Burning mouth syndrome
- Oral pathology
A burning feeling in a mouth that looks normal, most often in women after menopause. First rule out causes that can be treated.
What it is
Burning mouth syndrome is a chronic burning or scalding pain of the oral mucosa, usually the tip and sides of the tongue, lasting more than a few months, with a normal-looking mouth and no identifiable local or systemic cause. It is thought to be a neuropathic pain disorder. It is most common in peri- and postmenopausal women and often comes with dry mouth, altered taste and anxiety or depression. The pain is typically mild on waking and worsens through the day. Secondary burning mouth has an identifiable cause and must be excluded first.
How to recognise it
- Normal mucosa, bilateral burning of tongue, palate or lips, worse later in the day.
- Secondary causes: candidiasis, iron, B12, folate or zinc deficiency, diabetes, hypothyroidism, dry mouth, reflux, allergy to dental materials, drugs (ACE inhibitors).
- Parafunctional habits (tongue thrusting, clenching) can contribute.
- Diagnosis of the primary syndrome is by exclusion.
- Clonazepam used topically or systemically, and cognitive behavioural therapy, have the best evidence.
Differential and risks
- A visible lesion (red patch, ulcer, white plaque) means it is not burning mouth syndrome: look for the cause.
- Unilateral burning or numbness suggests a neurological cause and needs assessment.
- Patients often see many professionals; acknowledging the pain is real improves adherence.
Next step / Initial management
- Exclude secondary causes: full blood count, ferritin, B12, folate, glucose or HbA1c, thyroid function; treat candidiasis; review drugs.
- Explain the condition, reduce irritants (spicy food, alcohol mouthwashes, tobacco) and treat dry mouth.
- Persistent pain after exclusion: refer to oral medicine or a pain specialist; consider psychological support.
Test yourself
Think of the answer, then tap the question to see it.
What is required to diagnose primary burning mouth syndrome?
Chronic oral burning with a normal-appearing mouth after excluding local and systemic causes.
Which blood tests help exclude secondary burning mouth?
Full blood count, ferritin, B12, folate, glucose or HbA1c and thyroid function.
What is the typical daily pattern of pain?
Mild on waking and worsening through the day.
Connections
In Pharmacology1
Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.
Sources: Burning Mouth Syndrome (StatPearls Publishing (NCBI Bookshelf), 2023); Burning Mouth (National Institute of Dental and Craniofacial Research (NIDCR, NIH), 2024).
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Representative model, for educational purposes only.