STORY BYRetired police officer James Maddox noticed a metallic taste in his mouth in 1999 after extensive dental work. Soon, the metallic taste vanished, but he was left with a constant burning. Since then, he has seen dentists, neurosurgeons and oral pathologists to find a way to put out the fire.
Three percent of the population endures Burning Mouth Syndrome (BMS), a condition that is poorly understood but is exacerbated by certain diseases like Sjogren’s (pronounced “SHOW-grins”) Syndrome and other medical problems.
BMS is a chronic condition of the nerves that may last for years. Of those sufferers, 25 percent have a taste disorder. Fourteen percent of post-menopausal women experience BMS. And, although estrogen deficiency may trigger the problem, (which doesn’t improve with replacement hormones) men are not immune. In addition, there is some evidence that this nerve pain has an autoimmune origin.
Almost everyone has experienced unusual feelings in the mouth: dryness, rough areas, heat sensation or a metallic taste. The causes may be from stress, inadequate hydration, fever, spicy foods, upset stomach or medication. This may be uncomfortable, but it usually goes away about the time you make a dental appointment for it. BMS does not disappear so quietly or quickly. In fact, it usually lasts for years unless a specific cause can be idenitifed and treated.
Dry mouth itself brings a slew of customers to a dentist’s or doctor’s office. “More than 200 medications actually cause dry mouth. It also can be caused by diseases, in particular, Sjogren’s Syndrome,” explains Catherine M. Flaitz, DDS, MS, professor at The University of Texas Dental Branch at Houston. Sjogren’s is an autoimmune disorder, in which white blood cells attack the moisture-producing glands. Signature symptoms are dry eyes and dry mouth, but it is a systemic disease that can affect multiple organs. Up to 4 million Americans have Sjogren’s. Although the cause remains elusive in most individuals, sometimes, says Flaitz, Sjogren’s is the trigger for BMS.
It may be occasional, but if you have ever experienced that sudden flash of intense pain—like a pin stabbing you under your tongue—you'd remember it.
Flaitz says this is caused by a blockage or rapid production of fluids from the salivary glands under the tongue. Sour or acidic foods and beverages are most likely to trigger this response.
If you have discomfort with eating and the floor of the mouth becomes swollen, most likely you have a plugged duct that is not allowing the thick saliva to escape.
No treatment is necessary in most cases because the pain quickly goes away. If the pain lingers, frequently recurs or the floor of the mouth becomes enlarged, then your dentist can help identify the problem.
If there is a blockage or stone in the duct of the gland, you will usually need to be treated by an oral and maxillofacial surgeon or an otolaryngologist (ear, nose and throat doctor.)
Plenty of other triggers exist, too, Flaitz points out. “I have had adolescent and young adult patients who have developed BMS. Usually, it coincides with a recent severe cold or flu, trauma to the mouth or contact allergy. The initiating factors seem to be different in the accelerating age groups. It can be associated with systemic diseases.” Low-functioning thyroid, diabetes, some forms of anemia, nutritional problems, autoimmune diseases and yeast infection in the mouth also can play a part.
Also, adds Flaitz, it can be associated with Parkinson’s and certain stomach problems, such as reflux disease that causes chronic irritation of the throat and esophagus.
“My patients compare it to the feeling of scalding coffee, pizza burn or fire ants in the mouth.” Flaitz says that the most confounding aspect of BMS is that there are no obvious visual clues to the lining of mouth. For this reason, it does not garner the attention it deserves by many healthcare providers. Like many chronic pain conditions, it can continue indefinitely and take a real toll on emotional health for those affected. Although it is not a serious problem in itself, it certainly can become an issue of quality of life.
Flaitz suggests that people who experience this problem seek help first from a dentist to check out the obvious culprits. “Ordinarily, a healthcare professional would be able to look in your mouth and see that something isn’t right. There might be some shaggy white patches, or a little bit of redness,” Flaitz says. BMS is the result of nerve damage that changes one’s perceptions of taste, temperature, touch and moisture, but it can’t be visually identified.
Local causes might include:
If BMS is not due to one of the local factors, Flaitz believes in the simple approach:
She mentions that simply the flavor of gum or candy may be helpful to some patients, while others find the taste only increases bitterness. If these tactics fail, then antidepressant medications at low doses may be helpful to reduce the anxiety or preoccupation of the sensation. It usually takes a couple of months before these medications become effective.
Many people with BMS fear they have cancer, “because they’ve heard that if you’re in constant pain that doesn’t go away, that’s a sign of serous illness, like cancer.” Flaitz explains why BMS feels different: “With cancer, you don’t have pain in the entire mouth, as you do with BMS. You can have cancer metastasize and move to the mouth. The tumor cells can wrap around nerves in the beginning causing a more severe type of pain that is localized to one side. Then the mouth gets numb.”
Maddox recalls that every now and then, the burning will completely disappear. The first time it happened, it was the first interruption of pain in four years. He thought he was over BMS. It returned the next day. His neurologist told him that BMS showed up one day without warning, and it might just go away the same way. He says he hopes she’s right.
Last Updated: 1-13-2010
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Dr. Catherine M. Flaitz is a professor of diagnostic sciences at UTHealth Dental Branch and an oral pathologist.
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Simple Ways to Help
Young and Old Eyes
May is Healthy Vision Month and it is imperative to take care of eyes whether they’re young or old.
Children should have their vision checked by age 6, even if there aren’t any signs of eye problems. Healthy eyes and vision are very important to a child’s development. Finding and treating eye problems early on can save a child’s sight. Two common eye problems in children are:
Both of these eye problems can be treated if they are found early.
Here are ways to help your child develop vision skills:
Don’t let poor vision put elders at risk. Leave a three-foot, clear path through each room of their house. Outline edges of steps, coffee tables, doorways and bathtubs with colored tape to contrast with surrounding areas. Install lights along outdoor pathways and keep foyers well lit to avoid having to enter dark areas. Replace switch plates with colors that contrast with walls, or outline them with tape of contrasting colors. It is also always smart to use nightlights during the night.
