By Imelda Gott
Retired police officer James Maddox noticed a metallic taste in his mouth in 1999 after extensive dental work. Soon, the metallic taste vanished, but he was left with a constant burning. Since then, he has seen dentists, neurosurgeons and oral pathologists to find a way to put out the fire.
Three percent of the population endures Burning Mouth Syndrome (BMS), a condition that is poorly understood but is exacerbated by certain diseases like Sjögren’s (pronounced SHOW-grins) Syndrome and other medical problems.
BMS is a chronic condition of the nerves that may last for years. Of those sufferers, 25 percent have a taste disorder. Fourteen percent of post-menopausal women experience BMS. And, although estrogen deficiency may trigger the problem, (which doesn’t improve with replacement hormones) men are not immune. In addition, there is some evidence that this nerve pain has an autoimmune origin.
Almost everyone has experienced unusual feelings in the mouth: dryness, rough areas, heat sensation or a metallic taste. The causes may be from stress, inadequate hydration, fever, spicy foods, upset stomach or medication. This may be uncomfortable, but it usually goes away about the time you make a dental appointment for it. BMS does not disappear so quietly or quickly. In fact, it usually lasts for years unless a specific cause can be identified and treated.
Dry mouth itself brings a slew of customers to a dentist's or doctor's office. More than 200 medications actually cause dry mouth. It also can be caused by diseases, in particular, Sjögren’s Syndrome,? explains Catherine M. Flaitz, DDS, MS, formerly a professor at The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry. Sjögren’s is an autoimmune disorder, in which white blood cells attack the moisture-producing glands. Signature symptoms are dry eyes and dry mouth, but it is a systemic disease that can affect multiple organs. Up to 4 million Americans have Sjögren’s. Although the cause remains elusive in most individuals, sometimes, says Flaitz, Sjögren’s is the trigger for BMS.
Plenty of other triggers exist, too, Flaitz says. “I have had adolescent and young adult patients who have developed BMS. Usually, it coincides with a recent severe cold or flu, trauma to the mouth or contact allergy. The initiating factors seem to be different in the accelerating age groups. It can be associated with systemic diseases. Low-functioning thyroid, diabetes, some forms of anemia, nutritional problems, autoimmune diseases and yeast infection in the mouth also can play a part.”
Flaitz adds that it can be associated with Parkinson’s and certain stomach problems, such as reflux disease that causes chronic irritation of the throat and esophagus.
Why the scalding pain?
“My patients compare it to the feeling of scalding coffee, pizza burn or fire ants in the mouth,” Flaitz says. “The most confounding aspect of BMS is that there are no obvious visual clues to the lining of mouth. For this reason, it doesn’t garner the attention it deserves by many health care providers. Like many chronic pain conditions, it can continue indefinitely and take a real toll on emotional health for those affected. Although it’s not a serious problem in itself, it certainly can become an issue of quality of life.”
Flaitz suggests that people who experience this problem first seek help from a dentist to check out the obvious culprits. “Ordinarily, a health care professional would be able to look in your mouth and see that something isn’t right. There might be shaggy white patches, or a little bit of redness,”? Flaitz says. “BMS is the result of nerve damage that changes one’s perceptions of taste, temperature, touch and moisture, but it can’t be visually identified.”
Local causes might include:
- allergies to toothpaste or mouth rinse
- yeast infection
- chewing gum, primarily cinnamon flavor
- referred pain? from problems with the teeth
- muscle tenderness from habitual clenching
- jagged teeth rubbing against sensitive areas.
Putting out the fire
If BMS is not due to one of the local factors, Flaitz believes in the simple approach:
- Brush with bland, nonfoaming toothpaste formulated specifically for dry mouth conditions.
- Chew sugarless gum or candy, which will not promote tooth decay. It serves as a distraction and stimulates the nerves that produce saliva.
- Take a multivitamin with B-complex daily.
- Take alpha lipoic acid supplements three times daily for a couple of months.
- Sip on cold water or suck on crushed ice to help restore moisture and numb the mouth.
- sooth lips with nonmedicated and unflavored lip moisturizers
- Do regular exercise for overall improved health and well-being.
- Keep a diary and avoid foods and beverages that trigger the sensation.
Flaitz said simply changing the flavor of gum or candy may be helpful to some patients, while others find the taste only increases bitterness. If these tactics fail, then antidepressant medications at low doses may be helpful to reduce the anxiety or preoccupation with the sensation.
If the mouth is dry, taking medications to stimulate the salivary glands can be beneficial. It usually takes a couple of months before these medications become effective,” she says. “Many people continue to experience some oral tenderness despite the various treatment approaches but the goal is to give them more control in managing the problem.”
It’s not cancer
Many people with BMS fear they have cancer, because they’ve heard that if you’re in constant pain that doesn’t go away, that’s a sign of serious illness, like cancer. Flaitz explains why BMS feels different: With cancer, you don’t have pain in the entire mouth, as you do with BMS. You can have cancer metastasize and move to the mouth. The tumor cells can wrap around nerves in the beginning, causing a more severe type of pain that is localized to one side. Then the mouth gets numb.?
Maddox recalls that every now and then, the burning will completely disappear. The first time it happened, it was the first interruption of pain in four years. He thought he was over BMS. It returned the next day. His neurologist told him that BMS showed up one day without warning, and it might just go away the same way. He says he hopes she’s right.
That other weird sting & stab
It may be occasional, but if you’ve ever experienced a sudden flash of intense pain like a pin stabbing you under your tongue, you’d remember it.
Flaitz says this is caused by a blockage or rapid production of fluids from the salivary glands under the tongue. Sour or acidic foods and beverages are most likely to trigger this response.
If you have discomfort with eating and the floor of the mouth becomes swollen, most likely you have a plugged duct that is not allowing the thick saliva to escape. No treatment is necessary in most cases, because the pain quickly goes away. If the pain lingers, frequently recurs or if the floor of the mouth becomes enlarged, then your dentist can help identify the problem.
If there is a blockage or stone in the duct of the gland, you will usually need to be treated by an oral and maxillofacial surgeon or an otolaryngologist (ear, nose and throat specialist).
This article, which has been updated, originally appeared on HealthLEADER, an online wellness magazine produced by The University of Texas Health Science Center at Houston (UTHealth). Visit HealthLEADER for more articles on a broad array of health and wellness topics.