oral health

Whole lotta burning going on

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

flamy symbolPain, 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.


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Wednesday Bubble: bisphosphonates…enough to make your jaw drop

Posted by on Jun 2, 2010 in bone health, oral health | 0 comments


Are you being treated for osteoporosis? Has your doctor told you about a rare but extremely serious side effect of drugs known as bisphosphonates that causes the jaw bone to collapse?

Osteonecrosis is a disease that occurs when the blood supply to bone is cut off. This results can result in pain, limited range of motion and an eventual collapse of the bone in the affected area. According to the American Dental Association, reports of jaw osteonecrosis among very small numbers of patients taking Fosamax for osteoporosis started to emerge in 2003.  At higher risk were cancer patients who were receiving intravenous bisphosphonate therapy as part of their treatment. In the majority of patients, osteonecrosis developed after dental surgery.

As I’ve written previously, osteoporosis and low bone mineral density are well-known issues for menopausal women. Studies have shown that after age 35, women (and men) start to lose their bone density at a rate of 0.3% to 0.5% a year.  However, as estrogen levels decline through menopause, the rate of bone density loss accelerates. In fact, during the first five years after menopause, women can experience as much as a 30% loss of bone density. What’s more, experts estimate that by the time a woman reaches the age of 50, she has a 40% risk of suffering a fracture due to osteoporosis for the rest of her lifetime.

Bisphosphonates are frequently prescribed as an alternative to estrogen therapy for preserving bone mass during menopause. Although less than 1% of jaw osteonecrosis have been reported in patients taking oral bisphosphonates, recent research suggests that the majority don’t know about possible side effects. In fact, in this particular study of 71 women and 2 men, 82% said they couldn’t recall or were unsure if their physicians had told them about jaw osteonecrosis.

What you need to know

Taking care of your mouth is essential at any age but particularly during menopause. During the transition, women are especially at risk for altered taste and burning mouth syndrome. Additionally, we are learning that the drugs that we take to prevent loss may actually cause bone death in some women.

The American Dental Association recommends that patients inform their dentist and hygienist that they are taking bisphosphonates to prevent osteoporosis so that extra precaution can be taken before any routine or major dental procedures. if you start to experience the following signs and symptoms while taking bisphosphonates, call your doctor and dentist immediately:

  • pain, swelling
  • gum or jaw infection
  • gums that don’t heal
  • loose teeth
  • jaw heaviness or numbness
  • impaired range of motion
  • exposed bone

Undoubtedly, the benefits of bisphosphonate therapy definitely outweigh the risks. Still, it is unclear whether or not bisphosphonates will ultimately prove to be as risky as HRT, as there have also been reports of  hip fractures in a very small amount of women taking these drugs for five years or more.

Unfortunately, there are few medicinal alternatives available in the United States, although a new drug Prolia, was approved for treatment of osteoporosis just yesterday. I don’t know much about Prolia, other than it is an agent that has been widely used in treating cancer patients. However, there are some early indications that Prolia might also cause jaw osteonecrosis. Only time will tell.

Meanwhile, I can’t emphasize enough that physical activity and ample calcium and vitamin D intake are essential. The risk of doing nothing now? Enough to make your draw drop…literally.

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