Dear Dr James,
For almost a year now the tip and sides of my tongue have been very sore – it is a burning, scalded feeling as after taking a gulp of hot soup. Its appearance seems completely normal. Between them, my doctor and dentist have tried several treatments – antifungal lozenges, mouthwashes, zinc supplements – but to no avail. How wonderful it would be to eat and talk again in comfort.
Dear reader,
The tongue, palate and lips are amongst the most sensitive in the body, their rich nerve supply mediating the joys of food and kissing. There is a long list of possible reasons for a sore mouth – aphthous ulcers, the mucosal condition lichen planus, ill-fitting dentures and so on. But when, as here, the appearance is normal, the scalding sensation could be Burning Mouth Syndrome (BMS), for which there may be several “hidden” causes.
Toothpaste
The chemical added to some brands of toothpaste to create a frothy texture – sodium lauryl sulphate – may be the culprit, as it proved to be for a dentist from Cambridge. She advises “a soft toothbrush, children’s toothpaste and less zealous, though sufficient, brushing.”
Foods
For some, the mouth burns after eating specific foods such as cheese, tomatoes and chocolate – though here the link is obvious enough. Less so is the preservative sodium benzoate added to mayonnaise, fruit squashes and the like. This is confirmed by patch testing and prevented by reading the small print on packaging and avoiding those listing E number 211.
Nutrient Deficiency
The older age group or those on a restricted diet may be deficient in vitamins B6, B12, or zinc, with burning as a resulting symptom. The tongue appears red and smooth due to atrophy of the papillae on its surface. A simple blood test confirms the diagnosis.
Drug Side Effects
There are sporadic reports of burning mouth as a side effect of ACE inhibitors (such as Lisinopril) and the antidepressant Fluoxetine, both of which lower blood pressure.
Miscellaneous
Several other triggers mentioned by readers over the years include glasses washed in the dishwasher, air fresheners, the sweetener aspartame and certain brands of lipstick.
Primary Burning Mouth Syndrome
This range of “hidden” causes merits consideration, but for most, their BMS is likely due to disturbed functioning of the sensory nerves in the mouth (with unknown cause). While there is no specific remedy, the main ingredient of hot chilli peppers, capsaicin, may (paradoxically) be of value. Initially, and predictably, the burning sensation increases, but this is followed by a “refractory period” when the overall intensity calms down.
You can take capsaicin as 5-6 drops of Tabasco sauce (of which it is the main ingredient) diluted in a teaspoon of water and swished around the mouth four times a day. Cold apple juice or a mixture of kaopectate and Benadryl may also be helpful.
Beyond that, the medicines amitriptyline and gabapentin are commonly prescribed to alleviate neuropathic pain and may mitigate the burning, as does the sedative Clonazepam – which helps, perhaps, because it counters the distress associated with the condition.
Finally, a recent treatment which “blocks” pain fibres with a local anaesthetic looks promising in some cases. Those wishing to know more should Google “nerve block for burning mouth syndrome”.
Email queries and comments in confidence to drjames@telegraph.co.uk
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