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Burning Mouth Syndrome

Close up of person touching jaw area with sore spot glowing redBurning mouth syndrome (BMS) is believed to be a type of neuropathy. Neuropathy means that the nerve fibers are not functioning properly. In BMS, this causes the sensation of oral pain, altered taste and tongue functioning even though there isn’t any direct cause.

Symptoms of Burning Mouth Syndrome

Menopause, major life changes, psychiatric disorders, TMJ problems, occlusion problems, chronic fatigue syndrome can be contributing factors. Some patients report insomnia or difficulty staying asleep. Other symptoms include headache, fatigue, irritable bowel syndrome, ears ringing, shoulder pain and burning of skin in other areas.

Types of Pain

Burning mouth syndrome is reported to be caused neurologic, psychogenic or hormonal imbalances. Neurologic problems or pain can be of 3 different types:
•  Type 1: Pain free upon wakening and progressing during the day
•  Type 2: Pain constant day and night
•  Type 3: Pain can come and go - may go days or months without pain.

Neurologic problems are thought to arise from impingement on two of the twelve cranial nerves. The third or trigeminal nerve-branch 2 and 3 and the seventh cranial nerve-the facial nerve-chorda tympani branch. Occlusion and airway can also play a role in BMS.

Types of BMS

Two types of BMS have been described- primary and secondary:
•  Primary BMS: described as pain free after waking up and gradually throughout the day the intensity increases-especially at the endo of the work day.
•  Secondary BMS: associated with vitamin deficiencies, arthritis, and oral infections-thrush for example, thyroid disease, dental treatment and psychologic factors.

Burning mouth syndrome cannot be cured but it can be managed. Medicines, rinses, distraction techniques, diet, occlusion, exercise, and cognitive behavioral therapy can all be used to manage the pain.

Blood Testing

Before any diagnosis is made it is recommended to have the necessary blood work to rule out any underlying untreated medical conditions. Blood testing for burning mouth syndrome could include the following:
•  Iron
•  Vitamin B, C, D, K
•  Zinc
•  Magnesium
•  Selenium
•  Folate
•  Autoimmune panel for: Sjogren's syndrome, Celiac Disease, Irritable Bowel Syndrome
•  Diabetes
•  Hypothyroid
•  Parathyroid
•  Infections
•  Connective Tissue Disease
•  Mouth and Dental Problems or Infections
•  Allergies-contact dermatitis as well as foods, additives and dyes
•  Lyme Disease

Lyme DiseaseLaryngopharyngeal reflux (LPR) may play a role in burning mouth syndrome. You will need to have a pH impedance study that checks both liquid and vaporous reflux-both acid and non-acid reflux.

Managing Burning Mouth Syndrome

Some specialist have recommended rinsing with Tabasco hot sauce. It is thought this may decrease your overall sensitivity to the burning sensation. No research has shown for this to work. Dr. Hart does not recommend this as an option for pain management.

Low-Histamine Diet

Following a low-histamine diet can be helpful as well. Histamine is involved with our body’s immune, digestive and nervous systems. Our body produces histamine but it is also found in many foods. Just like you can be allergic to pollen and grassed and take an antihistamine to manage your itchy eyes and runny nose. To control the effects of histamine and burning mouth syndrome you can do an elimination diet to rule out the foods that can aggravate your mouth.

Foods high in histamine are:
•  Fermented food-yogurt, sour cream, kimchi, pickles
•  Processed food-sausages, salami
•  Alcohol-wine, beer and distilled spirits
•  Tomatoes
•  Mango
•  Pineapple
•  Canned fish-tuna, salmon
•  Vinegar

This diet is very restrictive and hard to stick to for a long time. You can gradually add foods back into your diet and see which ones you can tolerate more than others in an on-going search to manage your burning mouth syndrome. Carbonated drinks can be very painful, too.

Also, evaluation of airway disturbances such as obstructive sleep apnea should be done if the symptoms are present. Prescription medicines such as gabapentin, clonazepam, low dose naltrexone and nortriptyline can be used to manage the pain. Significant side effects can be associated with these medications.

Herbal Remedy

A study in “Current Biology” January 2, 2014 from University of California at Irvine used a Chinese herbal compound to relieve neuropathic pain. Oliver Civelli and his UC Irvine colleagues isolated-dehydrocorybulbine (DHCB) from roots of Corydalis yanhusuo plant. Their study in rodents, DHCB, decreased both inflammatory pain and injury-induced neuropathic pain. DHCB did not generate tolerance as in most conventional pain relievers-such as morphine. Corydalis is a flowering herbal plant that grows in Siberia, Northern China and Japan. People take it to relieve chest and abdominal pain and menstrual cramping. DHCB needs to be evaluated for any toxicity before it can be a drug. While DHCB is not currently available, it is part of the Corydalis yanhusuo root or extract that can be purchased in health stores or online.

Prescriptions and Topicals

Magic mouthwash is used to temporarily numb your mouth. Magic mouthwash is a prescription rinse usually comprised of Viscous lidocaine, Maalox and Benadryl. You can swish and spit or swallow this mixture as often as needed. Usually it’s used right before meals and bedtime to help lower your pain levels.

Tetracaine lollipops can be used as a topical anesthetic to prevent pain. They are made by a compounding pharmacy. The candy base is not sugar (a diabetic can use these) and can be flavored.

Kenalog with Orabase, a prescription, can also be used to manage oral pain. This medicine works fairly well; the effects can last 2- 3 hours. Aloe Vera by Nature’s Nectar can be a soothing rinse. This product can be found at Aldi’s.

Xerostom by Nature’s moisturizer can give relief for dry mouth found in burning mouth syndrome. It is found as a rinse and toothpaste. Amazon has this product. Chewing sugarless gum has found to be helpful, for pain relief.

Cognitive and Neuromuscular Therapy

Hobbies such as gardening, reading, and painting can be excellent ways to distract you from the pain. Exercise is also another way to take the focus away from the pain. Cognitive behavior therapy can be beneficial, too.

Managing occlusion with a neuromuscular orthotic is a successful way to manage the pain. The oral orthotic is used to minimize the perceived pain on the trigeminal and facial nerves. The International Association of Physiologic Aesthetics or The IAPA can provide you with a list of dentists who are trained to provide this type of orthotic. These dentists have studied at the Las Vegas International Global post graduate educational programs. An orthotic is not the same as a mouth guard.

Dr. Faryl Hart truly wants to help you if you think you have these symptoms since she has suffered with BMS for over 1 year. It can be very difficult to diagnose but she realized it after less than two days! Sometimes it can take months for the BMS diagnosis. Her neuromuscular orthotic has totally eliminated her burning mouth syndrome pain.
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