What is the treatment for burning and stabbing pain on the roof of the mouth?

Treatment for Burning and Stabbing Pain on the Roof of the Mouth

For burning and stabbing pain on the roof of the mouth, a combination of topical analgesics, oral rinses, and pain management medications is recommended, with benzydamine hydrochloride oral rinse being a first-line treatment option. 1

Initial Management

• Use alcohol-free sodium bicarbonate containing mouthwash four to six times daily, increasing frequency up to once per hour if needed for symptom relief 1
• Apply topical analgesics such as benzocaine for temporary pain relief of mouth and gum irritations 2
• Use an anti-inflammatory oral rinse or spray containing benzydamine hydrochloride every 3 hours, particularly before eating 1
• Apply white soft paraffin ointment to the lips every 2 hours during acute symptoms 1

Pain Management Options

• For moderate pain, consider topical NSAIDs (e.g., amlexanox 5% oral paste) 1
• When NSAIDs are not tolerated, use acetaminophen (paracetamol) as maintenance therapy 1
• For severe pain, consider anesthetic mouthwashes (viscous lidocaine 2%) 1
• If pain persists, consider systemic analgesics following the WHO pain management ladder 1

For Burning Mouth Syndrome

If symptoms persist and no obvious cause is found, consider treatment for burning mouth syndrome:

• Gabapentin has demonstrated efficacy in reducing burning sensation in 50% of patients 3
• Alpha lipoic acid combined with gabapentin has shown good outcomes in reducing burning sensation 3
• Topical clonazepam has shown modest evidence of potentially decreasing pain/burning 4
• Topical capsaicin (0.02% rinse) can significantly reduce pain/burning levels, though it may cause initial discomfort 5, 6

Addressing Associated Symptoms

• For dry mouth: increase hydration, use sugarless chewing gum or candy, and consider saliva substitutes 1, 3
• For taste disturbances: maintain regular oral hygiene with bland rinses (salt and sodium bicarbonate solution) 3
• Avoid irritating substances that may worsen symptoms:
  • Smoking and alcohol 1
  • Spicy, hot, acidic foods and drinks 1, 3
  • Oral care products containing alcohol or strong flavoring agents 3

When to Consider Additional Evaluation

• If symptoms persist beyond 4-6 weeks despite treatment 3
• If symptoms are accompanied by visible mucosal changes or lesions 7
• If there are signs of infection such as white patches (possible candidiasis) 1

Important Considerations

• Rule out local factors (dental issues, allergies, infections), systemic causes (connective tissue diseases, endocrine disorders), and medication side effects 7
• For refractory cases, evaluate for comorbid depression or anxiety 3
• Consider combination therapy with multiple agents for persistent symptoms 3