Burning Mouth Syndrome

Overview

What is burning mouth syndrome?

Burning mouth syndrome (BMS) is a burning sensation on your tongue, roof of your mouth or lips. It can happen anywhere in your mouth or throat. BMS often starts seemingly out of nowhere. It may feel like your tongue is being burned by a hot liquid like coffee.

People with BMS often report that the burning worsens throughout the day. Your mouth may feel OK when you wake up but develop a burning feeling later in the day. Once asleep, the pain may improve. The next day the cycle begins again.

A bitter or metallic taste often happens along with the burning feeling. Many people also feel a dry mouth despite having regular saliva flow. Sometimes, the burning is so severe that the chronic pain causes depression and anxiety.

Are there different types of burning mouth syndrome?

There are two categories of burning mouth syndrome:

  • Primary BMS is when burning mouth isn’t caused by an underlying condition.
  • Secondary BMS is caused by an underlying condition, such as acid reflux. Treating the condition often cures burning mouth syndrome.

Is burning mouth syndrome more common in certain people?

Burning mouth is most common in people in postmenopause who are over 60 years old. This is because reduced estrogen levels cause decreased taste bud sensitivity.

Another factor that makes women and people assigned female at birth more likely to have BMS is their ability to taste. People have genetic differences in their tasting ability. You may be a:

  • Nontaster.
  • Medium taster.
  • Super taster, who experiences flavors more intensely compared with the other types.

Women are more likely than men to be super tasters. Most women with BMS are super tasters who’ve since lost some of their taste sensation. Studies show that many of those people also clench their teeth. The pressure on the teeth may increase the burning feeling.

Other people also develop BMS — in those cases, they usually have another condition called geographic tongue. In this mild condition, red patches appear on the tongue’s surface.

Symptoms and Causes

What are the symptoms of burning mouth?

Burning mouth syndrome symptoms include:

  • Pain in your mouth that feels like tingling, scalding or burning.
  • Numbness in your mouth that comes and goes.
  • Altered taste.
  • Dry mouth.

What is the main cause of primary burning mouth syndrome?

Researchers believe the cause of primary BMS is nerve damage affecting the area of your tongue that controls taste and pain. There’s a relationship between burning mouth and taste (gustatory) changes.

Many people with burning mouth have lost their bitter taste buds, which are located at the tongue’s tip. Researchers believe that taste inhibits pain, but when people lose the ability to taste bitter flavors, pain fibers start to fire unexpectedly. People experience this pain as a burning sensation in their mouth.

What are the causes of secondary burning mouth syndrome?

Medical conditions that can cause secondary BMS include:

  • Acid reflux.
  • Allergies to metal dental products or certain foods.
  • Depression.
  • Dry mouth.
  • Hormonal changes.
  • Mouth infections.
  • Nutritional deficiencies.
  • Teeth grinding or jaw clenching.

Occasionally, people with Sjögren’s syndrome (which causes dry mouth and dry eyes), diabetes, thyroid disease and liver problems have burning mouth syndrome.

Are there certain medications that cause burning mouth syndrome?

Yes. Medications linked to BMS include ACE inhibitors for hypertension, some antidepressants and high blood pressure medications, such as:

  • Captopril.
  • Clonazepam.
  • Efavirenz.
  • Enalapril.
  • Fluoxetine.
  • Hormonal replacement therapies.
  • Sertraline.

What vitamin deficiency causes burning mouth syndrome?

Sometimes, a deficiency of vitamin B12, folate or iron can mimic the sensation of burning mouth.

Is burning mouth syndrome contagious?

No. Since the cause of primary BMS is nerve damage, you can’t spread it to someone else.

Diagnosis and Tests

How is burning mouth syndrome diagnosed?

BMS is challenging to diagnose. Part of diagnosing BMS is ruling out other conditions that can cause similar symptoms, such as an oral yeast infection (thrush).

If you have symptoms, see your dentist first. Oral health problems cause one-third of all BMS cases. If needed, your dentist may refer you to a specialist.

To confirm a diagnosis, your healthcare provider may perform:

  • Allergy tests.
  • Blood tests.
  • Imaging tests.
  • Oral swab tests.
  • Salivary flow test.
  • Tissue biopsy.

Management and Treatment

How can I relieve burning mouth syndrome?

You may find that sucking on ice chips or chewing gum helps with the discomfort. Topical or systemic clonazepam, a prescription medication, may also relieve the pain.

How is burning mouth treated?

For burning mouth syndrome treatment, some medications can help. The U.S. Food and Drug Administration (FDA) hasn’t approved these drugs specifically for BMS, but your healthcare provider may prescribe them to help the symptoms. These medications include:

  • Some antidepressants.
  • Antiseizure medication.
  • Gabapentin (a medicine used for seizures and herpes pain).

Your healthcare provider can help figure out which medications that may be most effective for you. If oral problems (like teeth grinding or jaw clenching) cause BMS, your dentist can help correct the issue. If an underlying condition causes BMS, treating that condition should help cure your burning mouth symptoms. You may need to switch medications to find the best one for you.

Prevention

How can I prevent burning mouth syndrome?

There may not be a way to prevent BMS. But you can lessen the symptoms by avoiding anything that irritates your mouth, including:

  • Alcohol.
  • High-acidic foods or drinks (like citrus juices).
  • Hot and spicy foods or drinks.
  • Mouthwash containing alcohol.
  • Tobacco products.

Also, make sure your diet contains enough vitamin B12, folate and iron.

Outlook / Prognosis

What is the outlook for burning mouth syndrome?

For some people, BMS goes away on its own after a few years. But that can be a long time to live with mouth pain. Seeking treatment from your healthcare provider can resolve the issue faster.

Living With

How long does it take for burning mouth syndrome to go away?

Without treatment, burning mouth syndrome can last for months or even years. About one-third of those with burning mouth syndrome will improve over three to five years without any treatment.

BMS treatment can provide relief within days or weeks. Talk to your healthcare provider about your specific treatment and when you can expect to feel better.

A note from Cleveland Clinic

Burning mouth syndrome (BMS) is an uncomfortable condition that creates chronic pain. While it’s sometimes difficult to diagnose, seeking care from your healthcare provider is the best way to cure the pain. Talk to your provider about your symptoms so you can find relief.

Last reviewed by a Cleveland Clinic medical professional on 06/26/2022.

References

  • American Academy of Family Physicians, Familydoctor.org. Burning Mouth Syndrome. (https://familydoctor.org/condition/burning-mouth-syndrome/) Accessed 6/26/2022.
  • Gruska M, Epstein J, Gorsky M. Burning Mouth Syndrome. (https://www.aafp.org/afp/2002/0215/p615.html) Am Fam Physician. 2002 Feb. 15;65(4):615-621. Accessed 6/26/2022.
  • National Institute of Dental and Craniofacial Research. Burning Mouth Syndrome. (https://www.nidcr.nih.gov/health-info/burning-mouth) Accessed 6/26/2022.
  • Raghavan SA, Puttaswamiah RN, Birur PN, Ramaswamy B, Sunny SP. Antidepressant-induced Burning Mouth Syndrome: A Unique Case. (https://www.epain.org/journal/view.html?volume=27&number=3&spage=294) Korean J Pain. 2014;27(3):294-296. Accessed 6/26/2022.

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