Burning Tongue: Causes and Therapy

Brief overview

What is tongue burning? A sensory disturbance in the area of the tongue, but sometimes also in the whole mouth, which is permanent or occurs periodically. May be accompanied by dry mouth, thirst and/or altered sense of taste.
Description: Burning, tingling or numbness of the tongue (and possibly in other regions of the mouth). The tongue usually burns or tingles at the front or at the edges. This can worsen during the course of the day and/or improve with eating or drinking. Often no visible changes (except in the case of a fungal infection, for example).
Who is affected? Mainly middle-aged and older women.
Causes: e.g. vitamin or iron deficiency, Sjögren’s syndrome, diabetes mellitus, multiple sclerosis, reflux disease (heartburn), fungal infection, mental illness (such as depression), side effects of medication, allergy to denture material or oral care products, etc.
Therapy: Treatment of known triggers or underlying diseases, otherwise symptomatic measures.
Home remedies & tips: e.g. sucking small ice chips, drinking water frequently and chewing (sugar-free) chewing gum for dry mouth, avoiding stress

Burning tongue: Causes & possible diseases

Sometimes no cause can be found for the unpleasant burning sensation on the tongue. This idiopathic burning tongue syndrome is probably a somatoform pain disorder.

Otherwise, the range of possible causes for burning tongue or burning mouth syndrome is very broad. It includes

Nutrient deficiency

In many sufferers, tongue burning can be attributed to a nutrient deficiency. Iron deficiency in stage 2, for example, can also cause a burning sensation on the tongue, along with many other symptoms. Doctors then speak of Plummer-Vinson syndrome.

A lack of vitamin B12 is another possible cause of tongue burning. The vitamin deficiency can also cause anaemia. This vitamin B12 deficiency anemia can result in a smooth, red, inflamed tongue with tongue burning – this form of tongue inflammation is called Möller-Hunter glossitis. In addition, a burning tongue can also occur with pernicious anemia – a particular form of vitamin B12 deficiency anemia.

A lack of vitamin B9 (folic acid deficiency) can also be accompanied by a burning or tingling sensation on the tongue. The same applies to a vitamin C deficiency.

Mental illnesses

A burning tongue can also be associated with anxious moods or a pathological fear of cancer (cancerophobia).

Other underlying diseases

Burning tongue is very often a side effect of underlying diseases such as

Sjögren’s syndrome
multiple sclerosis
Fibromyalgia
Diabetes mellitus
Reflux disease (heartburn)
gout
coeliac disease
Ulcerative colitis
Fungal infection (e.g. oral thrush: furry tongue, burning oral mucosa)
Nodular lichen (lichen ruber planus) in the mouth: chronic inflammatory disease with mucosal changes, sometimes associated with tongue burning and tongue pain
Map tongue (lingua geographica): chronic inflammatory change to the surface of the tongue of unknown cause, which can be accompanied by tongue burning and tongue pain
Wrinkled tongue (lingua plicata): Tongue with deep longitudinal and transverse furrows; usually congenital and harmless, but it can also be the case that the tongue hurts or burns (e.g. when eating spicy or acidic foods)
Thyroid dysfunction
Liver and bile duct infections
Cystic fibrosis
Aids
certain forms of cancer (such as Hodgkin’s disease)

Other causes

However, there are other possible causes if your tongue burns constantly or repeatedly:

Irritation in the mouth: Sharp tooth edges, protruding fillings, dental bridges and dentures can mechanically irritate the mucous membrane, causing a burning sensation on the tongue or a burning sensation in the mouth. Tartar, ulcers of the oral mucosa or gums (aphthae), gingivitis and tooth decay can also have an irritating effect and thus cause the burning sensation.
Electrical currents: If the tongue burns, it may also be due to tiny electrical currents generated by metal in the mouth (e.g. in tongue piercings or metal crowns).
Radiotherapy: Radiotherapy in the head or neck region of cancer patients can destroy the salivary glands. Those affected then often suffer from dry mouth and burning tongue.
Food intolerances: They can also be the reason for a tingling or burning sensation on the tongue or in the mouth.
Stress: It can both promote the development of tongue burning and intensify existing burning on the tongue.
Hormonal changes: The fact that burning tongue mainly affects middle-aged and older women could be due to hormonal changes during the menopause. It is possible that this promotes burning on the tongue through psychological stress or in a physiological way. So far, however, there is no evidence of a direct correlation.

Tongue pain in the sense of glossodynia is to be distinguished from pain caused by small blisters (pimples) on the tongue or in the mouth. These are known as aphthae. You can read more about the causes and treatment of these tongue blisters here.

Burning tongue: Therapy

The treatment of tongue burning depends on the cause (if this can be determined). Here are some examples:

A vitamin or iron deficiency can sometimes be remedied with a change in diet. If not, a vitamin or iron supplement can compensate for the deficiency. This may take some time, but afterwards you will also be cured of deficiency symptoms such as burning tongue.

Dental causes such as protruding fillings or sharp tooth edges can usually be remedied by the dentist.

Patients with Sjögren’s syndrome should be treated by a rheumatologist. Although the rheumatic autoimmune disease cannot be cured, symptoms such as dry mouth with a burning tongue can usually be alleviated. For example, medication with the active ingredient pilocarpine or cevimelin (currently only approved in the USA) can stimulate saliva production if the disease has not already damaged the salivary glands too severely.

If a fungal infection in the mouth causes the tongue to burn, the doctor can prescribe an antifungal agent (antimycotic).

Other underlying conditions such as heartburn or thyroid dysfunction should also be treated appropriately. The symptom of burning tongue often disappears or improves.

