Burning Mouth Syndrome, What Is It and How to Hopefully Find Relief

Burning Mouth Syndrome, What Is It and How to Hopefully Find Relief

Burning Mouth Syndrome, What Is It and How to Hopefully Find Relief

One day you wake up, and your mouth is a little more dryer than usual. You think nothing of it, but later you discover you have altered taste and smell as well. You notice in the afternoon that you have a burning sensation in your mouth, that becomes somewhat painful as the day progresses. You go to bed hoping it gets better, thinking maybe you drank too much a few days beforehand or that you had reflux the night before, perhaps those caused the pain? For the next few weeks, the symptoms wax and wane, and you develop more symptoms including anxiety, digestive problems, and insomnia. You begin to wonder if something is genuinely wrong and what you should do about it. You visit your doctor who sends you to a dentist who discharges you with a clean bill of health. You are later diagnosed with burning mouth syndrome by your doctor as a catch-all condition months later much like irritable bowel syndrome, and you leave with an antidepressant prescription which brings little relief. So what are the multiple possible causes of burning mouth syndrome and how might one find relief?

What are the Symptoms of Burning Mouth Syndrome?

There are a multitude of different symptoms of burning mouth syndrome and the majority of the symptoms differ between person to person and are strongly subjective. The degree of the severity of the symptoms also varies in magnitude and frequency. For many, the symptoms of burning mouth syndrome are at their minimum during the morning and increase in severity during the day. The symptoms of burning mouth syndrome for some maybe negligible during sleep, similar to silent reflux; however, up to sixty-five percent of people suffering from the disease can have daily continuous symptoms. Symptoms of the condition may be relieved while eating and drinking. Burning mouth syndrome also has a much higher chance of occurring in the elderly (75+ years old) with it occurring 1,598 cases per 100,000 people in the United States or forty-four percent of all cases. For comparison, it occurs in 609 cases per 1,000 people or nineteen percent for all cases in young adults between eighteen and thirty-four. The condition “exhibits significant female predilection and the ratio between females and males varies from 3:1 to 16:1 in various literature studies.” People of Asian and Native American ancestry have a greater chance to develop the condition and people who have African heritage are the least likely to have burning mouth syndrome. Finally, “symptoms occur continuously for months or years without periods of cessation or remission, with some reports suggesting an average duration of 2 to 3 years,” and even some cases lasting ten to twelve years!1 2 3 4 5 6

The pain of burning mouth syndrome is generally located bilaterally and symmetrically in the anterior two thirds of the tongue, followed by the dorsum and lateral borders of the tongue, the anterior aspect of the hard palate, and the labial mucosa of the lips, and occurring in multiple sites. Other less commonly reported sites include the buccal mucosa, floor of the mouth, hard and soft palates, and the throat. The sites of pain do not seem to affect the course of the disorder or response to treatments.” The symptoms are usually spontaneous for most people with no immediate identifying factor as to why they develop in most cases. However, some people who develop burning mouth syndrome report that they either had an upper respiratory infection, had a dental procedure, or took certain medications including antibiotics right before or when the symptoms started. “Symptoms of BMS have been reported in higher incidence in persons with significantly heightened perception of taste, increased number of fungiform papillae, and potentially the presence of TAS2R38 gene polymorphisms.” Finally, alcohol consumption, smoking, and ingesting spicy food may or may not worsen the condition.7 8 9 10 11 12

So what are the symptoms of burning mouth syndrome?13 14 15 16 17 18

  • Anxiety
  • Altered blink response when stimulated
  • Decreased appetite
  • Decreased salivary flow
  • Depression
  • Digestive issues
  • Dizziness
  • Dysgeusia (altered taste in your mouth and of food ingested, might be bitter and or metallic)
  • Fissured tongue
  • Geographic tongue
  • Globus pharyngis (lump in throat feeling)
  • Increased thirst
  • Paresthesia of the oral cavity
  • Reflux sensation in the esophagus, throat, and oral cavity
  • Oral cavity burning sensation
  • Oral cavity mucosal pain
  • Sleep disturbances
  • Temporomandibular joint disorder
  • Tongue swelling and redness
  • Xerostomia (dry mouth)

There are three different subtypes of burning mouth syndrome which are known as the Lamey and Lewis burning mouth syndrome classification system, which include:19

  • Subtype one – prevalence is 35% – characteristics include symptom free-waking, progressive burning sensation developing in the late morning, gradually increasing in intensity, reaching its peak by the evening.
  • Subtype two – prevalence is 55% – characteristics include continuous symptoms throughout the day, present upon awakening, difficulty in sleep and frequent sleep disturbance.
  • Subtype three – prevalence is 10% – characteristics include intermittent symptoms, present only on some days, affecting sites that are atypical within the oral cavity.

