Burning mouth syndrome

Overview

Burning mouth syndrome (BMS) is a chronic pain condition characterized by a burning, scalding, or tingling sensation in the mouth, most often affecting the tongue, lips, gums, palate, or entire oral cavity. Despite the intense discomfort, the oral tissues usually appear normal on examination. BMS most commonly affects middle-aged and older women, particularly after menopause, and can have a significant impact on quality of life. The condition may be primary (idiopathic) or secondary to another medical or dental issue.

Causes

Burning mouth syndrome is classified into two types based on its underlying cause:

• Primary BMS (idiopathic): No identifiable cause; believed to be related to dysfunction in the nerves that control pain and taste in the mouth.

• Secondary BMS: Associated with an underlying condition such as:

  • Hormonal changes (e.g., menopause)

  • Nutritional deficiencies (e.g., vitamin B12, folate, iron)

  • Dry mouth (xerostomia) from medications, dehydration, or autoimmune diseases like Sjögren’s syndrome

  • Oral infections (e.g., oral candidiasis)

  • Allergic reactions to dental materials, toothpaste, or food additives

  • Gastroesophageal reflux disease (GERD)

  • Anxiety, depression, or chronic stress

Symptoms

The primary symptom of BMS is a persistent burning sensation in the mouth, often described as similar to having scalded the tongue. Additional symptoms may include:

• Burning or tingling sensation, especially on the tongue, lips, roof of the mouth, or entire mouth

• Dry mouth or altered saliva sensation

• Changes in taste – metallic or bitter taste

• Increased discomfort throughout the day, with symptoms often worsening in the evening

• Normal appearance of the mouth despite ongoing pain

In some cases, symptoms may come and go, while in others, the discomfort is constant.

Diagnosis

Burning mouth syndrome is a diagnosis of exclusion, meaning other possible causes must be ruled out first. The diagnostic process may include:

• Detailed medical and dental history – including medications, lifestyle factors, and psychological health

• Oral examination – to rule out visible lesions, infections, or other oral conditions

• Blood tests – to check for anemia, diabetes, thyroid dysfunction, or vitamin deficiencies

• Salivary flow tests – to evaluate for dry mouth

• Allergy testing – if contact sensitivity is suspected

• Fungal or bacterial cultures – to rule out oral infections

• Referral to a neurologist, endocrinologist, or psychologist – if appropriate, for further evaluation

Treatment

Treatment of burning mouth syndrome depends on whether it is primary or secondary:

• For secondary BMS: Addressing the underlying cause often leads to symptom improvement:

  • Correcting nutritional deficiencies

  • Treating dry mouth or oral infections

  • Managing systemic diseases like diabetes or hypothyroidism

  • Adjusting or changing medications that may contribute to symptoms

• For primary BMS: Treatment is focused on symptom relief and may include:

  • Medications such as:

    • Tricyclic antidepressants (e.g., amitriptyline)

    • Anticonvulsants (e.g., clonazepam, gabapentin)

    • Selective serotonin reuptake inhibitors (SSRIs)

  • Topical treatments – lidocaine mouth rinses or clonazepam lozenges

  • Cognitive behavioral therapy (CBT)

  • Saliva substitutes and mouth moisturizers

  • Low-level laser therapy (in some studies)

Prognosis

The course of burning mouth syndrome can vary. In some individuals, symptoms resolve spontaneously or improve with treatment, especially when a secondary cause is addressed. In others, the condition may persist for months or even years. Although BMS is not life-threatening, it can significantly affect quality of life, particularly due to its impact on eating, speaking, and emotional well-being. Early diagnosis, a personalized management plan, and emotional support can help many individuals find meaningful relief and improve daily functioning.