A psychotherapist or psychiatrist can help with burning tongue caused by psychological problems and illnesses. Depending on the diagnosis, the doctor will prescribe psychotherapy (particularly effective: cognitive behavioral therapy) and/or medication (such as antidepressants). Caution is advised with the latter: Some psychotropic drugs can themselves cause dry mouth and thus a burning sensation on the tongue or in the mouth.

If the burning tongue turns out to be a side effect of medication such as antidepressants or antihypertensives, patients should talk to their doctor – it may be possible to switch to a better-tolerated medication.

Under no circumstances should patients stop taking their medication on their own initiative! This could have dangerous consequences for their own health.

Severe tongue pain can be relieved purely symptomatically with local anesthetics (local anesthetics such as lidocaine) or painkillers. However, you should always try to identify and treat the cause beforehand.

Burning tongue: Home remedies & tips

Sucking (sugar-free) chewing gum stimulates salivation. Instead of chewing gum, you can also use sugar-free sweets or lozenges.
Drinking water frequently and sucking small ice chips keeps the mouth moist and stimulates salivation. This can also help against dry mouth with a burning tongue.
An alternative to ice chips are “ice cubes” made from frozen drinks such as apple or orange juice.
Some patients suck on frozen pineapple chunks when their mouth is dry. Here, the flow of saliva is additionally stimulated by enzymes from the tropical fruit.

If the tongue burning is due to heartburn (reflux disease) (acidic gastric juice rises into the mouth and irritates the mucous membranes), the following tips are helpful:

Eat small meals more often instead of a few large meals. Give preference to protein-rich rather than fatty foods.
Eat sitting down and do not lie down for two hours afterwards.
Sleep with your upper body elevated by 10 to 12 cm or on your left side (this prevents gastric juices from rising so easily).
When bending over, squat down instead of bending down.
Avoid alcohol (especially white wine), coffee, peppermint, fruit juices, carbonated drinks and tomato sauce.

You can find further advice on reflux disease and the associated burning tongue in our picture gallery “12 tips for heartburn”.

If you have a burning tongue due to oral thrush, a disinfectant tincture of myrrh or ratanhia can be used in addition to the antifungal medication prescribed by your doctor. Both tinctures are available from pharmacies and should be applied to the mucous membranes of the mouth or tongue at least one hour after the antifungal medication has been applied.

In general, if you have inflammation in the mouth, which can be accompanied by a burning tongue, you can rinse your mouth several times a day with a tea made from one of the following medicinal plants:

Sage: Pour 1 cup of boiling water over 2 tablespoons of chopped sage leaves, cover and leave to infuse for 5 to 10 minutes, then strain).
Mallow: Pour 1 cup of cold water over 1 tablespoon of mallow flowers and 2 tablespoons of mallow leaves, bring to the boil briefly, leave to infuse for 10 minutes and then strain.
Camomile: Pour 1 cup of boiling water over 1 tablespoon of camomile flowers, cover and leave to infuse for 5 to 10 minutes, then strain.
Marigold: Pour 1 to 2 teaspoons of marigold flowers over 1 cup of boiling water, leave to infuse for 10 minutes and then strain.

Alternatively, tinctures of many of these medicinal plants are available that can be used to treat inflammation in the mouth (and throat). For example, you can apply a 1:10 dilution of sage tincture (available from pharmacies) to the inflamed tongue and other inflamed mucous membrane areas in the mouth. Or you can get a tincture of marigold or thyme to rinse your mouth with, diluted in water. The pharmacist will advise you on the selection and use of a suitable preparation.

If stress and nervousness are bothering you and causing a burning tongue, the following herbal teas can provide valuable support:

Valerian: For a calming valerian tea, pour 1 cup of cold water over 2 teaspoons of crushed valerian root, leave to infuse for at least 12 hours, then strain and drink slightly warmed – for stress-related sleep disorders, drink several cups throughout the day.
Valerian & hops: To increase the calming effect of valerian tea, you can mix it with an extract of hops before drinking: pour hot water over 1 teaspoon of hop cones, leave to infuse for 10 minutes, then strain and add to the finished valerian tea (see above for preparation).

A full herbal bath, for example with lavender oil, also has a calming effect: mix 2 egg yolks, 1 cup of cream (or milk), 2 tablespoons of honey, 3 to 4 tablespoons of salt and 1 teaspoon of lavender oil and pour into bath water at a temperature of 37 to 38 degrees. Soak for at least 20 minutes.

If your tongue burns for any reason, it is advisable to avoid stress and other mental strain as much as possible. These can make the burning sensation on the tongue or in the mouth worse.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.

Burning tongue: Examinations & diagnosis

To get to the bottom of unexplained burning tongue, the doctor will first ask about your medical history (anamnesis). He will ask you, for example, how long you have had a burning sensation on your tongue, whether it is worse in certain situations and whether you have any other complaints. He will also ask whether you are taking any medication and whether you have any known underlying illnesses.

A look in the mouth

A look in the mouth sometimes provides the doctor with important information. A pale red tongue (also at the edges), which is slightly moist and easy to move and shows no changes in structure or coloration on the surface, is normal.

Further examinations

In many cases of burning tongue, however, no external changes are visible on the tongue or in the mouth. The doctor then has to rely on further examinations to make a diagnosis. These may include, for example

Blood tests: These can be used to detect an iron or vitamin deficiency or the resulting anemia, for example.
Saliva production test: This allows the doctor to determine whether dry mouth is the cause of the burning tongue.
Allergy tests: These can help if the doctor suspects that the burning sensation on the tongue or in the mouth could be an allergic reaction to metal fillings, for example.

In order to determine the cause of the burning tongue, it may be necessary to involve various specialists (ENT specialist, dentist, dermatologist, neurologist, psychiatrist, etc.).