OVERVIEW

What is Burning Mouth Syndrome?

Burning Mouth Syndrome (BMS) is a common oral mucosal disorder characterized by a burning or scalding sensation in the mouth, as if the mouth has been burned by hot food. The burning sensation most commonly occurs on the tip or sides of the tongue and is also referred to as glossodynia, tongue paresthesia, or oral mucosal paresthesia. It is often not accompanied by obvious clinical signs of damage. Specialized oral examinations usually show no abnormalities.

Is Burning Mouth Syndrome Common?

Yes, it is common, with a higher incidence among women during or around menopause. Female patients significantly outnumber male patients.

Is Burning Mouth Syndrome the Same as Amyloidosis of the Tongue?

No, they are different. Amyloidosis of the tongue is an early manifestation of amyloid deposition. Amyloidosis is a rare syndrome involving multiple organs throughout the body caused by protein metabolism disorders. Its etiology is unclear, and in many cases, it is a secondary manifestation of underlying diseases. It is more common in adolescents and middle-aged individuals, initially presenting as progressive macroglossia, leading to slurred speech and even difficulties in eating and swallowing. In advanced stages, it can cause difficulty in closing the lips, severely affecting physiological functions such as chewing, speech, and swallowing.

Can Burning Mouth Syndrome Become Cancerous or Contagious?

Burning Mouth Syndrome is typically a chronic condition that can persist for years or even decades. However, current research, both domestic and international, has found no evidence that this condition can develop into malignancy. Additionally, it is not contagious, so there is no need to have a "fear of cancer."

SYMPTOMS

What are the common manifestations of burning mouth syndrome?

• Common symptoms: The main symptom is a burning pain in the tongue, but patients may also experience numbness, tingling, dull taste, or discomfort.

• Pain location: Most often occurs at the tip of the tongue, followed by the edges, back, and root. Other areas like the cheeks, palate, or throat may also be affected. Single-site involvement is more common, but multiple areas can be affected.

• Duration: The course varies, but most patients experience prolonged symptoms that gradually worsen, lasting months or years without remission. A few patients may have a sudden onset.

• Associated symptoms: Clinical examinations are usually normal, but patients may report subjective symptoms like dry mouth or reduced taste sensation.

• Systemic symptoms: Aside from conditions like diabetes, anemia, menopause syndrome, or cerebrovascular diseases, patients may experience insomnia, headaches, fatigue, hot flashes, irritability, sweating, poor concentration, reduced libido, or vaginal burning. Many also report anxiety, depression, or excessive worry.

What conditions should burning mouth syndrome be differentiated from?

Burning mouth syndrome should be distinguished from tongue ulcers, tongue cancer, tongue amyloidosis, trigeminal neuralgia, and lingual papillitis. These conditions typically present with clear clinical signs that match their symptoms.

CAUSES

What Causes Burning Mouth Syndrome?

The etiology of burning mouth syndrome is complex, and there is currently no unified academic consensus. However, psychological factors play a prominent role.

• Local Factors: Such as dental calculus, residual roots or crowns, poorly fitted dentures, allergies to dental materials, oral filling materials, or medications, post-surgical scar irritation in the oral cavity, excessive alcohol consumption, heavy smoking, long-term chewing of gum containing high levels of peppermint oil, and other physical or chemical irritants. Other local pathological factors include impaired tongue microcirculation, changes in saliva composition, microcurrent formation in the mouth due to metal restorations, frequent tongue protrusion for self-examination, and pain caused by tongue muscle tension or strain from overuse. Additionally, it may be related to local bacterial or fungal infections.

• Systemic Factors:

  • Menopausal syndrome;

  • Systemic diseases: Approximately 35% of burning mouth syndrome patients exhibit abnormal glucose tolerance curves, while others may have thyroid dysfunction, immune disorders, or hormonal imbalances.

• Psychological Factors:

  • Personality traits: Many patients with burning mouth syndrome exhibit anxious, depressive, or emotionally unstable personalities.

