What are the treatments for tongue and mouth burning?

From the Guidelines

Treatment for tongue and mouth burning should prioritize addressing the underlying cause while managing symptoms, with a focus on topical anaesthetics, antiseptics, and corticosteroids as needed, as recommended by the most recent guidelines 1. When considering treatment options, it's essential to evaluate the severity and potential causes of the burning sensation. For immediate relief, options like viscous lidocaine 2% or cocaine mouthwashes 2%–5% can be used, as suggested in the guidelines for managing Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 1. Some key considerations for treatment include:

• Using an antiseptic oral rinse twice daily to reduce bacterial colonization of the mucosa, with options like 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash 1.
• Applying a topical corticosteroid four times daily, such as betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-min rinse-and-spit preparation, or clobetasol propionate 0.05% mixed in equal amounts with Orabase 1.
• Considering the use of nystatin oral suspension 100,000 units four times daily for 1 week, or miconazole oral gel 5–10 mL held in the mouth after food four times daily for 1 week, if candidal infection is suspected 1. It's also crucial to identify and treat any underlying conditions that may be contributing to the burning sensation, such as dry mouth, oral thrush, or vitamin deficiencies, as these can significantly impact the effectiveness of treatment and overall quality of life. Given the potential complexity of tongue and mouth burning, a comprehensive approach that incorporates both symptomatic relief and addressing underlying causes is likely to yield the best outcomes in terms of morbidity, mortality, and quality of life, as supported by the guidelines for managing Stevens-Johnson syndrome/toxic epidermal necrolysis in children and young people 1.

From the Research

Treatments for Tongue and Mouth Burning

The treatments for tongue and mouth burning, also known as Burning Mouth Syndrome (BMS), are varied and depend on the underlying cause of the condition. Some possible treatments include:

• Medications to suppress neurologic transduction, transmission, and pain signal facilitation 2
• Palliative treatments to provide relief from symptoms, although these may not be much better than a credible placebo treatment 2
• Screening for and treatment of underlying vitamin or mineral deficiencies, such as vitamin D, vitamin B6, zinc, or vitamin B1 3
• Management of systemic diseases, such as diabetes or thyroid disorders, that may be contributing to BMS symptoms 4, 2
• Psychological counseling or therapy to address depression, anxiety, or other emotional factors that may be contributing to BMS symptoms 4, 5

Approaches to Treatment

Different approaches to treatment have been described in the literature, including:

• Local treatments, such as topical anesthetics or oral gels, to provide relief from symptoms 5
• Systemic treatments, such as antidepressants or anti-anxiety medications, to address underlying emotional or psychological factors 4, 2
• Alternative therapies, such as acupuncture or cognitive-behavioral therapy, to provide relief from symptoms and improve quality of life 5

Challenges in Treatment

Despite the various treatment options available, BMS remains a challenging condition to treat, and spontaneous remission of pain has not been definitively demonstrated 2. A thorough examination and differential diagnosis are necessary to establish an effective treatment plan, and continuous symptomatic treatment and follow-up may be necessary to relieve symptoms 6.