Is it Burning Mouth Syndrome?
DEAR MAYO CLINIC: I haven't been able to find out much information on burning mouth syndrome, which I've had for the past four years. I take alpha lipoic acid but haven't had any relief. Are there any ongoing studies on this or recent findings?

ANSWER: Burning mouth syndrome is a complex chronic pain disorder, and ongoing research is examining the condition. But if you've had this for four years without relief, I'd recommend that -- before you try new treatments -- you get a thorough evaluation from a physician who is familiar with burning mouth syndrome. It's important to rule out underlying medical conditions that could be contributing to your symptoms. Then, if the condition truly is burning mouth syndrome, a wide variety of treatment options are available, including self-care steps that may reduce discomfort.

Symptoms of burning mouth syndrome can include a burning sensation that affects the tongue, lips, gums, palate, throat or the entire mouth; a tingling or numb sensation in the mouth; dry mouth; increased thirst; decreased taste; and taste changes, such as a bitter or metallic taste in the mouth. Symptoms usually wax and wane. For many people, symptoms are mild or absent in the morning and grow progressively worse throughout the day.

Many diseases and conditions can cause the symptoms of burning mouth syndrome. The most common include vitamin deficiencies, allergies, dry mouth, diabetes, thyroid disease, hormonal disorders and neurologic conditions. Sometimes, a combination of factors causes the symptoms. To most effectively manage the problem, it's best to work with a physician who's willing to comprehensively investigate all possible causes. If an underlying medical condition is identified, then treating that condition may help alleviate your symptoms.

In some cases, however, no clear cause can be found. If that's the case in your situation, treatment is still available, although it may take some time to find the therapy that works best for you.

You mention that you've been taking alpha lipoic acid, an antioxidant that may help relieve neuropathic pain. Alpha lipoic acid is effective in some patients with burning mouth syndrome. I often have my patients take it for approximately two to four months. If it helps, then I recommend they keep taking it. If they haven't received relief after four months, I suggest they discontinue it and try another treatment.

Other treatment options include a lozenge form of the anti-anxiety medication clonazepam; capsaicin, a pain reliever that comes from chili peppers; some types of antidepressants; medications used to treat oral thrush; and B vitamins.

In addition, there are many self-care steps you can take that may help relieve your discomfort. Try to identify triggers that make your symptoms worse and avoid them, if possible. For example, some people find that salty, acidic or spicy foods intensify the burning sensation. Also, stay away from foods that are natural oral irritants, such as chocolate, cinnamon and mint. Hard-edged foods like pretzels, tortilla chips and nuts can also irritate the inside of your mouth.

Keeping your mouth moist may help, too. Use a humidifier in your bedroom at night to maintain moisture in the air as you sleep. Carry a water bottle with you and take sips regularly. Alcohol and smoking can dry your mouth, so avoid them as much as possible. If dry mouth is a persistent problem, try an over-the-counter saliva substitute to replace your natural saliva.

Although there's rarely a simple way to manage burning mouth syndrome, when all of the factors at play are correctly treated, the prognosis is actually quite good. With comprehensive treatment, approximately 60 to 70 percent of people with burning mouth syndrome see their symptoms improve. I strongly recommend that you find a physician who will evaluate your condition thoroughly and then work with you to develop strategies to help alleviate the pain. - Alison Bruce, M.B., Ch.B., Dermatology, Mayo Clinic, Rochester, Minn.

(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to medicaledge@mayo.edu , or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For more information, visit www.mayoclinic.org.)