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Burning Mouth Syndrome Can Make Life Miserable

Treating the pain of burning mouth syndrome may require ruling out drug reactions and nutritional deficiencies.

Some very painful conditions can be difficult to treat. The diagnosis of burning mouth syndrome implies that any obvious causes of pain have been ruled out. Finding a way to cool the burning sensation is a significant challenge.

Treating Burning Mouth Syndrome Is a Challenge:

Q. I hope you can help with my dilemma. Burning tongue syndrome has plagued me for almost a year.

Because I have worked in the dental profession for over 30 years, I understand that there is no real cure for this diagnosis.

I have tried essential oils, hot sauce and steroid mouthwash to no avail. I love to cook and enjoy food and drink, but now I am at my wits’ end. Are there any remedies you can recommend?

A. Burning mouth syndrome (BMS) has the medical profession puzzled. The lips, tongue or entire mouth may be painful without obvious signs of inflammation. As you stated, there are no clear causes or cures. However, there may be some hints of nutritional deficits.

Nutrition and Burning Mouth Syndrome:

People with BMS are significantly more likely than others to show signs of iron or B-vitamin deficiency (Journal of the Formosan Medical Association, Feb. 2021). At the Mayo Clinic, screening revealed low values or deficiencies in vitamin D, vitamin B2, vitamin B6, zinc, vitamin B12 and folate (International Journal of Dermatology, Sep. 2017). Values for blood glucose and TSH were both frequently elevated, and the authors suggest screening for these factors. We wish we had more to offer, but as you note, this condition is challenging.

The Agony of Burning Mouth Syndrome:

Q. I have burning mouth syndrome. For at least two months, my mouth and tongue have been burning as if I had scalded them.

I’ve seen my dentist, dermatologist and primary care physician. They can find no disease. I tolerate only tepid drinks and bland foods; I brush my teeth with baking soda, as toothpaste burns.

I’ve tried rinsing my mouth with coconut oil, salt water, peroxide rinse and a mouth rinse for dry mouth. Nothing helps. Do you have any remedies?

A. The cause of burning mouth syndrome is frequently a mystery, making it exceptionally hard to treat. In this condition, there are no obvious diseases apparent in the mouth, although the pain can be excruciating. Some experts suspect that it is caused by a disorder of the nerves that serve the mouth, tongue and lips.

Medications That May Be Responsible:

Some medications may trigger this problem. Specifically, reactions to blood pressure pills such as enalapril, eprosartan or lisinopril have been reported in the medical literature.

Deficiencies That Could Lead to Burning Mouth Syndrome:

As mentioned above, low levels of B vitamins (B1, B2, B 6, B12 or folic acid) may also contribute. So could low levels of iron or zinc.

Ask for a blood test to check your status. If any of these nutrients is low, a supplement might help.

Alpha Lipoic Acid?

An objective review of research found that alpha-lipoic acid may also be helpful (Cochrane Library, Jan. 24, 2005). This natural product is sometimes used to ease the pain of diabetic neuropathy, so it makes sense that it might help with other forms of nerve-related pain. We have not seen more recent studies confirming its usefulness, however.

One recent case report claimed significant benefit to a patient through sphenopalatine ganglion nerve block (Brazilian Journal of Anesthesiology, March-April 2023). Doctors sometimes use this technique to treat other recalcitrant painful conditions, including migraine and cluster headache. It is inappropriate for people taking anticoagulant medicines. A single case report is hardly enough evidence to base a recommendation, though.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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