Burning mouth syndrome: symptoms, causes, treatment and what helps

Hull University Teaching Hospitals NHS Trust says treatment should be tailored to your needs and depends on the cause. Possible treatments include adjusting or replacing irritating dentures with your dentist, treating existing disorders such as diabetes, Sjögren's syndrome or a thyroid problem, recommending supplements for nutritional deficiencies, switching medicine where possible if a drug is causing the burning, and prescribing medicines to relieve dry mouth, treat oral candidiasis, help control pain from nerve damage or relieve anxiety and depression.

When no underlying cause can be found, which the trust says is the majority of cases, treatment is aimed at the symptoms to try to reduce the pain. Both Cambridge University Hospitals and Hull say symptoms often improve following reassurance that there is no serious disease present in the mouth, and that burning feelings can be worse at times of stress and go away when life is running more smoothly.

They say that, in the same way that low doses of antidepressants can help people with nerve pain even if they are not depressed, sometimes a low dose of an antidepressant can relieve burning mouth syndrome; the Hull leaflet gives 10 mg of amitriptyline at night as an example. Cambridge says hormone replacement therapy has not been shown to improve symptoms, and neither have vitamins if blood tests are normal. Hull says there is also some evidence for alpha lipoic acid supplements.

Both leaflets say that if you do not get better, trying not to focus on the feeling, learning to live with the sensation and remembering that no serious disease has been found can sometimes be the best way of managing this common problem.

Cambridge University Hospitals says most people with the condition complain of a burning or scalded feeling, and that alteration of taste, often a metallic, salty or unpleasant taste, is commonly associated. It often affects the tongue, lips and cheeks, but other parts of the lining inside the mouth can also feel uncomfortable.

Hull University Teaching Hospitals NHS Trust says moderate to severe burning is the main symptom and can persist for months or years. For many people the burning sensation begins in late morning, builds to a peak by evening and often subsides at night. Some feel constant pain, and for others the pain comes and goes. Other symptoms include tingling or numbness on the tip of the tongue or in the mouth, bitter or metallic changes in taste, and a dry or sore mouth.

• A burning, scalded or sore feeling on the tongue, lips, cheeks or palate.

• Tingling or numbness in the mouth.

• A metallic, bitter or unpleasant taste.

• A dry mouth.

Hull says the sensation of burning in the mouth can occasionally be the result of a range of medical or dental problems: hormonal changes around the menopause, dry mouth (which can be caused by many medicines and by disorders such as Sjögren's syndrome or diabetes), oral candidiasis (a fungal infection in the mouth), acid reflux, poorly fitting dentures or allergies to denture materials, and blood or vitamin deficiencies.

Both leaflets say it can also occur or get worse when someone is stressed, anxious or depressed or going through a difficult time of life, and that not knowing why your mouth is burning can also make you anxious. Hull says sometimes there is no obvious cause and the exact cause cannot always be identified with certainty.

The NHS dry mouth page lists common causes of a dry mouth including dehydration, medicines, breathing through the mouth at night, anxiety, cancer treatment and oral thrush, and says that sometimes a dry mouth that does not go away may be caused by a condition like diabetes or Sjögren's syndrome.

Cambridge University Hospitals describes burning mouth syndrome as a name given to discomfort or pain in the mouth that often affects the tongue, lips and cheeks. It says it is a common condition. It often affects women, particularly after the menopause, but men can sometimes get it too, and up to one in three older women report a burning sensation in their mouth.

Both leaflets say that if you describe a burning sensation in your mouth you will be examined thoroughly to make sure another medical or dental cause is not responsible. Sometimes people worry that they may have mouth cancer, which they note is a common anxiety, and a thorough examination with any necessary tests allows your doctor to reassure you that all is normal.

Hull says a review of your medical history, a thorough oral examination and a general examination may help identify the source of the burning. Tests may include blood tests to look for infection, nutritional deficiencies and disorders associated with burning mouth syndrome such as diabetes or thyroid problems, an oral swab or rinse to check for thrush if necessary, and rarely allergy testing for denture materials, certain foods or other substances.

Cambridge says some blood tests may be arranged to look for a possible cause. Because the diagnosis depends on excluding other causes, it can take more than one visit.

Hull suggests sipping water frequently, sucking on ice chips, avoiding irritating substances such as hot, spicy foods, mouthwashes that contain alcohol and acidic products like citrus fruits and juices, chewing sugar-free gum, and avoiding alcohol and tobacco products.

The NHS dry mouth page adds drinking plenty of cold water, sucking ice cubes or ice lollies, brushing your teeth twice a day with alcohol-free mouthwash, using lip balm if your lips are dry, and asking a pharmacist about gels, sprays, tablets or lozenges to keep your mouth moist. It says not to stop a prescribed medicine without getting medical advice, even if you think it might be causing your symptoms.

Hull says the burning can persist for months or years. Cambridge says it cannot always make you better, and that for some people trying not to focus on the feeling and living with the sensation is the best way of managing it, while for others treating a cause or a low-dose medicine gives relief.

The sources used here do not give a typical duration. If the burning is new, persistent or comes with other symptoms such as sore white patches or a painful, swollen or bleeding mouth, the NHS dry mouth page lists these as reasons to see a GP.

See a GP or dentist if you have a burning sensation in the mouth that does not go away. The NHS dry mouth page says to see a GP if your mouth is still dry after a few weeks of home or pharmacy treatments, your mouth is painful, red, swollen or bleeding, you have sore white patches in your mouth, you are having problems with your sense of taste that do not go away, or you think a prescribed medicine might be causing it.

A dentist can check dentures and teeth for irritation and a GP can arrange blood tests. Both can refer you to a specialist clinic if needed.

On the NHS the usual starting points are a dentist or GP, with referral to an oral medicine or oral and maxillofacial service for persistent symptoms, as the leaflets from hospital oral surgery departments suggest. Treatment can include a low dose of an antidepressant for nerve pain, which is a prescription medicine used off-label.

Private dentists and oral medicine specialists are another route. Whichever you use, ask what tests are proposed, what you are being treated for, and how long a treatment should be tried before it is reviewed.