Picture this scenario: you are making homemade pizza for dinner with fresh mozzarella, fresh tomatoes, and a handful of basil on a homemade crust. When the timer goes off, the cheese is bubbly and inviting. You cannot resist and take a bite. Immediately, your mouth floods with pain as the lava-like cheese hits the roof of your mouth, causing blisters. For the rest of the night, you are unable to taste anything and the roof off your mouth feels like it is on fire.

This is just a small taste of what burning mouth syndrome is like. Imagine this same sensation every day, for months (or years) at a time. Burning mouth syndrome is a rare but painful condition that is as mysterious as it is uncomfortable.

Symptoms of burning mouth syndrome

It is hard to know exactly how many people suffer from burning mouth syndrome, but in general it affects peri- and post-menopausal women most frequently. Symptoms include some or all of the following:

  • Pain that includes a burning or scalding feeling
  • Tingling or numbness
  • Inability to distinguish different tastes, or inaccurate identification of tastes
  • Dry mouth

The tongue is generally the main part of the mouth that is affected, but burning mouth syndrome can affect lips and gums as well.

There are three types of burning mouth syndrome:

  • Type 1: People with this type of burning mouth syndrome are symptom-free when they wake up. Symptoms increase as the day goes on and are often relieved by eating or drinking. This type may also be accompanied by a nutritional deficiency.
  • Type 2: Type 2 burning mouth symptom is characterized by symptoms that occur throughout the day and stop at night. Patients with anxiety may experience this type of burning mouth syndrome.
  • Type 3: Symptoms are not consistent and may not occur every day. Food allergy is one potential trigger of this type of burning mouth syndrome.

Diagnosing burning mouth syndrome

Diagnosis of burning mouth syndrome is very complex and generally requires eliminating all other possible diagnoses. In the vast majority of cases, burning mouth syndrome is not a visible disease and would not be readily apparent during a regular dental or physical checkup. Patients may be referred to oral surgeons, gastroenterologists, dermatologists, or ear, nose, and throat specialists. These doctors will make a physical exam and take a detailed medical history.

Other diagnostic tests may be completed, such as:

  • Oral swab
  • Diagnostic imaging
  • Allergy tests
  • Tissue biopsy
  • Blood tests
  • Test of salivary flow

Doctors may diagnose either primary or secondary burning mouth syndrome. Primary burning mouth syndrome is diagnosed when no underlying cause is apparent. The patient may have nerve damage in the mouth that causes pain signals to be sent to the brain when no painful stimuli is present.

Secondary burning mouth syndrome is the more common of the two syndromes. Secondary burning mouth syndrome is caused by an underlying condition. This can include the following:

  • Allergies or allergic reactions to food or dental products or instruments (the metals)
  • Mouth infection, including anything involving yeast (e.g., thrush)
  • Medications
  • Hormonal fluctuations (e.g., those that occur due to menopause, diabetes, or thyroid issues)
  • Dry mouth as a result of other disorders or medical treatments (e.g., radiation)
  • Nutritional deficiencies
  • Acid reflux

Treating burning mouth syndrome

Treatment of burning mouth syndrome is as individual as the people who have it. The first line of treatment may be pain-relieving medications, as well as treatments for dry mouth. Other treatments include identifying and treating the underlying cause. It is difficult to identify the one best treatment protocol because this syndrome is difficult to diagnose, has multiple potential causes, and has different presentation of symptoms in each person.

If you are experiencing burning mouth syndrome, there are a few ways to ease the pain. Eating and drinking often causes symptoms to dissipate. Drinking cold water, sucking on ice chips, and chewing sugarless gum then may be easy treatment options that won’t add calories to your diet. It is important to avoid certain foods and other substances to prevent a painful flare up. These include:

  • Spicy food
  • Hot food (temperature-wise)
  • Alcoholic beverages and anything else that contains alcohol (e.g., mouthwash)
  • Highly acidic foods such as vinegar and citrus fruits

Quitting smoking is another important step in treating burning mouth syndrome. Not only is smoking bad for your health in general, but cigarette smoke is an irritant that can intensify symptoms.

As with any invisible chronic pain condition, people with burning mouth syndrome may feel isolated and depressed as their condition continues. It is important to look for support, either in person or online, to help deal with the psychological effects of this disorder. Others with this disorder may find that participating in relaxing hobbies or pleasurable activities can help distract them from the pain. Relaxation exercises like mindfulness meditation, yoga, and t’ai chi may not lessen the pain but can give patients tools to deal with it. Stress and anxiety may be one of the main triggers of primary burning mouth syndrome. Taking steps to reduce stress can help.

For more information on this rare and mysterious condition, take a look at Medscape’s in-depth examination of burning mouth syndrome, including the prevalence and anatomy of the disorder.


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