Burning Mouth Syndrome: There is Hope

By Susan E. Sklar, M.D.

Burning mouth syndrome is a painful burning, scalding, or tingling feeling in the mouth and the tongue.

One of my first patients was Jeannie. At the time, she was vivacious 42-year-old mother of two children who worked as a massage therapist and chef. She was living the idyllic life in beautiful northern California until burning mouth syndrome came into her life.

Jeannie started having severe burning pain throughout her mouth and tongue. It had started two years before. Her life has become a living hell. Since then, she is not able to enjoy the great food she makes. She has a 45-minute routine to use mouthwashes and anesthetic pastes in her mouth to fall asleep. She doesn’t have a life-threatening condition, but her life is miserable because of burning mouth.

Jeannie has seen eight different health practitioners. These include a dentist, allergist, and an ENT (ear, nose, and throat) specialist. Also, she consulted alternative health practitioners  including an acupuncturist, a nutritionist, and a homeopathic practitioner. At one point, she saw an alternative health practitioner who put her on a popular “hormone stimulating” supplement with the assurance this would fix her hormone imbalances. However, within a few weeks she felt much worse.

Treating Burning Mouth Syndrome is Challenging for Many Doctors

According to a review article by David Mock on burning mouth syndrome in the International Journal of Oral Sciences:

“Most clinicians dread seeing the patient presenting with a primary complaint of burning pain on one or more oral mucosal surfaces (the lining of your mouth and tongue).”[1]

Doctors Dread Seeing You! Why?

Because they don’t know what to do for you! As a Harvard trained Obstetrician-Gynecologist, I have had the experience of seeing the tremendous changes that occur in some women. These are the changes in their hormones. For over a decade, I have been treating both men and women with bioidentical hormones.

I did not set out to treat women with burning mouth syndrome. However, I noticed that as I treated them for hormone imbalances and deficiencies, their burning mouth symptoms got better. With a full hormone balancing program, their burning mouth pain improved or went away. In addition, burning skin and itching skin on shoulders, backs, waists, and thighs also disappeared. There is solid scientific evidence for why this is true.

What is Burning Mouth Syndrome?

How do you know if you have burning mouth syndrome? Most importantly, you feel a scalding sensation that feels like getting burned by a hot liquid of your mouth and sometimes your tongue. The definition of burning mouth syndrome is: A burning sensation in the mouth for which no medical or dental cause. The burning sensation occurs daily and is present for 4-6 months.[2]

The pain is usually gone during sleep but starts in the morning. Later, the pain becomes mild to moderate by late morning and may progressively increase through the day. The pain reaches its worst level by late afternoon or early evening. In addition, the burning pain often interferes with falling asleep.

Doctors Underestimating Your Pain

The medical establishment has been underestimating the severity of burning mouth syndrome pain. Earlier medical studies minimized the severity of the pain, but more recent studies have reported that pain is moderate to severe. They have found the pain is like the intensity of toothache pain.

This is a high level of pain!

Patients may also have dry mouth, itching, feeling of roughness, a “sticky sensation”, trouble swallowing, a metallic taste or other taste changes. Usually, the start of the pain is spontaneous. But sometimes there is a specific event which started it such as a dental procedure, illness, or medication. Once burning starts, it often persists for many years.

There isn’t much information on the natural course of burning mouth syndrome. Some studies have shown partial recovery without treatment six to seven years after it starts. That’s a long time to wait to see if it’s going to go away!

What is the Cause of Burning Mouth Syndrome?

When my patient Jeannie sought help for burning mouth syndrome, she was up against some misconceptions.

  1. Doctors who believe that depression is the cause.
  2. Doctors who think anxiety is the cause.
  3. Scientists who think fear of cancer is the cause.

They were saying it’s all in your head! Many thought Jeannie was worrying herself into burning mouth syndrome. In addition, they are also saying that because you are depressed, you are perceiving normal sensations as painful.

Jeannie knew it wasn’t normal. I know it’s not normal. Because doctors can’t figure it out, they are blaming you, the person with burning mouth syndrome. The more enlightened doctors say you’re depressed because of the pain. That’s more like it. Of course, chronic pain is depressing, especially if it affects your sleep.

