You might notice a scalding, intense stinging sensation in your mouth – a deeply unpleasant feeling that, understandably, can start to take a toll on your daily life. If this discomfort persists, you may be experiencing what is medically known as Burning Mouth Syndrome (BMS).
To help us understand the condition better, we spoke with Dr Dídac Sotorra Figuerola, a leading specialist in Oral Medicine and Pathology, shared his expertise on how to identify and manage this persistent condition.
He also specifies who might be more at risk of BMS. “As a general rule, the condition most commonly affects women around the time of the menopause, typically between the ages of 50 and 60,” he reveals.
“That being said, it can occur at almost any age, usually from 30 onwards, and can affect men as well. We’re also seeing a growing trend of younger patients being diagnosed.”
What exactly is Burning Mouth Syndrome?
BMS is a chronic condition characterised by a painful stinging or scalding sensation throughout the mouth. While the disorder isn’t physically dangerous, it is incredibly distressing and can significantly diminish a person’s quality of life.
“Many patients struggle to find a healthcare professional who is able to find a definitive diagnosis and treatment”
It’s becoming an increasingly common diagnosis, with current studies suggesting it affects between 0.1% and 2% of the general population. However, the true figure is likely much higher; the condition is frequently underdiagnosed.
What causes BMS?
Burning Mouth Syndrome is technically classified as a neuropathic pain of unknown origin. Essentially, it’s caused by a dysfunction or dysregulation of the nervous system pathways responsible for transmitting pain and other sensations.
Recent research suggests that this scalding sensation may originate at two distinct levels: there’s the central level, within the dopaminergic pathways of the brain, or the peripheral level, specifically involving small-fibre neuropathy, which affects the nerve endings in the mouth.
How does it manifest, and what are the symptoms?
The primary symptom of Burning Mouth Syndrome is a persistent pain described as a stinging, scalding or “smarting” sensation felt on the oral mucosa (the soft lining of the mouth). When we talk about the mucosa of the oral cavity or mouth, we’re referring to: the tongue, which is typically the most affected area, the palate (the roof of the mouth), the insides of the cheeks, the lips and the gums.
“This is not a psychosomatic condition, despite the fact that it is often mistakenly dismissed as being “all in your mind” by some people, and even by some healthcare professionals”
The pain is usually chronic, and can often go on for several months. Most patients find that the intensity feels more severe in the afternoon than in the morning. Interestingly, the discomfort rarely interferes with sleep, meaning patients are usually able to rest at night without a problem. But in some cases the pain starts from the moment they wake up in the morning.
Beyond the burning sensation, other common symptoms include an alteration or loss of taste and a feeling of constantly having a dry mouth.
© Getty ImagesWhat factors influence its onset?
To date, no single cause has been identified as the direct trigger for BMS but there are several factors that are thought to act as “precipitants” or triggers that can set the process in motion. These include prolonged periods of stress or anxiety, anxiety-depressive disorders, menopause or viral upper respiratory tract infections such as a cold or ear infections (otitis). It can sometimes also be rooted in recent dental treatments, or appear as a side effect of certain medications.
Does it affect a patient’s quality of life?
While Burning Mouth Syndrome isn’t life-threatening, it can be incredibly debilitating. The constant discomfort often leads to a significant decline in a person’s quality of life, frequently causing deep frustration, anxiety and a sense of helplessness.
“BMS is a chronic, long-term painful condition; treatment is complex and usually requires a multidisciplinary approach”
Compounding the issue is the fact that the condition remains widely underdiagnosed. Because many healthcare professionals are unfamiliar with BMS and its management, patients often find themselves on a ‘medical merry-go-round’, visiting specialist after specialist without receiving a clear diagnosis or an effective treatment plan.
Which specialist should you turn to if you believe you have it?
The most qualified professional to diagnose and treat Burning Mouth Syndrome, along with any other non-dental conditions of the mouth, is a specialist in Oral Medicine. It’s the only profession with the in-depth clinical knowledge required to identify and medically manage complex oral diseases [that fall outside the scope of general dentistry].
What is the treatment once diagnosed?
There are several effective therapies that can manage the symptoms, but treatment is never “one size fits all”; it must be tailored to the individual. While there is currently no definitive cure, treatment can significantly reduce or even eliminate pain to improve a patient’s quality of life.
There are various options, such as locally applied desensitising drugs, systemic medications taken orally – such as certain anticonvulsants and psychotropics – which are highly effective at eliminating or reducing the pain.
Photobiostimulation therapy (Low Level Laser Therapy), cognitive behavioural psychological therapy as an adjuvant and transcranial magnetic stimulation can also be very effective.
© Getty ImagesCan it be prevented?
Currently, there are no proven preventative measures to stop Burning Mouth Syndrome from developing. However, it’s highly recommended that you prioritise oral health with a rigorous hygiene routine and regular check-ups with your dentist, adopt a healthy, balanced diet, exercise regularly and manage stress.
About the expert:
Barcelona, Spain-based Dr Dídac Sotorra Figuerola is a member of Top Doctors and the Medical Director of the Dídac Sotorra Institute of Oral Medicine and Pathology.
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