Burning mouth syndrome and the menopause

Why this painful condition occurs and how to manage it

If you’ve not experienced it, burning mouth syndrome (BMS) can sound rather strange. Yet glossodynia, as it’s also known, is fairly common – between 0.75 and 15% of the popular are affected by it, with more women experiencing it than men.

What is it?

Burning mouth syndrome is a name given to discomfort, pain or burning in the mouth. It is predominately found on the tongue, although can also affect the lips, palate or cheeks or be widespread and felt all over your mouth. It’s described as a burning or scalding feeling but some people also experience a numbness or tingling, a dry sensation or unpleasant taste that’s bitter or metallic. Usually, you would not be able to see any visible changes, or redness in the areas that are painful.

For some, the sensation can come and go, for others it’s continuous, and some people find it builds up during the day then eases at nighttime.

What causes BMS?

BMS occurs when the nerves in your mouth change the way they send message about warmth, cold and taste to your brain. According to the Oral Health Foundation, when the brain doesn’t understand the messages properly, it can cause the feeling of pain. It’s known as a neuropathic pain as it relates to damaged nerves.

No one knows what exactly causes BMS. Some possible causes of BMS, include stress, anxiety or depression, immune system problems, damage to the nerves controlling taste or pain, a reaction to certain types of toothpaste or mouthwash, being allergic to material in dentures, or certain medications such as ACE inhibitors (used to treat high blood pressure).

Various medical conditions can cause it, including dry mouth, acid reflux, thrush infections, nutritional deficiencies (such as iron, vitamin B12 or folic acid) and diabetes. Hormonal changes can also cause it, including underactive thyroid.

How is it linked to menopause?

The mean age of BMS patients is 50 to 60 years old, and prevalence among menopausal women ranges between 10% and 40%, depending on the research [1]. 

The drop in oestrogen is thought to be a factor but there is no explanation or evidence to support this.

Related: oral health and the menopause

How is it treated?

The first thing to do is make an appointment with your dentist so they can examine you and help to rule out any other medical or dental causes. If there is a dental cause, such as dry mouth or a fungal infection, they will help resolve this. If they are unable to find a dental cause, it will be referred on to a doctor or oral medicine specialist who can do further investigations, such as a blood sample to check your levels of iron, vitamin B12, folic acid and glucose or further medical investigations.

It’s worth noting that BMS can be a long-term condition – while some people may only experience it for a few months, for others it can take years to disappear, and some have it for the rest of their life. So, it’s important to explore remedies and coping strategies that help you.

Keep your mouth moist by sipping water often, sucking on crushed ice, or chewing sugar-free gum to produce saliva. Avoid irritants such as hot and spicy foods, mouthwashes containing alcohol, acidic fruits or juices, tobacco and alcohol.

There is conflicting evidence on the effectiveness of HRT to alleviate BMS. One study found an improvement in symptoms of 70% of 149 women given HRT, while another, which gave 3,173 perimenopausal women a questionnaire, found the positive impact of HRT could not be confirmed [2].

Trials have suggested that alphalipoc acid (available in health food shops) may be helpful – 200mg three times a day for a month then once daily.

If a prescribed medicine is causing dry mouth (as this is a common side effect), this may be modified to see if it is contributing to the BMS. Sometimes a mild antidepressant can also be prescribed to help those in severe pain, or feeling low as a result of the long-term symptoms.

Coping strategies, including rest, relaxation, cognitive behavioural therapy, antidepressants and counselling can also be considered. Symptoms can be alleviated when stress over the condition is decreased. It’s also important to note that half of all people with BMS will find it improves or goes away completely.

Resources

Dentist Dr Shabnam Zai is clinical director at West House Dental, westhousedental.com Follow her on Instagram @drshabnamzai

References

1-2. Ślebioda Z, Szponar E. (2014), ‘Burning mouth syndrome – a common dental problem in perimenopausal women’, Prz Menopauzalny, 13(3) pp.198-202. doi: 10.5114/pm.2014.43825