Burning Mouth Syndrome (BMS)

What is burning mouth syndrome (BMS) ?

Burning mouth syndrome is a condition that causes pain and discomfort in your mouth, lips, and/or tongue. BMS is more common in women than men. It is found more in women during or post menopause.

Patients with this disorder present with either burning or hypersensitivity of the tongue.

Others may have burning of the palate, gingiva, cheek, i.e., the soft tissues of the oral cavity.

The most common presentation is burning and hypersensitivity of the tongue. The tongue may become smooth from atrophy of the papillae and taste may be affected. Patients often present to a dentist.

Oral candidiasis, vitamin deficiencies, or chronic gingivitis must be ruled out. Typically, these diagnoses are excluded readily.

Burning mouth syndrome is an infrequent but serious cause of oral pain.

Although mouth pain has many causes with readily demonstrable pathological conditions, such as herpes simplex infections and aphthous ulcers, burning mouth syndrome is the diagnosis given to patients who complain of mouth and tongue pain in the presence of a completely normal physical examination.

Therefore burning mouth syndrome is by definition a diagnosis of exclusion.

Included in the diagnosis of burning mouth syndrome are the clinical syndromes of burning tongue syndrome, glossalgia, glossodynia, stomatodynia, and oral dysesthesia syndrome. Affecting females 7 to 8 times more frequently than men, burning mouth syndrome is a disease of the fifth decade and beyond.

The pain of burning mouth syndrome is characterized as a burning, hot, or scalded sensation of the mouth and tongue that may be accompanied by tingling.

Most commonly the anterior two-thirds of the tongue, palate, gingiva of the upper and lower alveolar region, and lips are involved, with the sublingual region less commonly affected.

The exact pathophysiology responsible for burning mouth syndrome remains elusive, and the putative causes in most cases are multifactorial.

Underlying nutritional disorders, psychiatric illness, allergic stomatitis, xerostomia, diabetes mellitus, menopause, and other endocrinopathies are often identified in patients with burning mouth syndrome, even though the oral examination is completely negative.

Magnetic resonance imaging (MRI) and functional MRI has identified altered structure and function of the hippocampus and medial prefrontal cortex in some patients with burning mouth syndrome.

Symptoms of burning mouth syndrome

People who have BMS usually report that symptoms happen all of a sudden. Typical symptoms include:

  • burning feeling in the mouth, tongue, and/or lips
  • increased pain during the day, and decreased or no pain at night
  • decreased pain after eating
  • dry mouth
  • bitter or metallic taste.

The hallmark of burning mouth syndrome is mouth and tongue burning pain in the absence of clinically demonstrable oral pathology. Depressive affect or a phobic preoccupation with occult cancer is often present, as is xerostomia.

The classic oral findings of nutritional deficiencies such as iron and zinc deficiency, pernicious anemia, and vitamin B complex deficiency may be absent in patients with burning mouth syndrome and must be confirmed with appropriate laboratory testing.

The clinician should observe the patient closely for abnormal tongue and mouth movements, such as bruxism, tongue thrusting, and repetitive running of the tongue against the teeth, because these are suggestive of behavioral abnormalities that may contribute to the patient’s pain symptomatology

What causes burning mouth syndrome?

There are no apparent causes for burning mouth syndrome. Cases have been linked to actions, such as:

  • nerve damage
  • a dental procedure
  • nutritional deficiency
  • menopause, or other hormonal changes
  • certain medicines, such as ACE inhibitors that are used to treat heart disease
  • extreme allergic reactions
  • health conditions that alter taste or saliva production
  • a mucosal disease
  • mental disorders.

How is burning mouth syndrome diagnosed?

There is no simple way to test for BMS. Your doctor will examine your mouth and ask about your medical history and symptoms. This will help better pinpoint a possible cause. They may perform tests to rule out other possible issues.

No specific test exists for burning mouth syndrome, and a presumptive diagnosis can be made only if (1) the clinical examination is normal and (2) a workup for all underlying pathological findings fails to identify a specific cause for the patient’s pain symptomatology.

A suggested workup based on the experience at the Mayo Clinic is outlined in the below table and should always include laboratory testing for vitamin deficiencies and diabetes and a culture for Candida infection.

Workup of Burning Mouth Syndrome

From Drage LA, Rogers RSR III. Burning mouth syndrome. Dermatol Clin . 2003;21:135–145.

Thorough history and review of symptoms
Medications causing xerostomia
Dental or denture work
Oral care, oral products
Oral habits or parafunctional behavior
History of depression, anxiety, cancerphobia
Family history of oral cancer, psychiatric diagnoses, and connective tissue disease
Oral examination
Erythema, candidiasis, xerostomia, or other mucosal abnormalities
Tongue disorders, such as a geographic, fissured, or atrophic tongue
Dental work or dentures
Laboratory tests
Complete blood count
Iron, total iron binding capacity, iron saturation, ferreting
Vitamin B 12 , folate, zinc
Glucose, glycosylated hemoglobin
Culture for Candida
Patch testing
Include standard series, metal series, oral flavors, and preservatives
Further consultation if indicated by history and review of systems
Psychometric testing and psychiatric consultation

Differential Diagnosis

Myriad causes of burning mouth and tongue pain have been identified, many of which are readily treatable. It is therefore imperative that the clinician faced with a patient with burning mouth and tongue pain obtain an extremely thorough history and perform an oral examination with these diseases in mind.

It should be kept in mind that more often than not the patient with burning mouth syndrome has more than one pathological condition contributing to the pain, and the possibility of multiple diagnosis should always be considered.

Causes of Burning Mouth and Tongue Pain

From Drage LA, Rogers RSR III. Burning mouth syndrome. Dermatol Clin. 2003;21:135–145.

