Burning mouth syndrome, also called burning tongue or chronic oral pain syndrome, is an unpleasant sensory disorder that often plagues sufferers for months or years. Treatment is difficult because the condition can be triggered by many different factors. In addition to oral and dental problems, hormonal disorders, allergies, neurological diseases or psychological problems are all possible causes.
What is burning mouth syndrome?
Burning mouth syndrome, a burning, sore sensation in the area of the tongue and surrounding mucous membranes, primarily affects women in their fifth to seventh decades of life. The intensity of the sensory disturbance ranges from mild tingling to burning, stabbing pain. It is not uncommon to experience other symptoms such as tingling, itching, dry mouth, a feeling of furiness, disturbances in the sense of taste, and a reduction in saliva production. The sensory disturbances are usually felt at the edges of the tongue as well as the tip, but sometimes the insensitivity may extend to the mucous membranes of the cheeks, palate, and lips. The discomfort, which is permanent in some sufferers and intermittent in others, usually intensifies over the course of a day in burning mouth syndrome, so that the severity is greatest in the evening.
Causes
There are many causes of burning mouth syndrome. In addition to underlying diseases such as vitamin or iron deficiency, anemia, diabetes mellitus, scleroderma, lupos, multiple sclerosis, or reflux disease, oral and dental problems such as caries, gingivitis, or ulcers of the oral mucosa can also be causative for burning mouth. Sometimes burning mouth syndrome is also triggered by ill-fitting dentures, sharp tooth edges or protruding crown margins that cause irritation or injury to the tongue or oral mucosa. An allergy to braces or the metals in dental fillings are also possible factors that can be responsible for burning in the mouth. Not infrequently, no physical cause can be identified for the painful sensory disturbance. Stress, anxiety and depression can be the trigger for burning in the mouth here and not only intensify the pain, but also prolong the suffering, since burning mouth syndrome is difficult to treat if psychological causes are present.
Symptoms, complaints and signs
The symptoms and complaints of burning mouth syndrome are very unpleasant and thereby also have a very negative impact on the quality of life of the affected person. The patients suffer thereby primarily from a very strongly pronounced burning on the tongue. There may also be severe pain and other unpleasant sensations in the mouth in general. Burning mouth syndrome also makes the daily life of the affected person much more difficult. This means that the usual intake of food and liquids is usually no longer possible without further ado and is then associated with severe pain. If the Burning Mouth Syndrome is triggered by an allergy, other symptoms of this allergy usually appear as well. The syndrome itself often spreads to the face, so that a burning sensation or itching can occur there as well. Furthermore, the burning mouth syndrome can also negatively affect the teeth, so that many affected people also suffer from caries. This can also cause severe pain in the teeth or gums. The syndrome also leads to psychological discomfort and depression in many patients, so that treatment by a psychologist is also often necessary.
Diagnosis and course
Affected persons suffering from burning mouth syndrome often turn to their dentist seeking help. In a detailed anamnesis interview, the dentist first asks the patient about the duration and intensity of the burning pain, as well as other symptoms. This is followed by a visual examination of the teeth and oral mucosa, during which the dentist can identify existing irritations and diseases within the mouth, jaw and facial area. If the causes are not in the dental field, depending on the suspicion, internists, ENT physicians, gynecologists, neurologists, dermatologists or psychologists can be consulted, who then perform the further examinations. In the case of fungal infection of the tongue, a swab is taken and later examined microscopically in the laboratory.If anemia, iron and vitamin deficiency or diabetes mellitus are suspected, a blood test will provide clarification. An allergy test provides information about existing allergies that may be causative for burning mouth syndrome.
When should you go to the doctor?
Since there is no self-healing in burning mouth syndrome, a doctor must be consulted in any case to treat the symptoms and discomfort of this disease. As a rule, the doctor should be consulted when there is a burning sensation on the tongue. Especially in case of a long-lasting burning sensation, which occurs even without a particular reason, an examination by a doctor is necessary. This can prevent further complications. In most cases, the burning sensation can spread to the entire mouth and thus indicate burning mouth syndrome. Likewise, a doctor should then be consulted if there is discomfort in the face or teeth. Burning mouth syndrome is usually diagnosed and treated by a dentist. However, in many cases, further treatment is also provided by another specialist if the cause of the condition is not found in the mouth. The earlier the disease is diagnosed, the better the symptoms can be treated.
