The Mystery Disease : Burning Mouth Syndrome

The Mystery Disease : Burning Mouth Syndrome

Burning mouth syndrome (BMS) is a complex and irritating condition. It is an infrequent but serious cause of oral pain. It is also one of the most commonly misdiagnosed conditions. 

BMS has multiple causes, including depression, deficiencies (vitamin B complex, folate, and iron), and oral habits (like teeth grinding and tongue thrusting). But, there are also unknown factors, which often lead to idiopathic BMS. 

Various treatments can be used to mitigate the symptoms and curb the discomfort. But, there is a lack of controlled trials to confirm their effectiveness. The question is, why is BMS such a mystery and what makes it difficult for experts to give a proper diagnosis? The guide below explores the intricacies of this condition. 

What is the burning mouth syndrome?

Burning mouth syndrome (BMS) is a medical term for a persistent or recurring condition. It causes a hot sensation on the roof of the mouth, tongue, cheeks, or lips. This sensation is often described as tingling, scalding, or burning.  

The sensations can persist for months or even longer. The discomfort may be accompanied by redness and/or dryness. But, in many cases, the mouth looks relatively normal. Some patients also experience dryness in the mouth and a change in taste. 

Diagnosing burning mouth syndrome is a challenge. A doctor or a dentist carefully eliminates the potential of any other conditions before confirming the presence of BMS. 

How common is burning mouth syndrome?

Burning mouth syndrome (BMS) impacts approximately 2% of the population, with women being diagnosed up to 7 times more frequently than men, stated N. Treister for the American Academy of Oral Medicine

Most patients are middle-aged women, explains Andres Pinto in a review published in General Dentistry. The majority of female patients are typically in the post-menopausal stage, although men and women in the pre/peri-menopausal phase can also experience this condition.

Since BMS is more common in women as they age, this suggests that hormonal changes during menopause can contribute to the development of the condition. The average age of BMS patients is around 50 to 60 years. Its prevalence in the general population is estimated to be approximately 4-5%. 

In Europe, the prevalence of BMS is slightly higher at 7%. But the rates are lower in other regions, ranging from 2% to 3% in Asia, and 0.7% in the United States. Among menopausal women, the prevalence of BMS varies between 10% and 40%, depending on the research center, explains Zuzanna Ślebioda for the Menopause Review

What causes burning mouth syndrome?

There are two types of BMS: primary and secondary. When BMS does not have an underlying medical cause, it is referred to as primary BMS. Primary BMS is thought to be a result of nerve damage. These nerves control taste and pain. 

Secondary BMS occurs as a consequence of specific medical conditions. By treating the underlying medical issue, doctors can alleviate the secondary BMS.

Causes of secondary BMS include:

  • Hormonal problems (i.e. thyroid complications, diabetes, etc)
  • Allergies to foods, dental materials, or dental products
  • Conditions that cause dry mouth (such as yeast infection, Sjogren's syndrome, HIV/AIDS, etc)
  • Medications (i.e. antidepressants, diuretics, muscle relaxants, etc)
  • Nutritional deficiency (like folate, iron, or vitamin B12)
  • Psychological complications (such as stress, depression, or anxiety)
  • Acid reflux
  • Oral habits (like tooth clenching, tongue biting, or tongue thrusting)
  • Irritating the mouth (i.e. using abrasive toothpaste, consuming too many acidic drinks or foods, overusing mouthwashes, or the dentures don’t fit)

Burning mouth syndrome can also occur all of a sudden and without a known reason. Some factors can increase the likelihood of developing BMS. 

For example, if you had a recent illness or a long-term medical condition, like neuropathy, Parkinson’s, or fibromyalgia, you can be prone to the condition. Certain traumatic experiences can increase depression, anxiety, and stress, which could contribute to BMS symptoms. 

How does burning mouth syndrome feel?

Most patients experience a burning sensation in various areas of the mouth. Such as the sides and tip of the tongue, the roof of the mouth, the top of the tongue, and the inside surface of the lips and cheeks. However, the pattern of burning can vary widely, and develop anywhere within the mouth. 

Some patients may feel like they had a mouthful of hot food, and the sensation doesn’t stop. They can also notice a metallic, bitter, or sour taste. It’s not uncommon to experience dryness in the mouth and reduced flavor. 

In some cases, people feel “crawling” or “draining” sensations in the mouth. The BMS symptoms can take time to develop, even without a known trigger. 

There are three identified clinical patterns:

  • Burning is minimal or absent in the morning. It gets worse during the day and reaches its peak in the evening. 
  • Symptoms persist throughout the day from the moment the patient wakes up.
  • Symptoms come and go. There can be days when patients don’t experience any burning mouth syndrome symptoms. This pattern happens less frequently compared to other clinical patterns of BMS. 

