(See also Evaluation of the Dental Patient Evaluation of the Dental Patient The first routine dental examination should take place by age 1 year or when the first tooth erupts. Subsequent evaluations should take place at 6-month intervals or whenever symptoms develop... read more 
.)
Burning mouth syndrome is uncommon and usually affects postmenopausal women. It is believed to be neurogenic, affecting central and peripheral nerves of pain and taste, and may be multifactorial in origin.
Causes of secondary burning mouth syndrome include
Nutritional deficiency (vitamin B12 Vitamin B12 Deficiency Dietary vitamin B12 deficiency usually results from inadequate absorption, but deficiency can develop in vegans who do not take vitamin supplements. Deficiency causes megaloblastic anemia, damage... read more , vitamin B9 [folate] Folate Deficiency Folate deficiency is common. It may result from inadequate intake, malabsorption, or use of various drugs. Deficiency causes megaloblastic anemia (indistinguishable from that due to vitamin... read more )
Anemia
Oral mucosal disorders (eg, stomatitis, lichen planus, pemphigoid, pemphigus vulgaris, neoplasia)
Angiotensin-converting enzyme (ACE) inhibitors Angiotensin-converting enzyme (ACE) inhibitors A number of drug classes are effective for initial and subsequent management of hypertension: Adrenergic modifiers Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers... read more
Oral parafunctional behavior (eg, tongue thrusting, clenching, bruxism Bruxism Bruxism is clenching or grinding of teeth. Bruxism can occur during sleep (sleep bruxism) and while awake (awake bruxism). In some people, bruxism causes headaches, neck pain, and/or jaw pain... read more )
Burning mouth syndrome may cause burning, tingling, or numbness of the tongue, palate, lips, or other mucosal surfaces of the mouth, often bilaterally and sometimes in multiple foci. The pain can be significant and may occur daily. It may be constant or increase throughout the day and may be relieved by eating or drinking. Perceived dry mouth and altered taste may occur. Pain, as well as associated emotional issues (anxiety, depression), can be socially debilitating. Duration of symptoms of burning mouth syndrome varies from months to years, but symptoms resolve spontaneously or if a secondary cause can be identified and addressed.
Diagnosis of Burning Mouth Syndrome
Clinical evaluation
Tests to exclude secondary causes
Diagnosis of burning mouth syndrome requires oral symptoms as noted above and the absence of oral signs. Pain must occur on 50% of days, for > 2 hours per day (some authors omit this potentially unreliable criterion), for > 3 months. Burning mouth syndrome is a diagnosis of exclusion; therefore, testing for secondary causes should be thorough and may involve salivary flow measurement, blood tests to evaluate for systemic conditions, head and neck imaging studies, and biopsy.
Treatment of Burning Mouth Syndrome
Symptomatic treatment
Curative treatment for secondary burning mouth syndrome
Treatment of burning mouth syndrome is difficult and may be unsatisfactory and frustrating for the patient. An empathic, multidisciplinary approach may be helpful, including cognitive-behavioral therapy Psychotherapy and drugs such as tricyclic antidepressants Heterocyclic Antidepressants Several drug classes and drugs can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Serotonin modulators (5-HT2 blockers) Serotonin-norepinephrine reuptake inhibitors... read more , alpha-lipoic acid, clonazepam, topical capsaicin, or gabapentin. Patient-initiated pain relief measures include cold beverages, ice chips, chewing gum (sugarless), and avoidance of irritants such as tobacco, spicy or acidic foods, and alcohol (in beverages and mouthwash).
Secondary burning mouth syndrome may be cured by appropriate treatment of the underlying cause.
