Dental Health Dental Health Basics

On the Tip of the Tongue: Explanations for Burning Mouth Syndrome

By Christine Haran

A burning feeling on the tongue or roof of the mouth can usually be traced to a steaming cappuccino, or maybe to hot mozzarella dripping from a slice of fresh pizza. But in some people, particularly postmenopausal women, a debilitating burning sensation in the mouth can develop out of the blue. And then it never leaves.

Burning mouth syndrome was once considered one of the many symptoms "nervous" older women invented for themselves. But new research now suggests that it is linked to taste changes in mouth. Below, Miriam Grushka, DDS, PhD, an associate professor of oral medicine at University of Illinois in Chicago, discusses common causes and treatments for burning mouth syndrome.

What is burning mouth syndrome?
It's defined as a constant burning sensation in the mouth that's usually present in the tongue and often on the palate, but it can be anywhere. It often starts suddenly and then it can continue for months or years. People complain that their mouth feels as though they had been burnt with hot coffee, except it just doesn't go away.

The burning sensation usually gets worse over the day. So it's not too bad in the morning, then it gets worse after the first meal of the day and then it peaks in the late afternoon or by early evening. Once people go to sleep, the pain usually disappears. And then when they wake up in the morning, they feel fine. And the cycle keeps repeating itself.

Are there any other symptoms associated with burning mouth syndrome?
Very commonly, it's associated with a metallic or bitter taste in the mouth that also gets worse over the day. A lot of people complain about dry mouth. But when you look in the mouth and check the flow of saliva it's normal.

These symptoms are often very severe. There have been a lot of studies looking at the psychological impact and if burning mouth syndrome is severe and ongoing, it can cause a lot of depression and anxiety. The pattern of changes is very similar to what's seen in other people who have chronic pain.

How is burning mouth syndrome usually diagnosed?
Until recently, the diagnosis was typically based on the clinical symptoms. It has been a diagnosis of exclusion, so that people were tested to see if they had an oral yeast infection or a vitamin deficiency or diabetes. And if they had none of those changes and their mouth looked normal and they had the typical pattern of burning, they ended up with a diagnosis of burning mouth.

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