SystemicLocalPsychogenic, Psychiatric, and Idiopathic
DeficienciesDenture factorsPsychiatric
IronDental workDepression
Vitamin B 12MechanicalAnxiety
FolateOral habit or parafunctional behaviorObsessive-compulsive disorder
ZincClenchingSomatoform disorder
B complex vitaminsBruxismCancerphobia
EndocrineTongue thrustingPsychosocial stressors
Diabetes mellitusMyofascial pain
HypothyroidismAllergic contact stomatitis
Menopause or hormonalDental restoration or denture materials
XerostomiaPreservative, additives, flavorings
Connective tissue diseaseNeurologic
Sjögren syndromeReferred from tonsils or teeth
Sicca syndromeLingual nerve neuropathy
Drug relatedGlossopharyngeal neuropathy
Anxiety or stressAcoustic neuroma
Angiotensin-converting enzyme inhibitorCandidiasis
Esophageal refluxAntibiotic related
AnemiaDenture related
Local trauma
Diabetes mellitus
Local disease

How is this treated?

The successful treatment of burning mouth syndrome requires the clinician to endeavor to identify the underlying pathology responsible for the patient’s pain.

There isn’t a specific cure for burning mouth syndrome. The best thing you can do is address your symptoms. Treatment is based on your symptoms and severity. Possible treatment options include:

  • products to produce saliva and relieve dry mouth
  • vitamin supplements, such as iron, zinc, or vitamin B, to provide nutrition
  • ointments, such as Capsaicin, to relieve pain
  • depression or anxiety medicines to relieve pain and improve your nervous system.

If your doctor thinks a certain medicine is causing BMS, they might suggest switching to a new one.

All underlying medical conditions (e.g., diabetes, deficiency syndromes) must be treated, along with the removal of any local irritants such as mouth washes, spicy foods, and cinnamon and mint products.

Providing the patient with a supportive and positive emotional environment and reassurance that cancer is not the cause of the pain is paramount if symptom relief is to be achieved.

Coexistent behavioral and psychiatric abnormalities also must be addressed in a positive therapeutic milieu. Empirical treatments, including anticandidal agents, vitamin B complex supplementation, and low-dose antidepressants, are also worthy of consideration.

Treatment often involves some combination of elimination of any local irritants, treatment of underlying medical conditions, pharmacological therapy, and behavioral therapy.

First, any nidus of tissue trauma that is contributing to the ongoing sympathetic dysfunction responsible for the symptoms must be identified and removed. Second, interruption of the sympathetic innervation of the face by stellate ganglion block with local anesthetic must be implemented.

This may require daily stellate ganglion block for a considerable period. Occupational therapy consisting of tactile desensitization of the affected mucosa also may be of value.

Underlying depression and sleep disturbance are best treated with a tricyclic antidepressant such as nortriptyline, given as a single 25-mg dose at bedtime.

Gabapentin may help palliate any neuritic pain component and is best started slowly with a single bedtime dose of 300 mg, titrating the dosage upward in divided doses to a maximum dose of 3600 mg per day. Pregabalin is a reasonable alternative to gabapentin and is better tolerated in some patients.

Pregabalin is started at 50 mg three times per day and may be titrated upward to 100 mg three times per day as disease effects allow. Pregabalin is excreted primarily by the kidneys, and the dosage should be decreased in patients with compromised renal function.

Opioid analgesics and benzodiazepines should be avoided to prevent iatrogenic chemical dependence.

Can burning mouth syndrome be prevented?

Since there isn’t a known cause for BMS, you cannot prevent or avoid it.

There isn’t a specific cure for burning mouth syndrome. The best thing you can do is address your symptoms. Treatment is based on your symptoms and severity. Possible treatment options include:

  • products to produce saliva and relieve dry mouth
  • vitamin supplements, such as iron, zinc, or vitamin B, to provide nutrition
  • ointments, such as Capsaicin, to relieve pain
  • depression or anxiety medicines to relieve pain and improve your nervous system.

If your doctor thinks a certain medicine is causing BMS, they might suggest switching to a new one.


The main complications surrounding the treatment of burning mouth syndrome are those associated with its misdiagnosis. Chemical dependence, depression, and multiple failed therapeutic procedures are the rule rather than the exception.

A diagnosis of a psychiatric basis for the patient’s pain should be made only after all somatic causes of burning mouth syndrome have carefully been ruled out.

Clinical Pearls

The key to diagnosing burning mouth syndrome is a high index of clinical suspicion. Once causes of burning mouth and tongue that have clinically identifiable pathological processes have been ruled out, a rational treatment plan addressing the often multifactorial nature of the patient’s pain can be initiated.

A supportive therapeutic environment is crucial if symptom reduction is to be achieved.

Living with burning mouth syndrome

Most cases of BMS improve on their own. Additional tips for easing your symptoms, include:

  • sucking on ice chips
  • drinking plenty of liquids
  • avoiding hot and spicy foods
  • avoiding foods and drinks that are high in acid, like citrus fruit, soda, and coffee
  • avoiding alcohol and tobacco products
  • avoiding products that contain alcohol
  • trying a new brand of toothpaste.

Questions to ask your doctor

  • If I have dry mouth, am I at higher risk of getting burning mouth syndrome?
  • What can I do to get rid of the taste and burning feeling in my mouth?
  • What can I do if I’m having trouble sleeping because of the pain?
  • Is something I’m eating causing my mouth to burn? If so, what changes can I make to my diet?
  • Will burning mouth syndrome go away on its own?


American Academy of Family Physicians, Burning Mouth Syndrome  


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