Complications from BMS mainly have to do with discomfort. Those who struggle with the condition can find it difficult to fall asleep or eat. In the long haul, this can lead to depression, stress, and anxiety. 

Can burning mouth syndrome be misdiagnosed?

BMS is hard to diagnose. This condition is difficult to diagnose because there is a contradiction between the significant and widespread pain and the absence of any visible physical changes in the oral mucosa. The duration and intensity of the pain can vary from patient to patient.

In other words, the patient can experience severe pain, but there are no signs of abnormalities in the oral tissues. This inconsistency makes it hard to diagnose BMS accurately, explains EC Coculescu and a team of experts for the Journal of Medicine and Life

BMS can also occur from a combination of factors. Such as oral habits, hormonal changes, psychological factors, drug use, and certain medical condition. This adds to the complexity of managing and diagnosing BMS.

The symptoms of BMS are subjective. This means they are based on individual patient reports rather than objective measures. Patients may develop different symptoms, making it all the more difficult to create standardized diagnostic criteria. 

There are also overlapping symptoms. BMS has similar symptoms to other oral conditions, like oral thrush, dry mouth, and neuropathy. This increases the risk of misdiagnosis, further complicating things for healthcare experts.

What can be mistaken for burning mouth syndrome?

Different health issues can be mistaken for BMS.

According to a small-scale study by Michele D Mignogna for the Journal of Oral & Facial Pain and Headache, Aspecific stomatitis and Candidiasis were the most common misinterpretations of BMS symptoms. In around 30% of patients, there was no explanation or diagnosis for the oral symptoms. 

Candidiasis (or oral thrush) is a fungal infection. Those affected can experience burning and painful sensations in the mouth. Accompanied by white patches, unpleasant or loss of taste, throat and mouth redness, and cracks found at the angles of the mouth. 

Aspecific stomatitis is a non-specific inflammation of the oral mucosa. It triggers inflammation or pain of the mucous membrane. It can also lead to burning sensations in the oral cavity.

Another frequent misdiagnosis is GERD (Gastroesophageal reflux disease). According to reports from Daniela Adamo and a team of experts published in the Wiley Online Library, it is easy to confuse BMS with GERD. 

GERD also called acid reflux, is a persistent condition that causes stomach acid to leak into the esophagus. The esophagus is a tube that connects the stomach and mouth. When the acid reaches the mouth, it comes in direct contact with the delicate tissues of the oral cavity.

The tissues in the mouth can’t handle the corrosive effects of stomach acid. This is why patients experience inflammation and irritation of the oral tissues, which, in turn, leads to a burning sensation in the mouth. 

Other conditions that can be confused with BMS are Sjogren's disease, Glossodynia, and nutritional deficiencies.

Patients with Sjogren's disease can develop oral symptoms, explains Hawra Aljanobi for the HHS Public Access manuscript. Oral health issues can occur mainly due to reduced saliva production. This can lead to dental caries, and in some cases, it can cause a burning mouth. The sensations can make it difficult to speak or swallow. It can also lead to a change in taste. 

Glossodynia means tongue pain. When there is inflammation, ulceration, or tumor of the tongue, patients can develop glossodynia, explains Dr.Manuela Stoicescu for the Medical Semiology Guide of the Digestive System. This pain can turn into burning-like sensations in the mouth.

When the body is not getting enough nutrients, it can experience a range of problems. Some of them include a burning mouth. BMS symptoms can be misdiagnosed with many nutritional deficiencies. Such as a deficiency in:

  • iron 
  • zinc
  • vitamin B9 (folate)
  • vitamin B6 (pyridoxine)
  • vitamin B2 (riboflavin)
  • vitamin B1 (thiamin)
  • vitamin B-12 (cobalamin)

These essential nutrients play a crucial role in maintaining the health and proper functioning of the oral tissues. That includes the tongue, mucous membranes, and nerve cells.

When the body lacks these nutrients, it can lead to various physiological changes and imbalances. This affects nerve signaling, tissue integrity, and oral moisture levels. As a result, the oral tissues may become more sensitive, dry, inflamed, or even damaged, resulting in a burning or tingling sensation in the mouth.

Is burning mouth syndrome mental?

BMS is a complex and multifaceted health problem, a review by Federica Galli for the National Library of Medicine shows. 

Psychological factors, like depression, anxiety, stress, and other psychiatric disorders play a key role in the BMS causes and symptoms.

For example, mental health conditions can make the burning mouth symptoms worse. They can affect the central nervous system, which can increase sensitivity to pain. This can make the BMS burning sensations more profound.

