Various treatments for burning mouth
DEAR DOCTOR: After suffering from a metallic taste in my mouth for two years, I’ve been told by my doctor that I might be suffering from burning mouth syndrome. What can you tell me about this?
DEAR READER: Burning mouth syndrome is a poorly understood chronic condition that leads — just as the name says — to a burning sensation within the mouth. The sensation occurs without any visible changes — no lesions, no redness, just pain. The syndrome is rare in people under 30 and is most prevalent in those ages 60 to 80. Women are more afflicted than men.
The pain is described as a scalding sensation, accompanied by tingling, numbness and a feeling of dryness in the mouth. A bitter or metallic taste is noted in two-thirds of patients. The tongue is the most common area involved, but the pain can occur anywhere in the mouth, including the lips.
It is important to rule out specific causes for the burning sensation in the mouth. Vitamin deficiencies, diabetes, autoimmune conditions and certain types of chemotherapy or radiation can lead to mouth-related nerve damage. Infections, the antidepressant paroxetine and ACE inhibitors used for blood pressure can all cause mouth pain.
Treating the syndrome can be difficult. Topical medications such as capsaicin (from chili peppers), clonazepam, lidocaine and doxepin can deaden the nerve stimuli in the area of pain.
Because of the psychological issues often associated with burning mouth syndrome, cognitive behavioral therapy can be effective in reducing pain, as can antidepressants — SSRIs, SNRIs and tricyclic drugs, like amitriptyline. Drugs used for nerve pain, including gabapentin and pregabalin (Lyrica), may also help.
Unfortunately, burning mouth syndrome can last for months to years, with many people having some degree of symptoms even after five years. So it’s best not to simply hope that it will go away. Severe symptoms warrant the use of a topical medication, alpha-lipoic acid, cognitive behavioral therapy or even oral medications.