Symptoms of Burning Mouth Disease
Burning mouth syndrome presents with a continuous burning, stinging, or itchy sensation in the oral mucosa—most commonly affecting the tongue tip bilaterally, lips, palate, and buccal mucosa—with completely normal-appearing oral tissue on examination. 1, 2
Primary Oral Symptoms
The hallmark symptom is burning pain that varies from mild to severe intensity, with the following characteristics: 1, 2
- Tongue involvement (most common): Affects the tip and lateral borders bilaterally, with the anterior two-thirds being the primary site 2, 3
- Lips: Burning sensation commonly reported 1, 2
- Palate and buccal mucosa: Frequently involved areas 1, 2
- Pain pattern: Continuous throughout the day, often worsening as the day progresses 1
The critical diagnostic feature is that the oral mucosa appears completely normal on examination despite the patient's symptoms—there are no visible lesions, erythema, or mucosal alterations. 2, 4
Associated Sensory Symptoms
Beyond burning, patients experience both positive and negative sensory disturbances: 5, 4
- Dysgeusia (taste alterations): Persistently altered taste, often described as metallic, or diminished taste sensations 1, 5
- Dysesthesia: Abnormal sensations including tingling or stinging 5, 4
- Paraesthesia: Loss of normal sensation 5
- Food intolerance: Acidic foods (tomatoes, orange juice) and spicy, hot foods cause considerable distress and worsen symptoms 5, 6
Oral Dryness
Dry mouth (xerostomia) is a frequent accompanying symptom, even when objective salivary flow may be normal. 1, 4, 7 This subjective dryness contributes significantly to patient discomfort and quality of life impairment. 1
Psychological and Quality of Life Impact
The syndrome is accompanied by significant psychological burden: 1, 8
- Depression: Commonly present in affected patients 1, 5
- Anxiety: Frequently reported 8
- Poor quality of life: The chronic, unremitting nature of symptoms substantially impacts daily functioning 1
Patient Demographics and Temporal Patterns
This condition predominantly affects peri- and post-menopausal women, with onset typically occurring 3-12 years after menopause. 2, 5 The prevalence increases dramatically with age, reaching 12.2% in women aged 60-69 years compared to essentially zero before age 30. 8
Important Clinical Caveats
The absence of visible mucosal changes is essential for diagnosis—if you observe lesions, erythema, ulceration, or other abnormalities, you must investigate secondary causes before labeling this as primary burning mouth syndrome. 2, 3 The presence of unilateral symptoms, non-healing lesions, or ulceration should prompt consideration of tongue biopsy to rule out malignancy. 3
Neurophysiological testing and tongue biopsies in primary BMS patients reveal significantly lower density of epithelial nerve fibers compared to controls, supporting the neuropathic origin of this disorder. 2, 5