DEAR DOCTOR K >> For some time, I've had a burning and tingling in my mouth. My dentist and doctor seem to be mystified. What could be causing my symptoms, and what can I do?
DEAR READER >> Several things might be causing these bothersome symptoms. Some that come to mind are nutritional deficiencies — particularly of B vitamins, iron and zinc. These problems can be detected by simple blood tests.
Medicines that cause the mouth to become dry (due to decreased saliva production) can result in mouth irritation. Sometimes a person can develop an allergy to dentures and related adhesive creams, toothpastes or mouthwashes. You can experiment by seeing what happens when you stop using one of these potential allergy triggers (and substituting a different brand). One particular brand of toothpaste once caused such symptoms in me.
Conditions that damage small nerves, such as diabetes, can cause mouth pain. So can mouth infections, particularly with fungus (yeast).
There also is a condition called burning mouth syndrome (BMS) that produces a burning — sometimes scalding — sensation on the lips and tongue and throughout the mouth. In BMS, the pain is present for at least some part of every day, the tissues of the mouth look normal (not irritated or inflamed) to the doctor or dentist, and the conditions I have mentioned already are not present. So that may explain why your dentist and doctor are mystified.
We don't know what causes BMS. Some think it is a psychiatric condition, but I'm dubious about that. I think that when doctors don't understand the cause of a person's symptoms, we sometimes think (and say to our patient) that the symptoms are just imaginary. That may make us feel better, but it doesn't make the patient feel so great. And if there really is a problem that we're ignoring, we have failed.
If I had to bet on what causes BMS, it would be this: subtle damage of the main nerve that detects pain in the mouth, the trigeminal nerve. Indeed, one study provides support for that theory.
Low doses of tricyclic drugs, certain medicines often used for seizures, and some pain-killing medicines and creams applied directly to the parts of your mouth that hurt may all help.
There are steps you can take to reduce your mouth discomfort. The National Institute of Dental and Craniofacial Research recommends the following to keep symptoms at bay:
• Sip water frequently.
• Avoid irritating substances: hot, spicy foods; mouthwashes with alcohol; and acid foods.
• Chew sugarless gum.
• Avoid alcohol and tobacco.
Dr. Komaroff is a physician and professor at Harvard Medical School.