Why Burning Mouth Syndrome is Difficult to Diagnose

Burning mouth syndrome (BMS), as defined by Mayo Clinic is the medical term for ongoing (chronic) or recurrent burning in the mouth without an obvious cause. This discomfort may affect the tongue, gums, lips, inside of your cheeks, roof of your mouth (palate) or widespread areas of your whole mouth. The burning sensation can be severe, as if you scalded your mouth.

Symptoms of burning mouth syndrome may include:

  • A burning or scalding sensation that most commonly affects your tongue, but may also affect your lips, gums, palate, throat or whole mouth.
  • A sensation of dry mouth with increased thirst.
  • Taste changes in your mouth, such as a bitter or metallic taste.
  • Loss of taste.
  • Tingling, stinging or numbness in your mouth.

What Causes BMS?

The exact cause of burning mouth syndrome is still unknown. Generally BMS is classified as either primary or secondary based on the probable cause of the burning sensation in your mouth.

In situations where there are no clinical or lab abnormalities, the condition is called primary or idiopathic burning mouth syndrome. Some research suggests that primary burning mouth syndrome is related to problems with taste and sensory nerves of the peripheral or central nervous system.

In other cases, burning mouth syndrome may be linked to an underlying medical condition. For such cases, it’s called secondary burning mouth syndrome. Underlying problems that may be linked to secondary burning mouth syndrome include:

  • Dry mouth (xerostomia).
  • Oral conditions, such as a fungal infection of the mouth (oral thrush), an inflammatory condition called oral lichen planus or a condition called geographic tongue that gives the tongue a maplike appearance.
  • Nutritional deficiencies, such as a lack of iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12).
  • Food allergies.
  • Gastroesophageal reflux disease (GERD).
  • Certain medications particularly high blood pressure medications.
  • Oral habits, such as tongue thrusting, biting the tip of the tongue and teeth grinding (bruxism).
  • Endocrine disorders, such as diabetes or underactive thyroid (hypothyroidism)
  • Excessive mouth irritation due to overbrushing your tongue, using abrasive toothpastes, overusing mouthwashes or having too many acidic drinks.
  • Psychological factors, such as anxiety, depression or stress.

Misdiagnosis of BMS is Very Common

According to new research at the School of Dental Medicine at Case Western Reserve University, not all burning mouths are the result of a medical condition known as “burning mouth syndrome” (BMS) and physicians and researchers need better standards for an appropriate diagnosis.

“BMS is a painful, complex condition associated with a chronic or recurring burning, scalding or tingling feeling in the mouth — sometimes accompanied by a metallic taste or dry mouth sensation. But because other conditions have similar symptoms, diagnosing BMS can be difficult,” said Milda Chmieliauskaite, a researcher and assistant professor of oral and maxillofacial medicine at the dental school.

She said the issues with misdiagnosis, depend to some extent on the context, but include resources, money and patient discomfort. So if a patient is misdiagnosed with burning mouth syndrome, but actually suffers from burning due to dry mouth, the patient will receive treatment for the wrong condition and the symptoms of burning will not improve.

She added that it is because many dentists and clinicians aren’t trained well on the topic, and the current method for making a diagnosis is ruling out other disorders.

Treating BMS should be approached with caution, said Chmieliauskaite, who co-authored the research recently published by Oral Diseases as part of the World Workshop on Oral Medicine VII. A lot of the other things that cause burning in the mouth (such as diabetes, anemia and dry mouth) can be easily treated.

The specific cause of BMS is uncertain, she said, but some evidence shows that it may be related to nerve dysfunction. Sometimes, chewing gum or eating certain foods lessens pain symptoms. Chmieliauskaite also pointed that the condition affects females more and between 1% to 4% of the population is affected by BMS.


There’s no known way to prevent burning mouth syndrome. But by avoiding tobacco, acidic foods, spicy foods and carbonated beverages, and excessive stress, you may be able to reduce the discomfort from burning mouth syndrome or prevent your discomfort from feeling worse.

If you have discomfort, burning or soreness of your tongue, lips, gums or other areas of your mouth, see your doctor or dentist. They may need to work together to help pinpoint a cause and develop an effective treatment plan.


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