Dear Doctor: I’m a 28-year-old woman and have symptoms that lead me to believe I have burning mouth syndrome. It started out being not so bad, but it is now continuous. I haven’t been diagnosed, but I would appreciate any information or help you can offer for this condition.

Dear Reader: Burning mouth syndrome, sometimes shortened to BMS, refers to the presence of specific sensations of pain that occur inside the mouth. These can range from a mild tingling, prickling or numbness to pain that feels like scalding or burning, which give the condition its name. The pain, which is often significant, may be intermittent or constant. In some people, the pain is widespread and involves the entire mouth. In others, it occurs in isolated areas, such as the lips, gums, tongue, insides of the cheeks, the roof of the mouth or the soft palate.

In some cases, these oral sensations are accompanied by dry mouth or noticeable changes to the sense of taste. These often include the presence of bitter or metallic flavors. Some people also find they have increased thirst. Burning mouth syndrome, which often appears quite suddenly, can occur in anyone and at any age. However, it is seen most often in women, as well as in adults over the age of 60.

When there is no obvious cause for burning mouth syndrome, such as an underlying medical condition, a specific medication or ongoing treatment, it’s known as primary burning mouth syndrome. When the syndrome develops as the result of a medical condition or treatment, it’s known as secondary BMS. The causes of primary burning mouth syndrome are not yet understood. However, researchers believe it to be associated with damage to the nerve pathways that play a role in taste and pain in the mouth region.

The causes of secondary BMS can include the hormonal changes associated with perimenopause or menopause, allergies to metals and other products used in dental repair, oral infections, diabetes or acid reflux, or to low levels of certain nutrients, including iron or vitamin B12. The condition can be a side effect of blood pressure meds, and it may arise in people undergoing radiation therapy. The condition has also been linked to hypothyroidism, which is an underactive thyroid gland. It’s possible that hypervigilant oral hygiene, such as the over-use of astringent mouthwash, abrasive toothpaste or dental bleach, can play a role.

There are no targeted tests for the condition. Diagnosis involves a medical history, a physical exam and collecting information that may reveal an underlying medical condition. Patients are also asked detailed questions about lifestyle, diet, medications and environment. Treatment for secondary BMS focuses on the underlying conditions that cause it. For primary BMS, the goal is to ease the existing symptoms. This can include the use of oral rinses, saliva-replacement products, pain relievers, certain antidepressants, anticonvulsants and behavioral therapy.

Patients are also advised to avoid tobacco products and alcohol, as well as spicy, acidic or overly hot food, and to switch to a mild toothpaste. This is a complex condition, and finding the appropriate treatment can take time and patience.

(Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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