What is it?
Burning mouth syndrome means that a burning feeling in the tongue, lips or palate carries on even though the examination shows nothing that explains it. The lining looks normal; there is no sore, patch or redness. For the diagnosis, the symptom has to have lasted for months and other causes have to have been ruled out.
Most people describe a similar day: the burning is mild or absent in the morning, builds as the day goes on and is at its worst towards the evening. Easing while eating and while drinking water is common. A dry feeling in the mouth and a change in taste may go with it; even so, saliva measurements can come back normal.
The burning should not be thought of as imagined. This picture is currently explained through changes in the way the small nerve fibres in the lining of the mouth work and in the balance between the taste and pain pathways. Finding no visible sore does not mean the pain is not real.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Causes that have to be ruled out first
A yeast infection, dry mouth, iron, B12 and folate deficiency, poorly controlled diabetes and acid reflux can all produce the same symptom. If one of these is found, the picture is not burning mouth syndrome; that cause is treated and the burning is expected to settle.
- 02
Mechanical and chemical irritants inside the mouth
A sharp filling edge, a denture that does not fit, teeth grinding and the habit of pressing your tongue against your teeth keep irritating the lining. Sodium lauryl sulfate in toothpaste, alcohol-based mouthwashes and strong flavourings such as cinnamon can also start the burning off or make it worse.
- 03
A change in the way the nerves work
In the picture that is left once the things that can be ruled out have been ruled out, a change is thought to have taken place in the way the small nerve fibres supplying the mouth work. That is why the symptom is dealt with under the heading of nerve pain, and this approach also sets the direction of treatment.
- 04
Hormonal stage of life, sleep and mental load
The symptom is reported most often by women after the menopause. Anxiety, disturbed sleep and the burning itself can feed one another. Some medicines can contribute by way of dry mouth; do not stop a medicine on your own, speak to the clinician who prescribed it.
How does it progress?
- Type 1
Burning that builds through the day
There is no symptom on waking, or only a mild one, and it builds as the day goes on. In this type, investigation aimed at nutrition and at causes elsewhere in the body comes to the fore.
- Type 2
Burning that lasts all day
The burning is there on waking in the morning as well and carries on all day. It commonly goes along with disturbed sleep and anxiety; sharing the management is needed more often in this type.
- Type 3
Burning that comes and goes
There are days with no symptom, and the burning turns up in less expected places such as the inside of the cheek. In this type, more attention is paid to contact allergy and to trigger foods.
How is it treated?
The first step lies with dentistry, and its purpose is to rule things out: the lining is assessed for yeast, saliva flow and the things that cause dry mouth are asked about, sharp filling edges and ill-fitting dentures are put right, and grinding and tongue-thrusting habits are reviewed. Symptoms that clear with these corrections are not the syndrome.
If blood tests are needed, ordering them and interpreting the result are not within a dentist's remit; you are referred to your GP or to a doctor in internal medicine. If a deficiency, diabetes or another cause elsewhere in the body is found, that clinician runs the treatment. The dentist carries on watching the findings inside the mouth during this time.
In the picture that is left once everything that can be ruled out has been, the management is shared. Together with oral medicine, neurology or a pain service, medicine options used for nerve pain, applied inside the mouth or taken by mouth, and behavioural support may come up; the decision about medicine rests with those clinicians. The aim is most often not for the burning to disappear altogether, but for its severity and the hours it lasts each day to come down.
- If a visible sore, or a white or red patch that does not wipe away, appears in the burning area, the picture has changed and it needs assessment.
- If the burning comes with numbness in the tongue, weakness or difficulty swallowing, do not delay.
- If dry eyes and joint symptoms have been added to the dry mouth, that combination needs looking into separately.
How is it prevented?
- Cut back on alcohol-based mouthwashes, on acidic and spicy foods, and on very hot drinks.
- Try a toothpaste that does not contain sodium lauryl sulfate; avoid products with strong cinnamon and mint flavourings.
- Manage dry mouth: drink water through the day, chew sugar-free gum, and ask yourself whether your mouth stays open at night.
- Give up smoking and alcohol; talk to your clinician about your sleep pattern and the anxiety you are carrying.
Frequently asked questions
- My tongue looks normal, so how can it be burning?
- That is exactly what defines this picture: the symptom carries on while the examination shows nothing that explains the burning. The pain may come not from how the lining looks but from the way the small nerve fibres supplying it work. That is why closing the matter with 'there is nothing wrong' is not the right approach.
- If I start taking vitamins, will the burning go?
- If there is a deficiency, treating it may reduce the symptom; but whether there is a deficiency is decided by a blood test, and the decision to treat rests with a clinician. Taking supplements on your own both makes the picture harder to read and may be unnecessary. The right order is assessment first, decision after.
- Will this burning go away completely?
- In people where one of the causes that can be ruled out is actually found, the symptom usually settles once that cause is treated. In the picture that is left, the course varies from person to person; in some, easing on its own over the years is reported. The aim of management is to reduce the severity of the burning and the hours it lasts each day; no promise of a definite outcome can be given.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.