Many people with sjogren's syndrome (SS) describe a burning sensation of the mouth and/or the tongue. It can also include the lips and the palate. Some feel constant pain and for others, the pain comes and goes. They describe it as burning, tingling, scalded, and numb feeling. It is possible that this sensation may be related to the neurologic manifestations of SS, which is when the nerves become damaged. Many people call it burning mouth syndrome or BMS.
DIAGNOSIS:
Doctors and dentists don’t have a specific test for BMS, which makes it hard to diagnose. No specific treatment works for everyone. However, a doctor can prescribe medications to help you manage the pain, dry mouth, or other symptoms.
Specialists who diagnose BMS include dentists who specialize in oral medicine or oral surgery. Otolaryngologists (ear, nose, and throat specialists), gastroenterologists, dermatologists, or neurologists may also be able to diagnose the disorder.
To diagnose BMS, a dentist or doctor will review your medical history and examine your mouth. Additional tests may be needed such as:
- Blood tests to check for underlying medical problems
- Oral swab tests
- Allergy tests
- Salivary flow test
- Tissue biopsy
- Imaging tests
Do not presume that your burning mouth symptoms are because of sjogren's as there are many causes for BMS that can be classified into 4 categories:
(1) local (candidiasis, benign migratory glossitis, reactions to dental materials, reactions to foods such as food intolerances or allergy)
(2) systemic (nutritional deficiencies, hormonal disturbances, anemia, diabetes mellitus)
(3) psychological (anxiety, depression)
(4) neurogenic factors (alterations in peripheral nerves, dopamine levels)
Management of BMS: If any local, systemic or psychological factors are evident, treat or eliminate.
Medications used for BMS include antidepressants, analgesics, antiepileptic, antifungal, antibacterial, sialagogues, antihistamines, anxiolytics, antipsychotics and vitamin, mineral, and hormonal replacements.
Topical medications
The topical application of clonazepam (by sucking a tablet of 1 mg), 3 times a day for 14 days can reduce the burning symptoms without causing side effect of its systemic.
Aloe Vera gel helps to reduce the burning sensation and pain in the sore areas of the tongue with a protector.
Systemic medication
Anti-depressants like amitriptyline, imipramine, clomipramine and nortriptyline are useful in treating BMS, and some authors contraindicate these drugs as they can worsen the condition in patients with dry mouth.
Alpha-lipoic acid acts as an anti-oxidant and powerful neuroprotective agent that prevent nerve damage and regenerating other antioxidants such as vitamin C and E, thereby reducing the symptoms. The patient must be advised to take medications for gastric protection.
Hormonal replacement therapy can reduce the burning symptoms and pain in peri and postmenopausal women.
TREATMENT According to UCONN Health :
Burning mouth patients, including those with Sjogren's, sometimes have an oral candidal (thrush) infection that is not readily apparent on examination. Because the treatment is benign (Nystatin vaginal troches slowly dissolved in the mouth, one troche four times a day), we recommend a two week treatment for possible candidiasis. Your doctor can obtain an oral candidal culture prior to treatment with Nystatin, but our recommendation is to treat regardless of culture results because we have seen improvement even when cultures are negative.
In addition to the above, we screen for nutritional deficiencies (B1, B2, B6, B12, folic acid and iron) and diabetes mellitus in all patients, because some of our patients have low vitamin and/or mineral test results, and elevated serum glucoses. Both nutritional deficiencies and diabetes have been reported to be associated with oral burning in other studies.
Lastly, if evaluation to this point is unrevealing, we suggest an MRI scan of the head, to make certain that there is nothing in the brain causing the burning sensations. For example it is possible that a small "stroke" in a specific area can cause oral burning symptoms. GET UCONN Health's full recommendations here.
HELPFUL TIPS Johns Hopkins Sjögren’s Center
Try these self-care tips to help ease the pain of burning mouth syndrome:
- Sip water frequently
- Suck on ice chips
- Avoid irritating substances like hot, spicy foods; mouthwashes that contain alcohol; and products high in acid, like citrus fruits and juices
- Chew sugarless gum
- Brush your teeth/ dentures with baking soda and water
- Avoid alcohol and tobacco products
RESOURCES:
National Institute of Dental and Craniofascial Research
Patient Education Sheet pdf from Sjögren’s Foundation, Inc.
Burning Mouth Syndrome pdf from National Institute of Dental and Craniofascial Research
Burning Mouth Syndrome from Johns Hopkins Sjögren’s Center
FURTHER READING:
A Novel Treatment of Burning Mouth Syndrome in a Patient with Sjogrens Syndrome - ACR Clinical Research
Alpha lipoic acid efficacy in burning mouth syndrome. A controlled clinical trial
All information on this site is meant for educational purposes only. Never disregard medical advice or delay in seeking it because of something you have read on this website.
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