Mouth on fire? It could be menopause

Published Nov 20, 2014

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London - Do spicy foods set your mouth on fire? Does stress or anxiety cause a scalding sensation on your tongue, lips or mouth?

You could be a sufferer of burning mouth - a bizarre but common condition thought to affect up to 15 percent of the population, typically the over 50s, with women more likely to suffer than men.

Some patients feel constant pain, while for others the burning sensations increase late morning and ease off at night. Symptoms, which can also include a bitter or metallic taste, are often made worse by spicy food, anxiety or just talking. Around half of cases resolve themselves after months or even years, but in others it persists for longer.

Burning mouth has baffled scientists for years, but new research suggests it may be linked to sleep problems, hormonal changes or problems with the saliva glands.

One theory is that it’s a neuropathic pain disorder, meaning it is the result of changes in the nerves, possibly involving the nerves carrying taste sensations.

This is borne out by recent research that found most sufferers responded to an antioxidant, alpha-lipoic acid, which is widely used to treat diabetic nerve pain. However, researchers from the Mayo Clinic in the US believe it may be related to problems with the taste and sensory nerves.

Other possible causes include hormonal changes during the menopause - women are most likely to start having symptoms between three years before and 12 years after the menopause.

Stress has also been implicated - the theory is it heightens sensitivity, leading to an increased perception of symptoms. In fact, psychological issues may be implicated in 50 percent of cases, according to a report in Journal of Dental Research, Dental Clinics, Dental Prospects.

Researchers cited the case of a 55-year-old patient suffering from stress, whose “burning mouth” symptoms were particularly bad when she watched soap operas with stressful family dispute plots.

Nutritional deficiencies may also be to blame. A common effect of vitamin B deficiency is a burning sensation in the mouth.

Heartburn and acid reflux, oral candidiasis (a fungal infection of the mouth), habitual lip sucking and smoking are other known risk factors.

The latest research suggests xerostomia, the medical term for having a dry mouth, may be the cause in some patients. In a study at the University of Milan, patients with burning mouth syndrome produced less saliva in a spit test than non-sufferers.

Meanwhile, another new study at China Medical University Hospital, Taiwan, found people with sleep apnoea - when the walls of the throat relax during sleep and interrupt normal breathing - were more than twice as likely to suffer from burning mouth syndrome.

Sleep disorders affect the immune system, leading to greater levels of inflammation, which may increase symptoms.

Whatever the cause, there are effective treatments. A study in the journal Gerodontology reported that when an antidepressant - paroxetine - was used for 12 weeks, around 80 percent of patients reported a reduction of symptoms, with few adverse effects.

“Some antidepressants are recommended for neuropathic pain and may help control symptoms of burning mouth syndrome, which many believe is a neuropathic pain disorder,” says Dr Stefano Fedele, senior lecturer and consultant in oral medicine at University College London’s Eastman Dental Institute.

He says they have the added benefit of helping to control associated depression, adding that patients often have anxiety, stress, depression and sleep disorders. “The constant discomfort can be physically and psychologically stressful and can lead to anger and frustration,” he adds. “Stress in turn can increase pain.”

He says treatment should manage relevant psychological conditions as well as physical ones, not relying only on medications. “The condition is best managed with a multidisciplinary approach. Studies of cognitive behavioural therapy and the anticonvulsant clonazepam have also demonstrated some benefits,” he adds.

Meanwhile, a study at the University of Valencia showed a mouth rinse containing capsaicin - an ingredient in chilli peppers - was effective for people who’d had the syndrome even as long as five years. It’s thought to be used as a desensitising agent to reduce pain levels.

“There is limited evidence that local application of capsaicin may reduce symptoms,” adds Dr Fedele.

Another effective treatment seems to be alpha-lipoic acid, used to treat many nerve conditions, including diabetic neuropathy. In a study at a number of centres including University College London, 60 patients were given the antioxidant or a placebo.

The majority of patients who received the acid showed some improvement after two months, which continued in more than 70 percent of patients for at least a year. Only 15 percent of the placebo group saw an improvement.

Researchers said this treatment could help if the syndrome is due to nerve damage, but may not do so where other causes are involved.

Simple steps can also help - these include sipping water frequently, avoiding irritating substances such as spicy or acidic foods and drink, and alcohol, and brushing teeth with baking soda and water (to neutralise acid in the mouth). - Daily Mail

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