New research on burning mouth syndrome found a clear link between BMS and higher rates of depression and anxiety. The study by Jong-Yeup Kim, published in Jama Network, included 1,758 patients with BMS. Based on the results, BMS patients had a greater prevalence of anxiety and depression during the follow-up period compared to those without the syndrome. 

How is burning mouth syndrome diagnosed?

Diagnosing BMS is a complex process. Doctors can’t use a single test to tell if someone has BMS. Instead, they have to rule out other potential health issues before diagnosing someone with burning mouth syndrome. 

A doctor or dentist can start by:

  • Encouraging you to talk about your symptoms. The goal is to understand your unique experience and pain level.
  • Examining the oral cavity. They will look for any abnormalities in the tissues, such as redness, inflammation, or swelling. 
  • Thoroughly assessing your medical history. It’s important to mention if you are using any medications or treatments. 
  • Delving deeper into your oral hygiene habits. The doctor or dentist may ask you how often you brush your teeth or floss. 

If there is a sign of any other underlying condition, a healthcare expert can suggest further testing. This includes performing various tests to collect the necessary information. These can include: 

    • Comprehensive blood tests: These evaluations can analyze your blood count, glucose, thyroid function, nutritional deficiencies, and the state of your immune system. The results can pinpoint the source of the oral discomfort.
    • Gastric reflux tests: These tests are designed to detect if the stomach acid is causing your mouth problems.
    • Allergy tests: It’s important to rule out any allergies as the cause of a burning mouth. Allergy testing can help determine if you have any sensitivities or allergies to specific consumables, mouth care products, or dental materials.
    • Oral biopsies or cultures: Experts collect samples from your mouth with a cotton swab. This test can determine if you have any bacterial, fungal, or viral infections. Biopsies involve extracting small tissue samples from your mouth. These samples are then examined in a laboratory to assess their cellular composition.
    • Salivary measurements: Given the dry sensation in your mouth, salivary tests can help assess the salivary flow.
    • Imaging: CT or MRI scans can check for additional health issues that could lead to BMS symptoms. 
    • Medication adjustment: If you are taking medication that could contribute to burning sensations, your healthcare provider may consider modifying the dosage or switching to a different product.
  • Mental health state: If you have anxiety, depression, or any other mental health conditions, this will also be taken into account when diagnosing BMS. 
  • How to treat burning mouth syndrome?

    Burning mouth syndrome treatment varies based on what’s causing the problem.

    For primary BMS, there is no cure. More research is necessary to find a suitable product or method that can help with treatment. The doctor will focus on the symptoms and try to alleviate their impact. 

    To achieve that, patients often need to try different treatment methods before they find the right one. Sometimes combination treatment might prove useful in reducing the discomfort. But, this takes time and effort. 

    Some of the treatments for primary BMS might include:

    • All natural artificial saliva products
    • Antidepressants
    • Capsaicin
    • Mouthwash for oral pain, like lidocaine
    • Alpha-lipoic acid
    • Medicines for nerve pain
    • Cognitive behavioral therapy

    For secondary BMS, the course of treatment starts by addressing the root of the problem. This means managing the underlying condition that might be responsible for the burning sensations. 

    For example, if you have an oral infection, then the doctor can suggest you take antibiotics. But, if the burning in the mouth comes from nutrient deficiencies, then supplementation can rectify the imbalance and alleviate the symptoms. 

    Conclusion

    BMS is a complex condition with a number of potential causes. It can cause burning-like sensations and discomfort in the mouth. Diagnosing it poses a challenge, considering doctors have to rule out different health problems with similar symptoms. To treat the issues, doctors have to address both physical and psychological factors. This helps reduce pain and improve oral health. However, more research is needed to fully understand the condition and develop better treatments.

    Solving burning mouth syndrome is one of the driving factors behind the creation of Essential Sprays.  Join our Facebook community for amazing support and to access or weekly Live events where Shane Cope, DDS, MSD answers questions and interacts with the group.

     

    References

    https://pubmed.ncbi.nlm.nih.gov/15055637/

    https://maaom.memberclicks.net/index.phpoption=com_content&view=article&id81:burning-mouth-syndrome&catid=22:patient-condition-information&Itemid=120

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520363/

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316128/

    https://pubmed.ncbi.nlm.nih.gov/15895840/

    https://onlinelibrary.wiley.com/doi/10.1111/odi.14553

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025751/

    https://www.sciencedirect.com/topics/medicine-and-dentistry/glossodynia

    https://pubmed.ncbi.nlm.nih.gov/27121358/

    https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2764771

    https://journals.lww.com/jfmpc/Fulltext/2022/03000/Oral_manifestations_in_COVID_19_patients__An.29.aspx

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