Dr Margaret answers emailers’ embarrassing problems
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Burning mouth

Dear Dr Margaret
My elderly mother has been suffering with a burning, stinging, sensitive tongue for 2 years. It really is quite severe. The doctor has treated her with various gels and lozenges, and recently with a tablet after a blood test showed a deficiency of vitamin B12. Unfortunately none of these treatments have worked. She has also had new dentures and been treated for thrush, but to no avail. Can you throw any light on this problem please?

A burning sensation in the mouth is a surprisingly common problem. It has an official name – ‘burning mouth syndrome’. Sufferers are usually in their 60s or older, so your mother is typical, but it can affect younger people. The tongue is most commonly affected. About half the people with burning mouth syndrome say the problem is there every day, from the moment they wake up until they go to bed. In others, it is not present when they wake, but gradually worsens during the day. Some people experience it only occasionally. You might expect that the mouth would look sore or inflamed, but that is not the case; the mouth looks normal.

It was sensible to consider new dentures. Ill-fitting dentures can sometimes trigger the problem, especially if there is not enough space for the tongue, or if the person has to use their tongue to keep the denture in place. Some people worry that burning mouth syndrome could be an allergy to the material the dentures are made from, but this does not seem to be the case.

It was good that her doctor tried thrush treatment and also checked her vitamin B12 level. Some research has suggested that about 40% of patients with burning mouth syndrome have low levels of some other vitamins – B1 (thiamine) and B6 (pyridoxine). These cannot be measured by normal blood tests, so it would be worth trying B1 and B6 supplements. To have an effect, they need to be taken in doses higher than you would find in ordinary multivitamin tablets, but her doctor could suggest a suitable dose and prescribe them. They should be tried for 4 weeks.

Does your mother say that her mouth feels dry most of the time and that the burning and dryness are the same thing? If so, she should drink plenty of water, and talk to her doctor about saliva substitutes, if these have not already been tried. Saliva substitutes are mucin or carboxymethylcellulose in the form of sprays or lozenges or swab sticks.

The problem is certainly made worse by stress and anxiety, so is your mother troubled by any worries? Many people with burning mouth syndrome worry that it is a sign of mouth cancer, but this is definitely not the case. Mouth cancer is a persistent lump or a sore (ulcer) in the mouth and not a general burning sensation.

References
Lamey P . Burning mouth syndrome: approach to successful management. Dental Update 1998; Sept: 298–300.
Hamburger J. Treating oral dryness. Update 2002; 28 March: 397–401.

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