|Burning Mouth Syndrome
If you've ever scalded your tongue, you've gotten a small taste of what it's like to have this painful and frustrating disorder. Burning mouth syndrome (BMS) is an aptly named but poorly understood pain disorder that disproportionately affects women of all races and backgrounds, mostly at midlife. It's considered a benign condition — in other words, it doesn't endanger health. But that may be scant comfort for a person who constantly feels as though her mouth has been burned by hot coffee or tea.
What is it?
BMS is defined as burning pain in the mouth with no apparent physical cause in fact usually the tongue and other areas of the mouth look perfectly healthy. People who have the disorder describe the sensation as hot, tingling, or painful — as if the mouth had been scalded — and report feeling it mostly on the tongue (in particular, the front two-thirds and tip of the tongue). The palate (roof of the mouth), lips, gums, and other parts of the mouth may also be affected. Other symptoms are dry mouth and taste changes, usually a bitter or metallic taste. About half of the people with BMS have symptoms throughout the day. For many others, the symptoms are absent or mild when they wake up, but gradually become worse as the day progresses. Only about 10% have occasional symptom-free days.
Before concluding that the problem is BMS, it's important to consider other medical conditions that can cause burning, tingling, dry mouth, or altered taste. These include infection, nutritional deficiencies (for example, certain B-vitamin deficiencies affect oral tissues), anemia, type 2 diabetes, and dry mouth. Burning sensations and dry mouth are also side effects of certain medications: for example, blood pressure medications, decongestants and antidepressants can cause dry mouth. If the tongue or other oral tissues are red, the problem could be Candida albicans, or thrush, a yeast infection. Dentures can also cause irritation, and reflux disease may leave a bitter taste in the mouth.
What causes it?
Many lines of research suggest that BMS is a neuropathic pain syndrome — pain caused by malfunctioning nerve fibers. Another theory is that the taste buds become hypersensitive because of damage to nerve fibers serving the front of the tongue.
Depression and anxiety, or some other psychological condition can be seen in BMS. But the role of emotions in BMS is not clear. Certainly, chronic discomfort can be upsetting and fatiguing and disturb sleep, all of which are likely to make symptoms worse. Anxiety can result in dry mouth that aggravates the burning sensation. It's also possible that nerve fibers are activated by an underlying psychological problem.
What to do about it
Treatment for primary BMS is aimed at managing symptoms. The following meds and nondrug approaches may help:
Anti-anxiety drugs, antidepressants. Certain drugs in these classes are effective in treating BMS and other neuropathic disorders, largely because they reduce the activity of nerve fibers. I usually start patients on clonazepam. If it is not effective I then try low doses of tricyclic antidepressants amitriptyline & nortriptyline
Capsaicin. It may be hard to believe, but the compound that puts the heat in hot chili peppers deletes substance P, a pain-signaling chemical in nerve cells. You can also try mixing five to six drops of hot pepper sauce (such as Tabasco) with one teaspoon of water and swishing it in your mouth.
Stress management. The relationship between stress and chronic disorders like BMS is complex and somewhat circular: stress may be a cause of the symptoms, a consequence, or both. In any case, it's important to manage stress. You can try such methods as meditation, yoga, exercise, or psychotherapy. In controlled trials, cognitive behavioral therapy has been shown to reduce BMS symptoms.