What is the most common cause of a burning sensation in the mouth?

Most Common Cause of Burning Sensation in Mouth

Burning Mouth Syndrome (BMS) is the most common cause of a burning sensation in the mouth, particularly in peri- and post-menopausal women, when no dental or medical causes can be identified. 1

Clinical Characteristics of Burning Mouth Syndrome

BMS presents with the following features:

• Location: Most commonly affects the tongue (especially the tip), but can also involve lips, palate, and buccal mucosa 1
• Timing: Continuous in most instances 1
• Quality: Burning, stinging, itchy, sore sensation 1
• Severity: Can range from mild to severe 1
• Associated symptoms:
  • Dry mouth
  • Abnormal taste
  • Often accompanied by depression
  • Poor quality of life 1

Diagnostic Approach

BMS is a diagnosis of exclusion. The following conditions must be ruled out:

1. Secondary causes of BMS:

   • Oral candidiasis
   • Mucosal lesions
   • Hematological disorders
   • Autoimmune disorders
   • Medication side effects 1
   • Dental problems (decay, mobile teeth) 1
   • Nutritional deficiencies (B vitamins, iron, folate) 2
   • Hormonal imbalances 2
   • Gastrointestinal diseases 2

2. Other neuropathic causes of oral burning:

   • Post-herpetic neuralgia
   • Post-traumatic trigeminal pain
   • Atypical odontalgia 1

3. Oral mucosa diseases with visible lesions:

   • Lichen planus 3
   • Herpes zoster
   • Herpes simplex
   • Recurrent oral ulceration 1

Management of Burning Mouth Syndrome

Treatment options include:

1. First-line approaches:

   • Reassurance and education about the condition 1
   • Cognitive behavioral therapy 1
   • Neuropathic pain medications (gabapentin) 4, 5

2. Additional pharmacological options:

   • Benzodiazepines (clonazepam) 5, 6
   • Tricyclic antidepressants 5
   • Alpha-lipoic acid 5, 6
   • Topical capsaicin 6

3. For dry mouth symptoms:

   • Dietary modifications 1
   • Improved hydration and limited caffeine intake 1
   • Topical measures (water sips, saliva substitutes, moisture-preserving rinses) 1, 4
   • Salivary stimulants (sugarless gum, lozenges) 1
   • Systemic sialagogues (cevimeline or pilocarpine) for severe cases 1

Special Considerations

• Menopausal connection: The high incidence in perimenopausal women suggests hormonal factors play a role 2
• Prognosis: Generally poor with only a small number resolving fully; however, patients can be reassured that it will not worsen 1
• Caution with topical anesthetics: Products like lidocaine should be used cautiously as they are not indicated for mucous membranes and can cause serious burns 7
• Multidisciplinary approach: Consider referrals to rheumatology and dentistry for comprehensive management 1

Pitfalls to Avoid

1. Failing to exclude secondary causes before diagnosing primary BMS
2. Overuse of topical anesthetics on oral mucosa
3. Not addressing psychological components (depression, anxiety)
4. Overlooking the impact on quality of life
5. Missing the connection to menopause in middle-aged women
6. Not providing reassurance about the benign nature of the condition

BMS remains a challenging condition to treat, but a systematic approach to diagnosis and management can significantly improve patients' quality of life.