Burning mouth syndrome is a chronic condition of burning intraoral pain, usually involving the tongue, in the absence of an identified cause. There are no physical signs or specific diagnostic tests, and treatment is symptomatic and often difficult.
(See also Evaluation of the Dental Patient.)
Burning mouth syndrome is uncommon, and the prevalence varies depending on the population being studied. A meta-analysis reported an overall prevalence of 1.7% in the general population, and 7.7% among patients referred to dental practices (1). Population-based data also suggests higher rates in postmenopausal women (2). Burning mouth syndrome rarely occurs before age of 30. It is believed to be neuropathic, affecting central and peripheral nerves of pain and taste, and may be multifactorial in origin (1).
Burning mouth syndrome has been classified in several different ways, and the definitions continue to evolve. Some criteria have defined burning mouth syndrome as oral pain recurring daily for > 2 hours for > 3 months (3). The pain has both a burning quality and is felt superficially in the mucosa. The oral mucosa is normal in appearance and not better accounted for by another diagnosis. Previously, burning mouth syndrome has also been classified as primary or idiopathic (4). Other classification systems have categorized it based on fluctuations in pain severity in 24 hours (eg, type 1, 2, 3).
Possible causes of burning mouth syndrome include (5, 6):
Nutritional deficiency (vitamin B12, vitamin B9 [folate], iron, zinc)
Endocrine disorders (diabetes mellitus, menopause/hormonal changes, thyroid disorders)
Candida infection (candidiasis)
Allergy (foods, dental products)
Oral parafunctional behavior (eg, tongue thrusting, clenching, bruxism)
Burning mouth syndrome may cause pain and burning, tingling, or numbness of the tongue, palate, lips, or other mucosal surfaces of the mouth, often bilaterally and sometimes in multiple foci. The tongue is most commonly affected, particularly the tip and anterior two-thirds of the tongue. The pain can be significant and may occur daily. It may be constant or increase throughout the day and may be relieved by eating or drinking. Xerostomia (subjective dry mouth) and dysgeusia (altered taste) may occur. Pain, as well as associated emotional issues (anxiety, depression), can be socially debilitating. Duration of symptoms of burning mouth syndrome varies from months to years, but symptoms may resolve spontaneously or when a secondary cause can be identified and addressed.
General references
1. Wu S, Zhang W, Yan J, et al. Worldwide prevalence estimates of burning mouth syndrome: A systematic review and meta-analysis. Oral Dis. 2022;28(6):1431-1440. doi:10.1111/odi.13868
2. Kohorst JJ, Bruce AJ, Torgerson RR, et al. A population-based study of the incidence of burning mouth syndrome. Mayo Clin Proc. 2014;89(11):1545-1552. doi:10.1016/j.mayocp.2014.05.018
3. Currie CC, Ohrbach R, De Leeuw R, et al. Developing a research diagnostic criteria for burning mouth syndrome: Results from an international Delphi process. J Oral Rehabil. 2021;48(3):308-331. doi:10.1111/joor.13123
4. Sun A, Wu KM, Wang YP, et al. Burning mouth syndrome: a review and update. J Oral Pathol Med. 2013;42(9):649-655. doi:10.1111/jop.12101
5. Thakkar J, Dym H. Management of Burning Mouth Syndrome. Dent Clin North Am. 2024;68(1):113-119. doi:10.1016/j.cden.2023.07.007
6. de Lima-Souza RA, Perez-de-Oliveira ME, Normando AGC, et al. Clinical and epidemiological profile of burning mouth syndrome patients following the International Headache Society classification: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2024;137(2):119-135. doi:10.1016/j.oooo.2023.10.002
Diagnosis of Burning Mouth Syndrome
Primarily history and physical examination
Sometimes tests to identify secondary causes
Diagnosis of burning mouth syndrome requires oral pain and burning symptoms in the presence of normal oral mucosa. Pain must occur every day, for > 2 hours per day (though some authors omit this potentially unreliable criterion), for > 3 months (1). Burning mouth syndrome is a diagnosis of exclusion; therefore, testing for secondary causes should be thorough and may involve salivary flow measurement, blood tests to evaluate for systemic conditions, head and neck imaging studies, and biopsy.
Diagnosis reference
1. International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia. 2020;40(2):129-221. doi:10.1177/0333102419893823
Treatment of Burning Mouth Syndrome
Symptomatic treatment
Treatment of the underlying cause for secondary burning mouth syndrome
Treatment of burning mouth syndrome is challenging due to its unclear etiology and the limited evidence supporting most interventions. A multidisciplinary approach may be helpful and interventions include cognitive-behavioral therapy; medications such as tricyclic antidepressants, alpha-lipoic acid, clonazepam, topical capsaicin, or gabapentin; and low-level laser therapy (; medications such as tricyclic antidepressants, alpha-lipoic acid, clonazepam, topical capsaicin, or gabapentin; and low-level laser therapy (1). Patient-initiated pain relief measures include cold beverages, ice chips, sugarless chewing gum, and avoidance of irritants such as tobacco, spicy or acidic foods, and alcohol (in beverages and mouthwash) (2).
Secondary burning mouth syndrome may be cured by appropriate treatment of the underlying cause.
Treatment references
1. Tan HL, Smith JG, Hoffmann J, et al. A systematic review of treatment for patients with burning mouth syndrome. Cephalalgia. 2022;42(2):128-161. doi: 10.1177/03331024211036152
2. Mishellany-Dutour A, Melin C, Gabrielli F, et al. Intraoral Factors Modulating Pain in Burning Mouth Syndrome. J Oral Rehabil. 2025;52(11):1906-1911. doi:10.1111/joor.14053
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