Q: In the past you answered a question involving BMS. Your advice was correct but could have gone one step further. As a pathologist with dual dentistry and medicine degrees, I am very familiar with BMS. You could have also suggested the patient seek help at a university dental school where there are oral; pathologists and oral medicine specialists who deal with these issues on a daily basis. The patient in question said they had gone to the Mayo Clinic so it sounds like he or she is in the Minnesota area. There is an oral medicine clinic at the University of Minnesota.
I have to add that I read your column every day and find your responses spot-on, both educating patients about their conditions and including the limitations of what we doctors can and cannot do; a very balanced approach. Thank you.
A: Thank you for the compliment and you are correct in that I could have referred the reader to a university dental school for follow-up. I often indicate patients should be seen by physicians in this and other facilities but guess I just have dropped the ball this time.
BMS (burning mouth syndrome) is a complex syndrome in which the tongue, lips, cheeks, roof of the mouth or areas of the entire mouth feel as if they have been scalded. There may be a loss of taste, a metallic taste in the mouth, with increased thirst. Interestingly, the condition may last for months or years and in rare instances, may rapidly dissipate or occur less frequently.
Primary burning mouth syndrome presently doesn’t have a specific cause. It may be related to issues with taste and the central or peripheral nervous system; however, secondary burning mouth syndrome is known to be caused by an underlying medical condition such as having an allergy, gastroesophageal reflux disease, oral thrush, dry mouth from a variety of medications (specifically those prescribed to treat hypertension),diabetes, hypothyroidism, wearing poorly-fitting dentures heart problems, anxiety, depression, or issues with the salivary glands, or even because of a nutritional vitamin B deficiency. The risk of burning mouth syndrome increases if a person has a URI (upper respiratory infection), has had recent dental procedures, is on specific medications, has had a traumatic life event, or is depressed. The condition affects women more than it does men and between 30 and 50% of patients improve spontaneously.
Unfortunately, burning mouth may be a diagnosis of exclusion, meaning there is no one test to provide a definitive diagnosis so several may have to be ruled out. Because of the dry mouth aspect, salivary testing will confirm whether there is a reduction in salivary flow, an oral culture may help zero in on fungal/bacterial/viral infection, and lab work may provide additional information that will help with making the diagnosis. Should the problem continue, an MRI, CT or other imaging tests may help rule out other condition.
Self-help on the home front may improve burning mouth. Alcohol and alcohol-containing products should be avoided because of potential irritation of the lining of the mouth. Spicy foods should be avoided, as should those foods that contain cinnamon and mint. Foods high in acids including orange juice, soft drinks, coffee and tomatoes should be avoided, as should highly spiced foods. Patients should consume more fluids. Lastly, reducing stress should also be attempted.
So readers with burning mouth syndrome, attempt the home remedies recommended and by all means consider making an appointment with a university dental school near you. You’ll be glad you did. And now I’m glad I did (make the recommendation).