Burning Mouth Syndrome: Causes, Symptoms and Finding Relief

A persistent burning, scalding, or tingling sensation in your mouth with no obvious cause can be deeply frustrating. Burning mouth syndrome (BMS) affects an estimated 1 to 5% of the population and is more common in women, particularly around and after menopause. Despite how uncomfortable it can be, it is often manageable once the right approach is found.

What Is Burning Mouth Syndrome?

Burning mouth syndrome is a chronic condition that causes a burning, tingling, or numb sensation in the mouth without any visible sores, ulcers, or redness. It most commonly affects the tongue but can also involve the palate, lips, gums, and inner cheeks.

Burning mouth syndrome is a condition characterised by a chronic burning, tingling, or numb sensation in the mouth, most commonly affecting the tongue, but also the palate (roof of the mouth), lips, gums, and inner cheeks. The mouth typically looks completely normal on examination. There are no visible sores, ulcers, or redness to explain the discomfort, which can make the condition all the more puzzling.

BMS is categorised into two types:

• Primary BMS: No identifiable underlying cause can be found. It's thought to be related to damage or dysfunction of the nerves that control taste and pain sensation in the mouth
• Secondary BMS: The burning sensation is caused by an underlying condition or factor that, when treated, typically resolves the symptoms

Experiencing a burning sensation in your mouth? Search for a dentist near you who can help investigate the cause.

Causes of Secondary Burning Mouth Syndrome

Before a diagnosis of primary BMS is considered, your dentist or doctor will want to rule out secondary causes. These include:

• Dry mouth (xerostomia): Often caused by medications (antidepressants, antihistamines, blood pressure drugs), mouth breathing, or conditions affecting the salivary glands. A dry mouth can create a burning sensation and makes the mouth more vulnerable to irritation
• Oral thrush (candidiasis): A fungal infection that can cause burning, soreness, and a white coating on the tongue or inner cheeks
• Nutritional deficiencies: Low levels of vitamin B12, iron, zinc, or folate have been linked to oral burning. These can be identified through blood tests
• Diabetes: Poorly controlled blood sugar can affect oral health and nerve function, contributing to burning sensations
• Medications: Certain drugs, particularly ACE inhibitors used for blood pressure, can cause oral burning as a side effect
• Allergies and irritants: Contact allergies to dental materials, toothpaste ingredients (especially sodium lauryl sulphate), or certain foods can mimic BMS
• Acid reflux (GERD): Stomach acid reaching the mouth can cause burning, particularly at night or when lying down
• Hormonal changes: BMS is significantly more common during and after menopause, suggesting a hormonal link, though the exact mechanism is not fully understood

Symptoms

People with BMS typically describe one or more of the following:

• Burning or scalding sensation: Most commonly on the tip and sides of the tongue, but can affect any part of the mouth. The sensation often worsens through the day, starting mild in the morning and peaking by evening
• Altered or metallic taste: Many people report a persistent bitter, metallic, or unpleasant taste, or a loss of taste
• Dry mouth: A feeling of dryness even when saliva production appears normal
• Tingling or numbness: Some people describe pins and needles rather than burning

How Is It Diagnosed?

Diagnosing BMS is largely a process of elimination. Your dentist or GP may:

• Examine your mouth thoroughly to check for visible signs of infection, ulcers, or other conditions (see our guide to mouth ulcers)
• Take blood tests to check for nutritional deficiencies, diabetes, and thyroid function
• Take swabs to test for oral thrush or other infections
• Review your medications to identify any that could be contributing
• Assess saliva flow to check for dry mouth

If all tests come back normal and no secondary cause is found, a diagnosis of primary BMS may be made.

Treatment Options

Treatment depends on whether a secondary cause is identified:

Treating the Underlying Cause

If secondary BMS is diagnosed, treating the root cause often resolves symptoms:

• Antifungal medication for oral thrush
• Vitamin or mineral supplements for deficiencies
• Adjusting or changing medications with your GP
• Managing diabetes or acid reflux
• Switching to a gentler toothpaste without sodium lauryl sulphate

Managing Primary BMS

When no underlying cause is found, treatment focuses on symptom management:

• Saliva substitutes and oral moisturisers to relieve dryness
• Alpha-lipoic acid (ALA): An antioxidant supplement that some studies suggest may help reduce BMS symptoms, though evidence is mixed
• Cognitive behavioural therapy (CBT): Can help manage the psychological impact and may reduce the perception of pain
• Low-dose medications: In some cases, tricyclic antidepressants, benzodiazepines, or gabapentin may be prescribed at low doses to help manage nerve-related pain

Lifestyle Tips for Managing Symptoms

While working with your dentist or GP on treatment, these day-to-day strategies may help:

• Stay well hydrated: Sip water regularly throughout the day
• Avoid triggers: Spicy foods, acidic drinks, alcohol, and very hot beverages can worsen symptoms
• Chew sugar-free gum: This stimulates saliva flow and can provide temporary relief
• Avoid mouthwashes containing alcohol: These can dry out and irritate the mouth further
• Manage stress: Anxiety and stress can worsen BMS symptoms. Relaxation techniques, mindfulness, or counselling may help

If you're also experiencing persistent bad breath or recurrent mouth ulcers alongside burning, mention these to your dentist. They may point to a specific underlying cause that can be treated.

Frequently Asked Questions

How long does burning mouth syndrome last?

Secondary BMS can resolve within weeks once the underlying cause is treated. Primary BMS is more unpredictable. Some people experience symptoms for months, while others have it for several years. Research suggests that around one third of people with primary BMS see spontaneous improvement within 6 to 7 years.

Which doctor should I see for burning mouth syndrome?

Start with your dentist or GP. They can examine your mouth, order blood tests, and rule out common secondary causes like vitamin deficiencies or oral thrush. If the diagnosis is unclear, you may be referred to an oral medicine specialist who has particular expertise in conditions affecting the soft tissues of the mouth.

Is burning mouth syndrome linked to anxiety?

There is a strong association between BMS and psychological factors including anxiety, depression, and stress. It is not always clear whether the anxiety causes or worsens the BMS, or whether living with chronic oral pain leads to anxiety. Cognitive behavioural therapy (CBT) has been shown to help some patients with both the psychological and physical symptoms.

Can certain foods make burning mouth syndrome worse?

Yes. Many people with BMS find that spicy foods, acidic foods and drinks (citrus, tomatoes, vinegar), hot beverages, alcohol, and products containing cinnamon or mint can worsen symptoms. Keeping a food diary can help you identify your personal triggers.

Does burning mouth syndrome affect taste?

Yes. Many people with BMS report a persistent bitter or metallic taste, or a partial loss of taste. These changes are thought to be related to the same nerve dysfunction that causes the burning sensation. If you are also experiencing a metallic taste in your mouth, this guide covers other possible causes.

Is burning mouth syndrome more common in women?

Yes. BMS is significantly more common in women, particularly those who are perimenopausal or postmenopausal. Studies suggest women are up to seven times more likely to develop BMS than men. Hormonal changes during menopause are thought to play a role, though the exact mechanism is not fully understood.