The most enlightened scientists in the medical establishment say burning mouth syndrome is a nerve problem. They’re right, but what is their solution? Put you on an antidepressant or anti-seizure  medication. These don’t work well for burning mouth syndrome. 

Who Gets Burning Mouth Syndrome?

Who gets burning mouth syndrome? Primarily women! And primarily women in menopause!

Read a part of this report from the journal of the American Academy of Family Practice:

“Based on the makeup of most studies published to date, oral burning appears to be most prevalent in postmenopausal women. It has been reported in 10 to 40 percent of women presenting for treatment of menopausal symptoms. “[3]

The medical establishment has tried to blame it on depression and anxiety. 90% of women in the studies of burning mouth syndrome are menopausal. When the primary people suffering are women, it’s easy for the medical establishment to write it off to emotional problems. This is so unfair to women.

What You Need to Know About Burning Mouth Syndrome

You need a lot of patience. Scientific studies show that the average time to diagnosis is 3 years. Yes, that’s 3 years of going to doctors, dentists, specialists, alternative practitioners. That’s 3 years of sleeplessness, pain, frustration, and thinking that you’re going crazy. That’s how long it takes to find out that you have burning mouth syndrome. Once you find out, then you need to find a solution. I’m hoping to shorten that time for you by giving you this information.

First, you need a diagnosis. You need to see at least one competent ENT (ear, nose, and throat) specialist, dentist, or allergist to examine your mouth and tongue. This is because some other conditions can cause similar symptoms. For example, poorly fitting dental work and allergies to dental materials can be the cause. Some patients have a yeast infection on the tongue and in the mouth that can cause discomfort. This is treatable. Skin conditions like herpes can also cause a burning sensation. So, eliminate these as a possibility first. If you have dry mouth, Sjogren’s syndrome, an autoimmune disease may be the problem.

Some doctors blame burning mouth on compulsive biting or chewing on your mouth or tongue. But you know it’s burning and you’re not compulsively doing anything. Furthermore, some doctors have blamed burning mouth on allergies to nylon and nickel. This has been pretty much ruled out. If your doctor tells you that everything looks normal and you still have the burning for 4-6 months, then you can be confident that you have burning mouth syndrome.

What to Do Next

If you are smoking, stop! That is an obvious irritant. There are other important reasons to stop also.

Look at the medications you are currently taking. Did you start a new medication just before your symptoms started? The most common medications that can cause burning mouth and tongue are in the blood pressure lowering family of medications called ACE inhibitors. For example, these are things like Lotensin and Prinivil. If you are taking this medication, speak to your doctor about changing to a different type of blood pressure lowering medicine.[4]

Antihistamines used for the treatment of hay fever can be the cause of burning mouth. In addition, anxiety lowering medications like Valium, and certain heart medications can be the cause of your pain. Therefore, review your medications, but do not stop them by yourself. Speak to your doctor about a substitute medicine.

Get your nutritional and metabolic status checked. Deficiencies in certain vitamins can contribute to burning tongue and mouth. Diabetes can cause mouth burning. Ask your doctor for the following blood testing: Vitamin B12, Homocysteine, blood sugar, and hemoglobin A1C. Also checking for anemia is essential.

What Not to Do

Don’t bother with mouth rinses of anti-inflammatory substances or prednisone. They generally don’t work. The same is true for numbing gels and rinses. 

Avoid Treatment for Anxiety and Depression

Generally, medications used to treat anxiety and depression are not effective. The anxiety medications are ones like Valium, Klonopin or Librium. They will sedate you. In addition, they are highly addicting. Don’t end up with an addiction problem in addition to your burning mouth. The one exception is a Klonopin lozenge that melts on the tongue and helps in some cases.

Doctors will propose antidepressant medications like Elavil. However, antidepressants have a number of side effects. For one thing, dry mouth. If your mouth is already burning and especially if you have dry mouth also, you will not want to use these. Other side effects with Elavil include sleepiness, dizziness, heart arrhythmias, strokes, seizures, tremor, and constipation. Does that sound like a good solution? And there are not studies that show they are effective.

