Burning Tongue (or Mouth) Syndrome

by , last modified on 1/9/22.
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red tongueBurning tongue syndrome (glossopyrosis or glossodynia) is when the sides and/or top surface of the tongue has an intermittent or constant burning sensation present. Yet the overall appearance looks normal. This burning sensation can even extend to the cheeks, lips, and roof of mouth (burning mouth syndrome or oropyrosis). Treatment is varied as there is no single cause for this condition. Rather, there are several possible causes that usually are all addressed simultaneously.

So what exactly is going on when the tongue or mouth starts to have a burning sensation?

Cause #1: Thrush

Perhaps the most commonly thought suspect is thrush… which actually is an uncommon cause of burning tongue syndrome. More usual is that thrush may exacerbate burning tongue symptoms triggered by a different underlying reason. As such, a patient may report only a temporary improvement with antifungal medications (ie, nystatin, diflucan, etc). Definitive treatment requires addressing the main underlying cause of symptoms.

Cause #2: Vitamin or Mineral Deficiencies

More often, the main cause of a burning tongue or mouth sensation is some type of vitamin or mineral deficiency. The most common deficits are Magnesium and Zinc. If anemia is potentially present, then Iron and Folate deficiencies are also suspected. Supplements are typically recommended for those suffering from burning tongue syndrome including TriMagnesium and Zinc Gluconate. B-complex and iron may also be recommended for certain patients where anemia is a concern.

Cause #3: Allergy

Some type of oral allergy or sensitivity is the next most common cause of burning tongue syndrome, especially to certain common toothpaste and mouthwash ingredients like sodium lauryl sulfate and fluoride. It is recommended to stop all mouthwashes and to use a natural toothpaste that does not contain SLS nor fluoride (ie, Tom's Natural).

Cause #4: Reflux

Finally… it could be reflux even if no heartburn is experienced. In fact, the burning tongue sensation is the "heartburn" a person may be experiencing due to reflux. As such, all patients with a burning tongue or mouth should also take a proton pump inhibitor twice a day for a minimum 3 weeks.

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Cause #5: Autoimmune Disorder

A relatively infrequent cause of burning tongue syndrome, certain autoimmune disorders may attack the tongue and/or mouth lining leading to a burning sensation.

Cause #6: Miscellaneous

Very rare causes of burning tongue or mouth syndrome include neuropathy and even shingles! Typically these diagnoses are entertained when everything else has either come back normal or has not worked.

Other Treatments with Only Anecdotal Support:

Beyond what has already been mentioned above, there are other simple things that can be tried to see if it helps with the burning sensation. Keep in mind that the following treatment suggestions provide more limited or transient improvement.

Multivitamin to help address any other vitamin or mineral deficiencies.

Alpha Lipoic Acid 200mg 3x per day

Maalox or Mylanta rinses four times a day (avoid eating/drinking for 30 minutes after rinses!)

Benadryl elixir rinses four times a day (avoid eating/drinking for 30 minutes after rinses!)

Capsaicin rinses 4 times a day. Capsaicin can be found in hot pepper sauces like tabasco. Capsaicin is available in both creams and lozenges, but you can make it yourself by mixing 5-6 drops of tabasco with one teaspoon of water and swishing it in the mouth. Be aware, the burning WILL intensify at first, but should significantly decrease after a few minutes.

Prescription medications often prescribed with only limited success include:

• Magic Mouthwash rinses containing some concoction of steroids and nystatin.

• TCA anti-depressant medications (ie, amitriptyline) or other neuromodulating class of drugs (ie, gabapentin and lyrica) to address any neuropathy that may be causing the burning sensation. (Reference)

• ODT clonazepam 0.125mg tid to be dissolved entirely where the burning sensation is located (meant to be a topical treatment rather than ingested). (Reference)

• Anti-viral medications (Reference)

In Summary

In summary, for a typical generic patient with burning tongue syndrome, it is recommended to try several interventions at the same time for at least 2 months including:

Take Magnesium and Zinc supplements. If anemia suspected, add B-complex and iron supplementation.

Use a SLS-free and fluoride-free toothpaste like Tom's Natural Toothpaste. No mouthwash of any kind should be used unless instructed by your doctor.

Take a proton pump inhibitor reflux medication twice a day for at least 3 weeks.

Finally, see your doctor for further testing and management.

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