An excerpt modified from Facial Pain: Living Well with Neuropathic Facial Pain
By Gary Klasser, DMD
Associate Professor, Louisiana State University School of Dentistry
Certificate in Orofacial Pain
Imagine waking up one morning and feeling as if your mouth is on fire. Your tongue tingles, your lips sting, and even water seems to make it worse. Yet when you look in the mirror, everything appears perfectly normal. For many people, this is the daily reality of Burning Mouth Syndrome (BMS), a puzzling and often frustrating condition that continues to challenge both patients and doctors.
What Is Burning Mouth Syndrome?
Burning Mouth Syndrome is a chronic pain condition that causes a burning or scalding feeling in the mouth without any visible signs of irritation or infection. The discomfort can affect the tongue, lips, gums, roof of the mouth, or the inside of the cheeks. Some people also describe a dry or metallic taste, tingling, or numbness.
Doctors have been aware of this condition since 1935, but even after decades of study, there’s still no single agreed-upon definition or clear diagnostic test. BMS has gone by many different names over the years — including “glossodynia,” “burning tongue,” “scalded mouth syndrome,” and “oral dysesthesia” — reflecting the uncertainty and confusion that surrounds it.
For patients, this can be deeply frustrating. They experience real and sometimes severe pain, but medical tests often come back normal. For clinicians, diagnosing BMS can also be difficult, as the mouth may look completely healthy, and no infection, sores, or other visible problems are found.
Syndrome or Symptom?
Experts still debate whether BMS is a syndrome — meaning a disease in its own right — or a disorder, where the burning is a symptom of another underlying problem. In many cases, doctors classify BMS as a diagnosis of exclusion, which means it’s identified only after other causes (like infections, allergies, or nutritional deficiencies) have been ruled out.
Regardless of terminology, what’s clear is that BMS is a complex condition likely caused by several factors working together, from nerve changes to hormonal shifts to emotional stress.
Who Gets It?
Studies suggest that between 0.7% and 15% of adults may experience BMS at some point, depending on how the research is conducted. The condition is most common in women over 50, especially those who are postmenopausal. In fact, women are about five to seven times more likely to develop BMS than men.
Why women are more affected isn’t entirely clear. Hormonal changes during menopause may play a role, but studies haven’t found strong evidence linking hormone replacement therapy to symptom relief. BMS also appears to become more common with age, though it can occasionally affect younger adults.
What Does It Feel Like?
People with BMS use many different words to describe the sensation: burning, scalding, tingling, stinging, or rawness. The pain often affects both sides of the tongue, the lips, or the roof of the mouth. Some people also notice a bitter or metallic taste or feel as if their mouth is unusually dry.
In most cases, symptoms start gradually and persist for months or even years. Some people report that the burning builds up throughout the day. It may be mild in the morning but reach its peak in the evening. Eating or drinking may temporarily relieve the discomfort, while spicy, acidic, or hot foods can make it worse.
Although the pain can be moderate to severe, the mouth usually appears normal when examined. This mismatch between how it feels and how it looks can make patients worry that their pain is “in their head.” It’s not — the discomfort is real and can seriously impact quality of life, affecting eating, speaking, and sleep.
Why Does It Happen?
The exact cause of BMS remains uncertain, but researchers believe it often involves nerve dysfunction. The nerves that control taste and pain in the mouth may send incorrect signals to the brain, creating the burning sensation even in the absence of an injury.
Other possible contributors include:
• Hormonal changes, especially around menopause
• Dry mouth (xerostomia) due to medications or reduced saliva flow
• Nutritional deficiencies, such as low iron, zinc, or vitamin B12
• Allergic reactions or sensitivities to dental materials, mouthwashes, or flavoring agents
• Psychological factors, such as stress, anxiety, or depression
• Neurological or autoimmune conditions, though these are less common
Because there’s no single cause, there’s also no one-size- fits-all treatment.
How Is It Diagnosed?
Since BMS can mimic or overlap with many other conditions, diagnosis begins with a thorough medical and dental history. Your doctor or dentist will ask when the burning began, how long it lasts each day, and whether anything triggers or eases it.
They’ll also review medications, diet, and oral care products and may run blood tests to rule out diabetes, vitamin deficiencies, thyroid issues, or infections. Tests for allergies, dry mouth, or taste changes may also be done. In some cases, imaging or biopsies are used to rule out other diseases.
If no specific cause is found and the mouth tissue looks healthy, BMS is diagnosed.
Living With and Managing BMS
Although there is currently no cure for Burning Mouth Syndrome, many people find ways to reduce their symptoms and improve their comfort. Successful management often involves a multidisciplinary approach, meaning several types of care are used together — medical, dental, and psychological.
Here are some of the main strategies used today:
- Self-care and Lifestyle Changes
Avoiding triggers can make a big difference. This
might include:
• Using alcohol-free, flavor-free mouthwashes
• Avoiding spicy, acidic, or hot foods
• Limiting gum, mints, or cinnamon-flavored products
• Drinking plenty of water
• Reducing stress through exercise, yoga, or relaxation therapy
Some patients benefit from desensitizing mouth appliances or behavioral therapies that help reduce the focus on pain. - Topical Treatments
Doctors sometimes prescribe mouth rinses, gels, or lozenges that contain mild anesthetics, capsaicin, or clonazepam (a medication that can calm nerve activity). Some studies suggest low level laser therapy may help reduce pain, although research is still ongoing. - Oral or Systemic Medications
Because nerve signals are thought to play a major role, doctors may try medications used for nerve pain, such as certain antidepressants, anticonvulsants, or anti-anxiety drugs. These aren’t “painkillers” in the usual sense but work by calming overactive nerve pathways. - Psychological Support
Since chronic pain and emotional distress can feed into each other, cognitive behavioral therapy (CBT) and stress management programs can be helpful. These don’t mean the pain is psychological, rather, they teach coping skills and reduce the body’s stress response, which can make symptoms less intense.
The Outlook
For some people, BMS symptoms may fade over time, sometimes within a few years, though others may continue to experience discomfort long-term. Studies show that around half of patients experience at least partial improvement, and up to one in five may have complete remission over several years.
Even though there’s no single “cure,” understanding and managing the condition can significantly improve day-to-day life. Working closely with a knowledgeable dentist or orofacial pain specialist, oral medicine specialist, or neurologist. can help identify triggers, tailor treatments, and provide support.
Hope for the Future
Researchers are continuing to explore how nerve pathways, hormones, and the brain interact to cause oral burning. With better understanding, new and more targeted treatments are likely to emerge.
In the meantime, the key message for anyone living with Burning Mouth Syndrome is this: your pain is real, and help is available. With the right combination of care and coping strategies, it’s possible to find relief and reclaim comfort — one step, and one day, at a time.
Learn more about Burning Mouth Syndrome
This article is an excerpt from Dr. Klasser’s chapter on Burning Mouth Syndrome from our most recent book. The full chapter and other important facial pain information can be found in Facial Pain: Living Well with Neuropathic Facial Pain. Click to purchase.
