Burning Tongue Differential Diagnosis

The differential diagnosis for burning tongue can be organized into the following categories:

• Single Most Likely Diagnosis

  • Burning Mouth Syndrome (BMS): This is the most likely diagnosis, as it is a common condition characterized by a burning sensation in the tongue and other areas of the mouth without any visible signs of oral disease. The exact cause of BMS is often unknown, but it can be related to hormonal changes, nutritional deficiencies, or psychological factors.

• Other Likely Diagnoses

  • Oral Lichen Planus: An autoimmune condition that can cause a burning sensation in the mouth, along with white patches or lacy lesions on the tongue and mucous membranes.
  • Geographic Tongue: A condition characterized by the appearance of single or multiple, well-demarcated areas of erythema (redness) on the tongue, which can cause a burning sensation.
  • Nutritional Deficiencies (e.g., Vitamin B12, Iron, or Folate deficiency): Deficiencies in these vitamins and minerals can cause a range of oral symptoms, including a burning tongue.
  • Dry Mouth (Xerostomia): Reduced saliva production can lead to a burning sensation in the mouth and tongue.
  • Oral Candidiasis (Thrush): A fungal infection that can cause a burning sensation, especially in immunocompromised individuals or those with dentures.

• Do Not Miss Diagnoses

  • Oral Cancer: Although rare, oral cancer can present with a burning sensation in the tongue or other areas of the mouth. It is crucial to rule out this diagnosis, especially in patients with a history of tobacco or alcohol use.
  • Diabetes Mellitus: Uncontrolled diabetes can cause a burning sensation in the mouth and tongue due to high blood sugar levels.
  • Sjögren's Syndrome: An autoimmune disorder that can cause dry mouth and a burning sensation in the tongue and other areas of the mouth.

• Rare Diagnoses

  • Pernicious Anemia: A rare condition caused by a lack of intrinsic factor, leading to vitamin B12 deficiency, which can cause a burning tongue.
  • Erythema Multiforme: A rare skin condition that can affect the mouth and cause a burning sensation, along with other symptoms like ulcers and skin lesions.
  • Sarcoidosis: A rare autoimmune disorder that can cause a range of symptoms, including a burning sensation in the tongue and other areas of the mouth.