Treatment and therapy
Treatment of burning mouth syndrome depends on the underlying cause. Complete freedom from pain is usually not achieved within a short time, as the discomfort often persists over a long period of time. If the burning pain is an accompanying symptom of an underlying disease, the pain will slowly subside or improve after the appropriate treatment. In cases of anemia, iron or vitamin deficiency, the administration of tablets is usually sufficient. In severe cases, a blood transfusion may be necessary. Diabetes mellitus can be treated well by dietary changes and weight reduction coupled with the administration of insulin in tablet or syringe form. Tooth decay is removed with a drill and then refilled with a metal or plastic material. Gum inflammation recedes with thorough oral hygiene. If there is an allergy to the materials of the dental fillings or dentures, they must be removed and replaced by other materials. If there are no organic causes for the burning tongue, psychological support is required. In the course of therapy, the patient learns to live with the disease and to regard a reduction in the sensation of pain as a success of treatment. Sometimes the administration of antidepressants can have a positive effect on the pain sensation. Special pain therapy in the form of repeated, reciprocal blockade of the stellate ganglion with a local anesthetic with a long-term effect can not only relieve the discomfort of burning mouth syndrome, but also erase the sensation of pain.
Outlook and prognosis
Since burning mouth syndrome can be triggered by various factors, treatment of the disease often proves to be very difficult, so that those affected thereby suffer from the discomfort of the syndrome over a long period of time. A complete cure can usually be achieved once the exact causes of the syndrome have been identified. If the Burning Mouth Syndrome is caused by certain foods, the syndrome can be completely alleviated by the affected person abstaining from these foods. Even if there are deficiencies, the symptoms can usually be treated well by having the patient take supplements. The same is true if the condition is caused by diabetes, in which case the symptoms can likewise be alleviated by treating the diabetes. In this case, complete relief of the pain often only occurs over a longer period of time, so that patients are dependent on a long course of therapy. In the case of food intolerances, the affected person must do without the food for the rest of his or her life and cannot take it. Since burning mouth syndrome also leads to discomfort in the teeth, these must also be treated. Without treatment, this syndrome does not heal itself and, in many cases, the discomfort worsens.
Prevention
There are no specific measures to prevent burning mouth syndrome. Good oral hygiene with mild agents is particularly important.A healthy diet and avoidance of highly seasoned and acidic foods, alcohol and nicotine can provide relief for existing burning tongue. Regular preventive checkups and dental examinations can diagnose and treat irritations and diseases at an early stage, before the burning pain develops. Relaxation exercises to reduce stress and psychological help for anxiety disorders and depression can prevent burning mouth syndrome from developing or relieve the pain.
Aftercare
In burning mouth syndrome, symptomatic treatment approaches and medical aftercare can improve symptoms. Although the causes of burning tongue and oral mucosa cannot always be clarified, the symptoms can usually be treated successfully. Sometimes several triggers come together. This makes follow-up treatment more difficult. As a rule, burning mouth syndrome has no psychological causes. Nevertheless, psychological aftercare can be useful if burning mouth syndrome affects the quality of life. Glossalgia can be stressful. It can affect the experience of taste. For many sufferers, food intake is made difficult by disturbing sensations such as tingling or painful stinging. Triggers such as poorly maintained dentures, an intolerance of dental materials or allergies must be eliminated if possible. In aftercare, the aim is to restore the quality of life of those affected. The treating physicians strive to make it easier for the affected person to deal with the symptoms that arise. If Candida albicans is present, nutritional counseling may be part of the aftercare measures. Vitamin deficiencies, diabetes, gastroesophageal reflux syndrome, or other underlying conditions may be co-treated as triggers for burning mouth syndrome.
Here’s what you can do yourself
Your own scope of action in everyday life is comparatively small with burning mouth syndrome. Small everyday tips and tricks, however, make life more bearable. In the first place here is the positive attitude to life. This can be practiced again and again every day – despite the illness – and quickly becomes second nature. Cognitive behavioral therapy and relaxation techniques support this. In addition, intensive oral care is the basis for a good mouth feeling. Mild toothpastes and mouthwashes help to achieve this. Oral mucosal therapeutics sometimes have anti-inflammatory or mucosal anesthetic solutions that help relieve the symptoms. However, these should be alcohol-free, as they otherwise exacerbate the burning sensation. Furthermore, some medicinal plants such as mallow leaves, linden blossoms or marshmallow roots also contain irritation-relieving mucilage. As a tea, tincture (also alcohol-free) or gel for application, they are a valuable support. Dry mouth is counteracted with plenty of water and tea. It should be at least two liters a day. Sucking ice cubes or appropriate pastilles has also proved to be a valuable tip. As far as nutrition is concerned, it is better to avoid highly spiced or acidic foods (including vinegar). Nuts also irritate the mucous membranes due to their oxalic acid content. Refraining from alcohol and nicotine (irritants) is also indicated. Overall, the entire physical condition improves with regular exercise as well as adequate sleep.
