Whole lotta burning going on

Posted by Liz on Feb 18, 2013 in oral health | 0 comments

Pain, burning, tender, tinging, hot, scalding, numb. Does this sound familiar? I suspect that it’s time for a proper update on burning mouth syndrome (BMS), a burning sensation/pain on the tip of the tongue, the lips or other oral mucous membranes. And one of the most troubling aspects of BMS is that most studies suggest that the majority who suffer are middle-aged women in menopause. In fact, the female to male ratio of BMS is a whopping 7 to 1.

According to a review in the International Journal of Preventive Medicine, women with BMS complain that it’s least bothersome upon awakening and then reappears after the first meal of the day. The pain tends to increase with intensity as the day turns into night, and it may interfere with the ability to fall asleep (lord knows many of us already deal with sleep issues due to hormones). BMS can cause irritability, anxiety, depression and no wonder! Mouth pain and burning and tingling..oh my…not to mention taste disruption.

Speaking of hormones (it seems that that’s all we speak about on this blog), many theories abound as to the cause of burning mouth syndrome but none are more intriguing than some fairly recent data that suggest that it is directly related to chronic stress, that, in turn, alters the production of steroids by the adrenals and affects the nerve endings in the skin and tissue and nervous system that also produce steroids. Menopause is the icing on the cake; during menopause, there is a dramatic fall in sex steroids that interact with androgen and estrogen. This turn of events work in concert to create a perfect storm of hormonal cacophony, potentially setting your mouth aflame.

Short of understanding the ‘how’ and ‘why,’ what can you do? Treatment is clearly directed at symptoms. If you experience BMS, you need to see a practitioner for a thorough examination and series of lab tests to rule out other more definitive causes, like diabetes, or vitamin deficiencies. Your health team, a dentist, endocrinologist, dermatologist and naturopath or gynecologist need to work together to help you obtain relief. While topical drugs like clonazepam may help, you may prefer to go the natural route. There is evidence that capsaicin rinse (e.g. hot pepper sauce), mixed with water in a ratio of 2:1 and applied up to three times a day may help reduce pain and burning. Acupuncture may also help; a recent (albeit small) study shows that 20 sessions over 8 weeks significantly reduced oral mouth pain. Another review was more impressive and suggests that either acupuncture or acupressure may be of benefit for BMS. Interestingly, the evidence for alpha-lipoic acid supplement or alpha-lipoic acid plus HRT is very sparse at best; a recent review has rated both strategies as having low quality evidence of their value in alleviating BMS pain. Unfortunately the same is true of cognitive behavioral therapy.

It’s a bit frustrating, isn’t it? Like many nerve-related conditions, there is benefit is trying different strategies to see if one works best for you. Meanwhile, work on the stress aspect of BMS. It may reduce some of that lotta burning.