  • Cancerophobia: Reports indicate that over 75% of patients worry about having cancer, and 80% seek multiple medical consultations. About 17% of patients have family members with tongue cancer, while 37% frequently self-examine after noticing the bumpy foliate or circumvallate papillae at the base of the tongue, leading to a vicious cycle of "self-examination—panic—further self-examination—increased panic—worsening tongue pain."

• Neurological Disorders: The interaction mechanism between taste and pain in the central nervous system suggests that pathological changes may occur in burning mouth syndrome patients at the level of the chorda tympani and glossopharyngeal nerves.

DIAGNOSIS

How is burning mouth syndrome diagnosed?

There is currently no unified diagnostic standard, making diagnosis somewhat challenging.

• A diagnosis can generally be made based on burning pain in the tongue or other oral areas, abnormal sensations, and the characteristic mismatch between clinical symptoms and signs.

• However, all other possible organic conditions, such as trigeminal neuralgia, tongue cancer, tongue ulcers, and tongue amyloidosis, must first be ruled out.

What tests are needed for patients with burning mouth syndrome? Why are these tests necessary?

Due to the unique diagnostic challenges and complex etiology of this condition, there are no specific laboratory markers or pathological findings. However, laboratory tests are required to exclude systemic diseases. Local examinations should focus on dental conditions, residual roots or crowns, and salivary gland function. Tests such as blood glucose and sex hormone levels may also help identify systemic contributing factors.

TREATMENT

Which department should I visit for burning mouth syndrome?

Oral mucosal diseases department, ENT department, or psychiatry/psychology department.

Does burning mouth syndrome require hospitalization?

Usually not.

How is burning mouth syndrome treated?

There is no specific and highly effective treatment for burning mouth syndrome, but the role of psychological therapy should not be overlooked:

• Etiological treatment: Eliminate local contributing factors and discontinue suspected medications.

  • Correct the patient's habit of frequently checking their tongue and actively treat systemic diseases such as diabetes;

  • For patients with obvious menopausal symptoms and no contraindications, diethylstilbestrol 0.25 mg/day may be tried. After symptoms improve, reduce the dose to 0.125 mg/day. Take continuously for 21 days, then stop for 7 days. This cycle can be repeated for up to three months, avoiding long-term high-dose use;

  • For vitamin deficiencies or poor nutritional status, supplement with B-complex vitamins and vitamin E.

• Symptomatic treatment: Patients with insomnia, depression, or other psychiatric symptoms may take anti-anxiety medications, antipsychotics, antiepileptics, or analgesics.

• Psychological therapy: Also known as psychotherapy, it applies psychological principles and techniques to influence patients through verbal or non-verbal communication, aiming to improve their mental state and behavior, thereby alleviating symptoms and enhancing treatment outcomes.

What is the treatment outcome for patients with burning mouth syndrome?

Although burning mouth syndrome cannot be completely cured in the short term, studies show that over half of patients experience gradual improvement in oral symptoms within 6–7 years, and about 1/5 of patients may recover spontaneously.

DIET & LIFESTYLE

What should patients with burning mouth syndrome pay attention to in their diet?

Maintain a healthy, regular, and balanced diet, consume foods rich in vitamins, and minimize spicy or irritating foods.

What should patients with burning mouth syndrome pay attention to in daily life?

• Undergo psychological counseling to eliminate cancer-related anxiety;

• Correct the bad habit of frequently checking the tongue by sticking it out;

• Maintain oral hygiene, rinse the mouth after meals, and clean dentures regularly to keep them hygienic;

• Engage in regular physical exercise to improve the body's resistance.

PREVENTION

Can Burning Mouth Syndrome Be Prevented?

Burning mouth syndrome occurs due to a combination of multiple factors, so preventing the influencing factors mentioned above can reduce its likelihood. Particularly concerning psychological factors, if one finds themselves mentally distressed and unable to self-adjust, psychotherapy can be sought. Cognitive therapy, a rapidly developing psychological treatment in recent years, is based on the theory that cognitive processes influence behavior and emotions. Through cognitive and behavioral intervention techniques, it aims to modify irrational thoughts and perceptions, thereby addressing negative emotions and maladaptive behaviors. This approach helps overcome psychological barriers and promotes mental and physical well-being.