Diagnosis is usually made from an oral examination, medical history, and from symptomology by a dentist, oral surgeon, or primary care physician. Blood tests (complete blood count, fasting glucose, inflammation [hs-CRP, sedimentation rate, abnormal antinuclear antibody, and rheumatoid factor], nutritional deficiencies [iron, zinc, copper, magnesium, calcium, B1, B2, B6, folate, vitamin B12, vitamin D], and thyroid), oral microbial cultures and examination (fungal, viral, parasitical, or bacterial), viral antibody testing, oral biopsy, allergy tests, salivary measurements, tests to determine if reflux is occurring, medical imaging (MRI or CT scan), and a review of your medications and supplements might be performed to hopefully establish a cause of your condition. Diagnosis of the condition might be difficult because its symptoms match many other health conditions and widely vary. Finally, “In a study by Mignogna and colleague it was reported that the average delay from onset of the symptoms to definitive diagnosis was 34 months“.20 21 22 23 24 25

What are the Possible Causes of Burning Mouth Syndrome?

There are many possible causes of burning mouth syndrome and they include:26 27 28 29 30 31 32 33 34

Within the Oral Cavity

  • Allergies (additives, cinnamon, chestnuts, dental materials, dental restorations, foods [including oral latex allergy syndrome], preservatives [benzoic acid, sodium metabisulphite, and sorbic acid], sodium lauryl sulfate, spices) causing allergic contact stomatitis
  • Amalgams (mercury-containing and bisphenol A)
  • Dental procedure complications
  • Dentures
  • Geographic tongue
  • Hyposalivation (medication induced [anticholinergic medications, antidepressants, antipsychotics, and anxiolytic medications], radiation therapy, salivary gland disorders, salivary stones)
  • Oral infections (bacterial, fungal, parasitical, viral) microorganisms that are implicated include Candida, Enterobacter, Klebsiella, Fusobacterium, Staphylococcus aureus, Citrobacter, and H. pylori
  • Parafunctional habits (bruxism, clenching, tongue positioning)
  • Permanent oral cavity metal fixtures (for example a stainless steel retainer)
  • Root canals
  • Temporomandibular joint disorder

Systemic

  • Abnormal interaction between the sensory functions of facial and trigeminal nerves
  • Anxiety
  • Blood flow disturbances within the oral cavity
  • Connective tissue diseases
  • Deficiencies (iron, zinc, copper, magnesium, calcium, B1, B2, B6, folate, vitamin B12, vitamin D)
  • Diabetes
  • Heavy metal toxicity (cadmium, mercury, nickel, palladium)
  • Histamine intolerance and mast cell activation disorder
  • HPTGA axis issues commonly known as adrenal fatigue (hypothalamus, pituitary, thyroid, gonad, adrenal)
  • Hormone imbalances
  • Increased activity of the nigrostriatal dopaminergic system altering nociceptive (sensation of pain) processing
  • Lichen planus
  • Menopause
  • Medications (ACE inhibitors [Kallikrein, a molecule active in the kinin pathway, may be increased in the saliva of people suffering from burning mouth syndrome and taking ACE inhibitors, ACE inhibitors also deplete zinc], the antiretrovirals/protease inhibitors including nevirapine and efavirenz, hormonal replacement therapies, L-thyroxines, and Topiramate)
  • Multiple myeloma
  • Niacin toxicity
  • Neuropathy (diabetic, small fiber, large fiber, inflammatory)
  • Poor thyroid health and disease
  • Reflux diseases
  • Sicca syndrome
  • Sjogren syndrome (Citrobacter and H. pylori dysbiosis are known causes)
  • Stress
  • Systemic lupus erythematosus (systemic chronic Staph dysbiosis)
  • Upper gut dysbiosis
  • Viral infection acute
  • Viral reactivation (Herpes simplex 1 and 2, Varicella, Epstein Barr, Cytomegalovirus)

How Might one Find Relief?

Finding relief from burning mouth syndrome might be difficult because there are so many different potential causes of the condition. However, I am going to give you some advice on how to figure out what might be causing it for you and supplements and lifestyle changes that seem to improve the condition.

