People with burning mouth syndrome are often told their mouth looks perfectly healthy, and it usually does. The burning, scalding or tingling, most often on the tongue, is real even though nothing shows on examination. It is recognised as a chronic pain condition involving the nerves, and while there is no single reliable cure, symptoms can often be eased once other causes have been ruled out.
More common than most people think
A 2022 systematic review in Oral Diseases (Wu and colleagues) pooled 18 studies and estimated the prevalence of burning mouth syndrome at about 1.7% in the general population and about 7.7% among patients attending clinics. It was more common in women than men, and women over 50 were the group most affected. Many women notice it starting around or after menopause, which our article on menopause and oral health discusses.
Ruling out a cause comes first
Clinicians separate burning that has an identifiable cause, sometimes called secondary burning mouth, from burning with no cause that can be found, called primary burning mouth syndrome. The distinction shapes everything that follows, so a careful assessment starts by looking for anything treatable.
Possible drivers of secondary burning include:
- a dry mouth, from medicines, medical conditions or breathing through the mouth
- oral thrush, an overgrowth of yeast
- low iron, vitamin B12, folate or zinc
- diabetes that is not well controlled
- acid reflux reaching the mouth, covered in our article on reflux and your teeth
- a reaction to a toothpaste ingredient, mouthwash, flavouring or denture material
- a side effect of some medicines, including certain blood pressure medicines
When a cause like these is found and treated, the burning often settles. A diagnosis of primary burning mouth syndrome is made only after these possibilities have been checked. In that case, the small nerves that carry pain and taste sensations appear to be sending pain signals without any injury to the tissue.
A typical daily pattern
The feeling is often compared to the scald after a sip of something too hot. It most commonly affects the tip and sides of the tongue, though the lips, the roof of the mouth or the whole mouth can be involved. Many people wake with little discomfort and find it builds through the day, peaking in the evening. Eating or drinking can temporarily ease it or distract from it. Some people also notice a metallic or bitter taste, or a dry feeling even when saliva tests are normal.
Other conditions can cause soreness of the tongue but look different. A tongue with shifting smooth red patches, for example, may be geographic tongue, which a dentist can usually recognise on sight.
Calming the irritation at home
Many people find a few simple changes reduce flare-ups:
- use a mild toothpaste without sodium lauryl sulfate and without strong mint or cinnamon flavour
- avoid mouthwashes that contain alcohol
- sip water through the day, and try sugar-free gum or a saliva substitute if dryness is part of the problem
- cut back on acidic, very spicy and very hot foods and drinks while symptoms are active
- reduce alcohol and stop smoking or vaping, as both irritate the lining of the mouth
Switching toothpaste is a simple test in itself: if the burning eases over a couple of weeks, an ingredient may have been contributing.
Medical treatment is a matter of trial and adjustment
Treatment for primary burning mouth syndrome is still uncertain. A Cochrane review (McMillan and colleagues, 2016) looked at 23 randomised trials covering medicines, supplements, psychological therapies and topical treatments. It found the quality of evidence was very low across the board and concluded there was insufficient evidence to support or refute any single treatment.
In practice, that means management is often a careful trial of options under the guidance of a GP, dentist or relevant specialist. Some topical treatments applied in the mouth, and some medicines used for nerve pain, may be tried for persistent cases. These are prescribing decisions for your treating clinician, who will consider your general health and other medicines. Stress, anxiety and poor sleep can all amplify chronic pain, so support through your GP or a psychologist is often part of a sensible plan; our article on stress and oral health touches on that link.
When to have your mouth checked
Burning mouth syndrome itself is not considered dangerous, but other conditions that cause soreness can be, so it is worth an examination rather than assuming. See a dentist or your GP if burning has lasted longer than two weeks, if an ulcer, lump or white or red patch has not healed within three weeks, if swallowing is becoming difficult, or if the burning began after starting a new medicine or wearing a new denture.
At an appointment, a dentist can examine the tongue, cheeks, gums and palate, check whether a denture fits well and whether its material or a product you use could be irritating the tissues, and look for signs of thrush or dry mouth. If blood tests for iron, vitamins or blood sugar are needed, your GP can arrange them.
Questions about burning mouth
Will it go away by itself?
Burning with a treatable cause often settles once that cause is addressed. Primary burning mouth syndrome can come and go and may improve over time, and symptoms can often be reduced with the right management.
Could my toothpaste be causing it?
It can contribute. Sodium lauryl sulfate and strong mint or cinnamon flavours can irritate the mouth in some people, and switching to a mild alternative is an easy first step.
Who should I see first?
Your dentist or GP. A dentist can examine the mouth and check dentures and products, and can work with your GP on blood tests or refer you on if needed.
Getting a burning mouth assessed
If a burning or sore mouth has been bothering you, a dentist at our Melrose Park practice can examine the soft tissues, review any dentures and the products you use, and help look for a treatable cause. Book a general dental check or see our current deals page for what is on offer.
This article is general information and not a substitute for personal advice from a dentist or doctor. A sore or burning mouth is a sensitive issue, and if it is affecting your wellbeing please speak with a health professional you trust.
