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. Secondary burning mouth syndrome refers to similar symptoms caused by another disorder.
(See also Evaluation of the Dental Patient.)
Burning mouth syndrome is uncommon (although its actual incidence is not well reported) and usually affects postmenopausal women. It is believed to be neurogenic, affecting central and peripheral nerves of pain and taste, and may be multifactorial in origin (1).
Causes of secondary burning mouth syndrome include
Nutritional deficiency (vitamin B12, vitamin B9 [folate])
Candida infection (candidiasis)
Allergy (foods, dental products)
Oral mucosal disorders (eg, stomatitis, lichen planus, pemphigoid, pemphigus vulgaris, neoplasia)
Oral parafunctional behavior (eg, tongue thrusting, clenching, bruxism)
Burning mouth syndrome may cause burning, tingling, or numbness of the tongue, palate, lips, or other mucosal surfaces of the mouth, often bilaterally and sometimes in multiple foci. 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. Perceived dry mouth and 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 resolve spontaneously or if a secondary cause can be identified and addressed.
General reference
1. Momin S: Burning mouth syndrome—A frustrating problem. JAMA Otolaryngol Head Neck Surg 147(6):580, 2021. doi:10.1001/jamaoto.2021.0177
Diagnosis of Burning Mouth Syndrome
Clinical evaluation
Tests to exclude secondary causes
Diagnosis of burning mouth syndrome requires oral symptoms as noted above and the absence of oral signs. Pain must occur on 50% of days, for > 2 hours per day (some authors omit this potentially unreliable criterion), for > 3 months. 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.
Treatment of Burning Mouth Syndrome
Symptomatic treatment
Curative treatment for secondary burning mouth syndrome
Treatment of burning mouth syndrome is difficult and may be unsatisfactory and frustrating for the patient. An empathic, multidisciplinary approach may be helpful, including cognitive-behavioral therapy and drugs such as tricyclic antidepressants, alpha-lipoic acid, clonazepam, topical capsaicin, or gabapentin (, alpha-lipoic acid, clonazepam, topical capsaicin, or gabapentin (1). Patient-initiated pain relief measures include cold beverages, ice chips, chewing gum (sugarless), and avoidance of irritants such as tobacco, spicy or acidic foods, and alcohol (in beverages and mouthwash).
Secondary burning mouth syndrome may be cured by appropriate treatment of the underlying cause.
Treatment reference
1. Tan HL, Smith JG, Hoffmann J, et al: A systematic review of treatment for patients with burning mouth syndrome. Cephalalgia 42(2):128-161, 2022. doi: 10.1177/03331024211036152