What about other antidepressants like Prozac. Well, first, depression is not the cause of your burning mouth syndrome. Yes, you may be depressed by the time it took to diagnose it and by the frustration in getting it treated. But think carefully before using anti-depressants. They have lots of side effects. For example, side effects can include weight gain, decreased sex drive, permanent changes in your brain chemistry and sometimes withdrawal symptoms when you try to go off. Moreover, studies have not proved that they are effective.

What about using anti-seizure medications? Some doctors have proposed these medications for use in several pain syndromes. They change the nerve conduction of the pain nerves. These may help but beware of side effects like sedation and feeling like a zombie. Moreover, there is no scientific proof that they are effective for burning mouth syndrome.[5]

What About Laser Treatment?   

The use of low level laser is supposed to help blood flow to your tongue, reduce inflammation and help with tissue repair.  Results of studies using this for BMS are mixed, with some showing pain relief and improved quality of life, while others do not. 

While the medical establishment tries anti-depressant medications, anti-anxiety medications, and anti-seizure medicine to relieve symptoms, they don’t treat the root cause. The root cause is hormone deficiencies. Researchers say they’ve studied hormone treatments, but they have only looked at estrogen. Results are mixed and, in addition, this is not enough to study.

What is the Solution for Burning Mouth Syndrome?

 While the medical establishment tries anti-depressant medications, anti-anxiety medications, and anti-seizure medicine to relieve symptoms, they don’t treat the root cause. The root cause is hormone deficiencies. Researchers say they’ve studied hormone treatments, but they have only looked at estrogen. Results are mixed and, in addition, this is not enough to study. 

The solution is to treat the underlying problem which causes burning mouth syndrome. You do not have a deficiency in Prozac or Librium. You do have deficiencies in many steroid hormones. Why is this? For one thing, you are menopausal or perimenopausal. Your hormone levels have been declining for years and now have reached a critical level. 

Added to this is stress. And who isn’t stressed? The modern world, our demanding lives, past trauma, and illnesses can cause a stress response in your body that depletes your important neuroactive hormones. These are hormones that specifically act within the nerves in your body. Seeing professionals who examine the surface of your tongue and mouth is important for diagnosis and exclusion of oral disease. But this will not supply a solution. The problem is not visible. It is in the nerves. The deficiencies in your hormone levels are causing malfunction in your nerves. This Is what is causing your burning mouth syndrome.

What can you do? You need to see a doctor who has expertise in anti-aging medicine and who can treat burning mouth syndrome. These are doctors who recognize that hormones are important regulators of your health. They govern your nervous, reproductive, immune, and metabolic functions. Get on a program of full hormone restoration and balancing. In addition find a restorative medicine practitioner who can treat chronic pain. Your best chance at recovery is to be under the care of a specialized anti-aging or functional medicine doctor.

For those who are not able to find an anti-aging specialist, or who cannot afford the services of this type of doctor, Susan Sklar, MD developed BMS Advanced Support. In the form of a nutritional supplement, it contains some of the hormones and vitamins that are known to help heal nerves.

References

  1. David Mock, and Deepika Chugh
    Burning Mouth Syndrome
    Int J Oral Sci. 2010 Mar; 2(1): 1–4.
    LINK: Burning Mouth Syndrome
  2. The International Classification of Headache Disorders, 3rd edition (beta version).
    Cephalalgia 2013 Jul;33(9):629-808.
    LINK: The International Classification of Headache Disorders, 3rd edition (beta version).
  3. MIRIAM GRUSHKA, M.SC., D.D.S., PH.D., JOEL B. EPSTEIN, D.M.D., M.S.D., MEIR GORSKY, D.M.D.
    Burning Mouth Syndrome
    Am Fam Physician. 2002 Feb 15;65(4):615-621.
    LINK: Burning Mouth Syndrome
  4. Vincent D Eusterman, MD, DDS
    Which drugs may be etiologic factors in burning mouth syndrome (BMS)?
    Medscape Oct 08, 2019
    LINK: Which drugs may be etiologic factors in burning mouth syndrome (BMS)?
  5. McMillan R, Forssell H, Buchanan J, Glenny A, Weldon JC, Zakrzewska JM
    Interventions for treating burning mouth syndrome
    Cochrane 17 November 2016
    LINK: Interventions for treating burning mouth syndrome

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