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Dental and Oral Health (Adults)

Help me please with my Burning Mouth Syndrome

08/05/2008

Question:

I`ve had this problem for over a year and I feel like I`ve tried about everything. I found out what I had by inputting symptoms on the internet. My doctor nor my dentist have ever heard of this. I am 48, menopausal, I do have hypothyroidism, high blood pressure, depression and acid reflux.

I`ve been tested for thrush or fungus in my mouth, I`ve been tested for Sjogrens, we`ve adjusted my blood pressure medication, I`ve tried hormone therapy, it`s not my toothpaste or mouth wash, my acid reflux is under control. I`ve tried taking vitamin B however, it usually seems I end up with too much in my system. I`ve also tried Alpha Lipoid but had an allergic reaction.

The current medications I am on are: Synthroid, Protonix, Cymbalta and Micardis. Through research I realize that medications and hormones can play an important role in this problem.

I`m thinking my problem may be nerves. When I wake up in the morning or take a nap, my mouth feels fine. However, sometimes I`ll find my teeth bumping up and down on each other softly and my tongue gently pushing out between my teeth. I`ve tried to catch myself and correct the problem on my own but sometimes I don`t catch it until it`s too late. I`ve thought about wearing a mouth guard during the day but I am not sure if that will work. What do you recommend?

I`m hoping (actually praying) you can help.

Answer:

Although you never really comment directly as to how the mouth or tongue feels, your description certainly sounds like you may have developed burning mouth syndrome. Additional information about this condition can be found at the links below.

In this condition, the nerves of the mouth may become hyperirritable, and normal, barely-notable sensations (like the tongue rubbing against the teeth) may seem painful or uncomfortable. While pain is the most common symptom, alterations in taste and smell have also been described in affected patients.

Having said this, you describe a habit of pushing your tongue against your teeth that may contribute to your symptoms. It may be a worthwhile investment to have a thin mouthguard constructed by your dentist to reduce or stop the problem with teeth bumping. In turn, this may break the habit of tongue thrusting/pushing and might reduce your symptoms. If they do not improve and you cannot take alpha lipoic acid, the other thing that I recommend for my patients with burning mouth syndrome is a modified form of capsaicin therapy. Capsaicin, the “hot” in hot peppers, has been shown in laboratory animals to reduce the number of nerves close to the skin that carry pain (pain fibers). It (the brand name is Zostrix) has been used to treat people with severe chronic pain of the skin in conditions such as shingles (recurrent varicella zoster virus infection).

While too strong for use in the mouth, a common product found in the grocery store can substitute for this prescription medication. Available in many brands, select any hot pepper sauce (I usually suggest a red chili pepper sauce since they are very common in the US). Dilute 3-5 drops of hot sauce in a teaspoon of water. Swish this mixture in the mouth for 45 seconds and expectorate. If too hot, reduce the hot sauce. If hardly noticeable, you can increase the amount of hot sauce relative to the water. Use after meals and right before going to bed. Since the dose is quite mild (relatively), changes in the sensations within the mouth will be slow. Most of my patients report that at around the 10-14 day mark, they feel improvement in their symptoms. Continue to use as needed.

This is not a cure but often gives a sense of control back to patients who, like yourself, have not previously been able to improve their symptoms. It also has the advantages of being inexpensive, having no drug interactions and virtually no other complication besides a transient “hot” feeling inside the mouth.

Good luck!

Related Resources:

Burning Mouth Syndrome
American Academy of Oral & Maxillofacial (AAOMP)

For more information:

Go to the Dental and Oral Health (Adults) health topic, where you can:

Response by:

John R Kalmar, DMD, PhD John R Kalmar, DMD, PhD
Clinical Professor of Pathology
College of Dentistry
The Ohio State University