Burning Mouth Syndrome: Causes

Pathogenesis (development of disease)

In primary burning mouth syndrome (BMS), no changes in the tongue or oral mucosa can be identified, as this designation refers exclusively to the idiopathic form. In this context, burning tongue is one of the idiopathic chronic pain disorders. Secondary BMS must be ruled out before a diagnosis of primary BMS is made. The pathogenesis of BMS is still unclear and probably multifactorial. Currently, it is discussed that BMS might be a neuropathic disease – a so-called “small fiber neuropathy”.

Etiology (Causes)

The etiology is varied, but often no cause is apparent.

Secondary Burning Mouth Syndrome

Biographic causes

• Anatomic variant: lingua plicata (wrinkled tongue) is often associated with burning; usually develops in childhood; also commonly found in patients with trisomy 21 (Down syndrome).
• Gender
  • Women (esp. postmenopausal > 55 years) are significantly more frequently affected than men (3.5-13: 1)Wherein postmenopausal (post-menopausal) women are particularly affected: Estrogen deficiency → increased incidence of burning tongue in climacteric and postmenopausal.

Behavioral causes

• Nutrition
  • Decreased food intake and low intake of vitamins (e.g., because of anorexia nervosa) → inflammation of the corners of the mouth (synonyms: Mouth angle rhagade, cheilitis angularis, angulus infectiosus oris, perlèche) and inflammation of the mucous membrane of the tongue (glossitis).
  • Burns from food, drink
• Consumption of stimulants
  • Alcohol – here: Alcohol abuse (alcohol dependence), especially with nicotine abuse.
  • Tobacco (smoking) – here: chronic nicotine abuse, which leads to nonspecific redness and irritation of the oral mucosa.
• Tongue habit, unspecified

Disease-related causes

Blood, blood-forming organs – immune system (D50-D90).

• Iron deficiency anemia – anemia caused by iron deficiency.
• Immunodeficiency/deficiency → candidiasis (synonyms: candidasis, candidosis).
• Pernicious anemia – anemia (anemia) caused by a deficiency of vitamin B12 or, less commonly, folic acid deficiency.
• Plummer-Vinson syndrome (synonyms: sideropenic dysphagia, Paterson-Brown-Kelly syndrome) – combination of several symptoms caused by mucosal atrophy in the upper gastrointestinal tract (oral cavity to stomach); the disease leads to difficulty swallowing and burning of the tongue due to mucosal atrophy in the mouth, furthermore occur: Mucosal defects, oral rhagades (tears in the corner of the mouth), brittle nails and hair and dysphagia (difficulty swallowing) due to larger mucosal defects; the disease is a risk factor for the development of esophageal cancer (esophageal cancer).

Endocrine, nutritional, and metabolic diseases (E00-E90).

• Diabetes mellitus (→ candidiasis)
• Iron deficiency
• Folic acid deficiency
• Food intolerances, such as cinnamon intolerance.
• Vitamin B6 deficiency
• Vitamin B12 deficiency
• Zinc deficiency

Cardiovascular system (I00-I99)

• Osler-Weber-Rendu disease (synonyms: Osler disease; Osler syndrome; Osler-Weber-Rendu disease; Osler-Rendu-Weber disease; hereditary hemorrhagic telangiectasia, HHT) – autosomal-dominant inherited disorder in which telangiectasias (abnormal dilation of blood vessels) occur. These can occur anywhere, but are found especially in the nose (leading symptom: epistaxis (nosebleed)), mouth, face, and the mucous membranes of the gastrointestinal tract. Because the telangiectasias are very vulnerable, it is easy to tear and thus bleeding.

Skin and subcutaneous (L00-L99).

• Lichen ruber planus (nodular lichen) – description of small flat, slightly scaly nodules here: Lichen ruber mucosae oris; burning tongue pain may occur before the appearance of visible changes.

Infectious and parasitic diseases (A00-B99).

• Candidiasis – infectious diseases caused by fungi (fungi sprouts) of the genus Candida (here: inflammation of the oral mucosa, including the tongue).
• Helicobacter pylori infection
• HIV infection – burning mouth is described as an indication of early-stage HIV infection

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

• Gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; Reflux esophagitis; peptic esophagitis) – inflammatory disease of the esophagus (esophagitis) caused by the pathological reflux (reflux) of acid gastric juice and other gastric contents.
• Gingivostomatitis ulcerosa/ulcerous inflammation of the gums and oral mucosa (forms: Plaut-Vincent due tomixed bacterial infection; agranulocytosis /absence or severe decrease of granulocytes in the blood due tointolerance reactions).
• Laryngopharyngeal reflux (LRP) – “silent reflux” in which the cardinal symptoms of gastroesophageal reflux, such as heartburn and regurgitation (backflow of food pulp from the esophagus into the mouth), are absent.
• Lingua geographica (map tongue): harmless change in the tongue surface; constitutional anomaly; the tongue gets its typical appearance by shedding the epithelium of the filiform papillae of the tongue surface (papillae filiformes); whitish and reddish districts resembling a map appear; spectrum of complaints ranges from asymptomatic to a burning sensation or burning pain.
• Stomatitis forms oral mucositis:
  • Stomatitis aphthosa (oral thrush wg HSV-1)Stomatitis catarrhalis; forms: Hunter’s glossitis due to pernicious anemia; measles stomatitis due to measles virus; scarlet fever glossitis due to group A ß-hemolytic streptococci).
  • Stomatitis granulomatosa (special form: Melkersson-Rosenthal syndrome due toarteritis (granulomatous inflammation)).
  • Stomatitis herpetica (herpes labialis ww. HSV-1)
  • Stomatitis mycotica (thrush stomatitis ww. Candida albicans).
  • Stomatitis necroticans (forms: Agranulocytosis due tointolerance reactions; Noma (water cancer) due tobacteria, malnutrition); cytostatic therapy due toe.g. cisplatin).
• Xerostomia (dry mouth).
• Tongue fissure (mucous membrane tear in the tongue), usually painless.

Musculoskeletal system and connective tissue (M00-M99).

• Sjögren’s syndrome – autoimmune disease from the group of collagenoses leading to chronic inflammatory disease or destruction of the exocrine glands, with the salivary and lacrimal glands most commonly affected.

Psyche – Nervous System (F00-F99; G00-G99).

• Anxiety
• Anorexia nervosa (Anorexia)
• Bulimia nervosa (BN; binge eating disorder)
• Depression

Injuries, poisonings and other consequences of external causes (S00-T98).

• Allergies, unspecified: e.g.
  • Food allergies or
  • Allergies to food ingredients: e.g. flavor enhancers, preservatives (e.g. benzoic acid), food colors, stabilizers (e.g. ascorbic acid).
• Mucosal trauma (mucosal injuries) caused by ill-fitting dentures or decayed teeth.
• Injuries to the tongue (e.g., burns from food, drink).

Medication

• See below “Dry mouth due to medication”.