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Dental and Oral Health (Adults)

Burning mouth syndrome

05/29/2007

Question:

My mother-in-law has what I think is called burning mouth syndrome. She is 80 and it started last summer. She had a mild stroke sometime prior to the onset of the symptoms. We don't know the exact date of the stroke. We just noticed that she appeared to be slurring some words and didn`t seem as steady. It took over a month to get an appointment with a neurologist so it was several months later before we found out for sure she had had a stroke. She also had guillain barre in the late 1960`s and has limited mobility of her hands and legs as a result of it. The problem with her mouth began toward the end of last summer. She has been to numerous doctors and no one can find the cause of it or give her a treatment that will work. It is getting worse. Last night I talked to her and I could tell she was very upset because it hurt so bad. It is her gums and lips that are burning. What kind of doctor does she need to see? Thank you!

Answer:

Burning mouth or Burning mouth Syndrome is a very complex and poorly understood problem.

There are many theories on the cause of this disorder that range from trauma or chemical insult to the lingual or trigeminal nerve to hormonal imbalances, viral infections and finally psychologically based causes.

The problem has been described to generally affect post menopausal women, but there are other studies that describe male subjects with BMS. Because of the prevalence of females that are post menopausal, hormonal variances have been implicated, but results are only anecdotal. There are positive associations with the syndrome such as decrease or loss of saliva and changes in taste perception. Certain medications have been associated with BMS such as the ACE class of drugs (Angiotension converting enzyme inhibitors). Fungal infections or increased yeast carriage has been theorized to be responsible, but the increase in fungal carriage may be related to the decrease in salivary flow and not the causative agent.

As mentioned certain drugs can cause oral dryness as can certain autoimmune disease and thus may be causally associated with BMS.

To answer you concerns, she should see a dentist trained on oral medicine and BMS patients. An oral surgeon would be another option for evaluating your mother in law. If that is not a possibility a neurologist would be in order to evaluate the possibility of nerve involvement to the tongue (cranial nerves 5, 7, and 9).

I do not suspect that Guillian Barre syndrome is associated with this occurring, but I would not rule it out, especially if she has been on long term meds for the movement disorder.

Management and treatment for BMS is more palliative than curative. In many cases the problems "burn themselves out"

Many patients complain that symptoms are worse as the day progresses and decrease during the night. Palliative treatments involve fluids for oral dryness, antifungal medications if the fungal load is documented to be high (Note just placing a patient on antifungal drugs because the clinician is suspect of an infection is wrong, fungal carriage should be measured by culture prior to prescribing the drug!).

I forgot to mention that nutritional deficiency may be a probable cause of BMS (B complexes and or zinc deficiencies) and sometimes supplementation may be helpful.

Some instances the use of Tricyclic antidepressants (amitriptyline) or Benzodiazepines (Clonazepam) as a mouth rinse and other medications such as gabapentin (Neurontin) have been used for BMS.

I hope this helps.

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Response by:

Case Western Reserve University Richard J Jurevic, DDS, PhD
Assistant Professor of Biological Sciences
Department of Biological Sciences
School of Dental Medicine
Case Western Reserve University
Richard J Jurevic, DDS, PhD