Make the Diagnosis: Troubling Tongue Growth

August 2018

Burning tongue syndrome (BMS) has many different alternative names including scalded mouth syndrome, burning lips syndrome, glossodynia, glossopyrosis, stomatodynia, stomatopyrosis, and oral galvanism. Regardless of the name, the condition involves chronic, burning pain in the tongue, gums, lips, and inside of the mouth.

While there aren’t any visible signs or lesions to observe, the very real pain can range from moderate to severe, and some have compared its intensity to that of a toothache.

BMS usually begins without any recognizable trigger, and may last for a few weeks, months, or even years.

Diagnosis is usually a process of ruling out other possible conditions, and treatment varies from lifestyle changes in diet and behavior to the administration of traditional drugs.

Two-thirds of those reporting BMS will have recovered in 6-7 years as constant pain and discomfort becomes more episodic. There is no known prevention for this problem at present.

The most obvious symptom of BMS is an unpleasant to painful burning sensation on the tongue, lips, gums, palate, throat, or even in the whole mouth. It is also possible to have a numbing or tingling sensation in the mouth or on the tip of the tongue.

Interestingly, most patients report that they awake with little or no pain and the intensity increases as the day progresses, peaking by bedtime. They experience little or no pain during the night hours, starting the cycle anew each day. Some report having a very dry mouth and increased thirst. Another symptom may be a loss of taste or a change from normal to a bitter or metallic one that lingers in the mouth. These evidences of BMS may be continuous or periodic.

While the actual causes of BMS have yet to be been clearly established, it seems that the condition can be divided into two general categories. When the outbreak has no identifiable cause, it is treated as “primary” or “idiopathic” BMS. Researchers suspect that there is a dysfunction of the sensory and taste nerve of the peripheral and/or the central nervous systems.

The cranial nerves are also associated with the taste sensations. “Supertasters,” those people with a really high density of the small papillae that contain the taste buds seem to be slightly more prone to BMS, possibly because all those extra taste receptors are surrounded by basket-like clusters of pain neurons that may fire up if the taste buds stop functioning, as often happens during menopause.

Secondary BMS
If an underlying problem is identified and BMS becomes a symptom of the greater illness, the term “secondary” BMS is used. As mentioned previously menopause seems to be a key player in this health issue. As a woman’s estrogen levels drop in pre-menopause, it fades from her saliva as well.

With the loss of function of her bitter taste buds, it would appear that the pain neurons are activated and BMS may be the result. The fact that 40% of menopausal women suffer from this condition that starts about 3 years before menopause and lasts as long as 12 years after, seems to support this theory.

Other Possible Causes

  • Oral candida (yeast infection of mouth)
  • Hormonal deficiencies or abnormalities
  • Diabetes (specifically Type 2)
  • Dry mouth
  • Blood abnormalities (anemia, dyscrasias)
  • Medications (especially those given for high blood pressure)
  • Endocrine disorders (hypothyroidism)
  • Nutritional deficiencies (B vitamins, niacin, folic acid, iron, zinc)
  • Allergies (food, gum, toothpaste, mouthwash)

Risk Factors
Most sufferers of BMS are middle-aged women between the ages of fifty and seventy years. They are seven times more likely to be affected than men, which may support the argument for hormonal imbalance experienced during menopause as the most frequent underlying condition.

There doesn’t appear to be an identifiable trigger, and the onset is usually spontaneous. Approximately 30% of those diagnosed with BMS report recent dental procedures, illnesses, or newly prescribed medications in their history intake.

Other important factors seem to be stress or a traumatic life event, allergic reactions, upper respiratory infections, and excessive taste bud loaded papillae.

Tests and Diagnosis
Because there is no present consensus on the origins or causes of BMS, most doctors will try to diagnose this condition by process of elimination, ruling out all other possibilities.