoking
  • Thyroid dysfunction
  • Xerostomia (dry mouth)

How is BMS diagnosed?

Diagnosis of BMS is difficult because no specific test exists for the condition. Patients are frequently shuttled from one doctor to another in an attempt to find a diagnosis, cause, or treatment. Other medical problems should be ruled out first: blood work to rule out anemia, endocrine problems, infection or nutritional deficiencies; an oral swab to check for thrush; an MRI of the brain to check for any organic cause; allergy testing; and oral culture or biopsy to check for infection or thrush. If no underlying condition is identified, a diagnosis of BMS is made.

How is BMS treated?

Treatment is based on the patient’s symptoms. Because another stimulus in the mouth may mask the pain, patients use various strategies to gain relief. These include eating, sipping water, sucking on ice, brushing teeth, using mouth freshening strips, applying an oral numbing agent to the affected area, and using other oral care drops and rinses on the market. Usually the most effective action is chewing sugar-free gum. Unfortunately, these tactics offer only temporary relief of the pain.

Medical and nursing plans of care should fit the individual’s needs depending on the cause of the BMS, including adjusting ill fitting dentures, providing vitamin B supplements to correct deficiencies, switching medications, treating oral thrush, relieving anxiety and depression, controlling pain from nerve damage, and treating existing disorders like diabetes. Benzodiazepines (clonazepam), tricyclic antidepressants or anticonvulsants (gabapentin) may be effective. Topical capsaicin has been tried as a desensitizing agent but is not tolerable to all patients.


What is it like to have BMS?

I have suffered from this chronic condition for 18 months. I went through the various labs, physicians, tests and drugs and have found for me, the answer is a combination of clonazepam and duloxetine. My pain has gone from a daily rating of 7-8 to a 0-3 since being on these medications. Most days my pain is a zero but I have found certain triggers that will cause it to flare up: orange juice, salty foods, and even some sweet foods will cause a flare. I have also found that stress seems to make BMS more noticeable. My arsenal of items to help the pain has decreased to carrying gum and breath strips, and most days I do not need either of them.

BMS is a distressing disease and requires persistence of the medical profession to continue to strive to find answers for those suffering with it.

Debra S. Fischio is a staff nurse at Union Hospital in Dover, Ohio, on the surgical telemetry unit.

References

Grushka M, Epstein JB, Gorsky M. Burning mouth Syndrome. American Family Physician. 2002;65(4):615-621. Available at http://www.aafp.org/afp/20020215/615.html. Accessed November 12, 2010.

Burning Mouth Syndrome. WebMD. 2010. Available at < a href=”http://www.webmd.com/oral-health/burning-mouth-syndrome” target=”_blank”> http://www.webmd.com/oral-health/burning-mouth-syndrome. Accessed November 12, 2010.

Burning Mouth Syndrome. NetWellness. 2010. Available at http://netwellness.org/healthtopics/mouthdiseases/burningmouth.cfm. Accessed November 12, 2010.

Haran C. On the tip of the tongue: Explanations for Burning Mouth Syndrome. Healthvideo.com. 2004. Available at http://www.aafp.org/afp/2002/0215/p615.html. Accessed November 12, 2010.

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10 thoughts on “What is burning mouth syndrome?”

  1. adrianna says:

    Deb – I can use your help and advise – at my wits end with this ailment. Willing to pay for your time. Please call me (no phone numbers allowed). Adrianna from NY.

  2. Kathy Grentzenberg says:

    I also have the BMS. A few tips I’ve figured out for myself can help. The 600 mg. Alpha Lipoic Acid does seem to decrease it. Also took klonopin for it which worked but gave me horrific nightmares. My husband suggested I try those frozen teething rings that babies use. I feel a tad silly but they really do help. I highly recommend them!! Chewing sugarless gum helps a lot – Trident bubble gum gives the most relief. Also there is something dentists call “magic mouthwash.” It is a combination of a numbing agent and I think, milk of magnesia. It is prescribed for mouth sores but works great for BMS. Of course all these things provide temporary relief but I find if I can kind of “break the cycle” it doesn’t seem as bad after these “treatments” as it did before them. Sucking on popsicles helps; and even an ice pack on the side of the face helps. I keep a Yeti by the bed full of ice water. Mine is worse at night so sometimes sleeping is difficult. I drink lots of ice water. My last thing is a small dose of valium can relax you enough so it’s not as noticeable and you can go to sleep. I know it is very annoying and frustrating; but I think for most – manageable. I would suggest seeing a specialist not just your regular dentist. I saw an oral surgeon who knew right away what it was.

  3. BlueH2odiver says:

    Had BMS since late 2009 and only determined it could be that after, many visits to GP, Dentists, Oral Surgeon(biopsies said it was not cancerous but could be)and Allergist. Started seaching internet in medical research and up popped Dr. R. Rogers–lot of different BMS testing–under Dermatology. None of the Dr.s mentioned posibilty. Dr. R. Rogers recommends, to reduce symptoms of BMS, at least 600 mg Alpha Lipoic Acid, per day. More wont hurt–up to 2400mg/ 1200day/1200nite. THANK YOU!! DR.R!!

  4. Anonymous says:

    I am a post menaposal woman of 56. I’ve had it for approximatley 6 years. It started out as a metal taste in my mouth. I was very stressed at the time and the first thing I thought of was that a filling was leaking or something. My dentist assured me that it was not. Then came the pain, red bumps, hotness, etc. Always better in the morning and worstens as the day goes by. The metal taste comes back sometimes too. I have been taking Cymbalta for 7 years….not for depression but to decrea

  5. D Fischio says:

    sorry, that pain scale was 1-10 not 1-19. A little slip of the finger.
    Thanks again to all those leaving comments
    Deb

  6. D Fischio says:

    note from the author. thanks to all for the comments. I have 2 things to add. I did try alphalipoic acid as well as B vitamins & they were not effective for me. Since the article was actually written, I have had a relapse and am now on clonazapam 0.5 tid, cymbalta 60mg daily, and lyrica 75mg tid. It took some adjusting of doses and frequency, but right now my pain has been staying at a 0-1 level on the 1-19 pain scale. Good luck to those of you who suffer with this condition. Deb Fischio

  7. Anonymous says:

    I am a nurse practitioner in ENT, and would like to add that Alpha-lipoic acid 200 mg po TID has been shown in the literature to be helpful.

  8. Joanne says:

    This is a very interesting article about a baffling problem that I have never heard of before…thank you for publishing it – and thanks to the author for writing it!

  9. Anonymous says:

    Thank you for this article. I have experienced BMS for the past 11 months. The medical profession largely is unaware of BMS or the treatment without accessing the internet. I have spent thousands of dollars trying to diagnose and relieve my symptoms. As an RN with 22 years experience I have never heard of this problem. My symptoms are exactly as described in this article. My 84yo mother-in-law directed me to a Yale physician researching this syndrome. Still working on relieving my symptoms

  10. ewilhelm says:

    Very well written and i learned a lot. Of course the author is a world-class nurse and mother so I am not surprised.

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