  • Run a Spectracell test to rule out iron, zinc, copper, magnesium, calcium, B1, B2, B6, folate, vitamin B12, and vitamin D deficiencies which can cause the condition. If you have deficiencies in these nutrients, correct them.
  • If you are dealing with silent reflux or upper gut dysbiosis relieve them.
  • Test for (Herpes simplex 1 and 2, Varicella, Epstein Barr, Cytomegalovirus antibodies) and relieve viral reactivation if it is occurring.
  • If you are obese or believe that you have diabetes, monitor your fasting blood glucose for a few weeks and see. If you are diabetic work on relieving the condition (through proper exercise, diet [for some the Bulletproof diet may work for others a reduced carbohydrate diet like Perfect Health Diet may work], proper sunlight exposure, proper circadian rhythm, and magnesium supplementation) to see if your burning mouth syndrome improves and if so it was caused by diabetic neuropathy.
  • Get a heavy metal hair test performed and determine if you have elevated amounts of cadmium, mercury, nickel, palladium. If you test positive, detox the heavy metal burden and avoid sources of the heavy metals.
  • If you are taking ACE inhibitors, antiretrovirals/protease inhibitors including nevirapine and efavirenz, hormonal replacement therapies, L-thyroxines, antihistamines, psychiatric medications that cause dry mouth, or the medication Topiramate and you having burning mouth syndrome, ask your doctor if you can taper off the medications and discontinue them to see if your symptoms improve.
  • If you have root canals, metal-containing oral hardware, dentures, mercury amalgams, or bisphenol A containing fillings consider replacing, correcting (dentures), or removing them properly and see if your symptoms improve.
  • If you suffer from bruxism or temporomandibular joint disorder, a proper oral appliance may help relieve those conditions and may improve burning mouth syndrome.
  • Practice proper oral hygiene.
  • Improve thyroid and adrenal function. Supplementation of iodine and selenium may improve thyroid function.
  • Following a diet like the Perfect Health Diet may reduce inflammation and improve symptoms.
  • Avoid cinnamon ingestion, chestnuts, preservatives [benzoic acid, sodium metabisulphite, and sorbic acid], oral sodium lauryl sulfate, and spice ingestion to see if that helps reduce symptoms.
  • Proper omega 3 dietary ingestion and/or supplementation may reduce inflammation and improve symptoms.
  • Proper sunlight exposure, circadian rhythm, and sleep hygiene may reduce inflammation and improve symptoms.
  • I recommend supplementation of R-lipoic acid to see if it helps improve burning mouth syndrome symptoms if you do not have any mercury amalgams and are not mercury burdened. Alpha lipoic acid has been shown in studies to improve burning mouth syndrome symptoms. Lipoic acid “acts as an antioxidant and a powerful neuroprotective agent that prevents nerve damage by free radicals, regenerating other antioxidants such as vitamin C and E, able to increase the intracellular levels of glutathione.” I would recommend taking one to two hundred milligrams at breakfast and taking another one to two hundred milligrams at lunch.35
  • Supplementation of one cayenne pepper capsule, three times daily with meals, may reduce burning mouth syndrome pain by activating the TRPV1 receptors. Do not use if you are suffering from reflux and/or have stomach ulcers. “Systemic capsaicin (0.25% capsules, 3 times a day, for 1 month) proves to be effective in reducing pain intensity.”36
  • I generally do not recommend the use of antidepressants, anxiolytics, antipsychotics, and anticonvulsants, for the condition because their results are mixed at best and many can worsen symptoms and cause dry mouth.
  • For some people, histamine intolerance and/or mast cell activation disorder can cause burning mouth syndrome. If you have Th2 or Th17 dominance symptoms and burning mouth syndrome I recommend trying a low histamine diet and taking supplements to reduce and help metabolize histamine including quercetin (do not use if you have a COMT polymorphism) and vitamin C.37 38 39
  • Consider using low-level laser therapy, or red light LED therapy to see if it reduces symptoms and provides relief.40 41 42
  • If you are suffering from anxiety and depression, join a support group, practice cognitive behavioral therapy, talk to a chaplain of your faith, or practice the trauma release exercise to help manage symptoms.
  • Run a proper hormonal test like a DUTCH urine test and determine if a hormonal imbalance is contributing to your burning mouth syndrome symptoms, if you have a hormonal imbalance, correct it(be aware that for some hormonal replacement therapy may cause or worsen the syndrome as well).
  • Finally, contact me for coaching if you need a personal protocol and advice for Burning Mouth Syndrome and any interpretation of the above referenced tests.
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