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Sore and Burning Mouth

Sore and Burning Mouth: Causes, Symptoms, and Management

Definition:

Sore and burning mouth refers to a condition where a person experiences pain, burning, or discomfort in the oral cavity, including the tongue, lips, gums, palate, or inner cheeks. It can be localized (affecting specific areas) or generalized (involving the entire mouth).

Burning sensation in the mouth without an identifiable cause is known as Burning Mouth Syndrome (BMS), which can be primary (idiopathic) or secondary (caused by an underlying condition).

Causes of Sore and Burning Mouth

1. Local Oral Conditions

  • Oral Candidiasis (Thrush): A fungal infection causing burning, soreness, and white patches on the tongue or inner cheeks.
  • Oral Lichen Planus: A chronic inflammatory condition with white lacy patches and burning sensation.
  • Oral Submucous Fibrosis (OSMF): Caused by betel nut chewing, leading to fibrosis and burning sensation.
  • Geographic Tongue (Benign Migratory Glossitis): Irregular red patches with white borders on the tongue causing discomfort.
  • Xerostomia (Dry Mouth): Saliva deficiency leading to burning, sore sensations.
  • Trauma: Biting injuries, ill-fitting dentures, sharp teeth, or excessive brushing.
  • Allergic Reactions: Sensitivity to toothpaste, mouthwashes, or certain foods.

2. Systemic Causes

  • Nutritional Deficiencies:
    • Vitamin B12, iron, folic acid, and zinc deficiencies can cause burning and sore sensations.
  • Hormonal Changes:
    • Menopause-related estrogen decline often causes Burning Mouth Syndrome (BMS).
  • Diabetes Mellitus:
    • Poorly controlled diabetes can cause dry mouth, thrush, and burning sensations.
  • Gastroesophageal Reflux Disease (GERD):
    • Acid reflux can lead to burning mouth, throat irritation, and sour taste.
  • Neuropathy:
    • Nerve damage or dysfunction (seen in diabetics, post-viral syndromes, or due to certain medications) can lead to unexplained burning sensations.
  • Autoimmune Diseases:
    • Sjogren’s syndrome (causes dry mouth and burning sensation).
    • Lupus and Pemphigus Vulgaris (causes ulceration and soreness).

3. Psychological and Medication-Related Causes

  • Anxiety, Depression, and Stress:
    • Often linked to Burning Mouth Syndrome with no obvious physical cause.
  • Medications:
    • ACE inhibitors (for blood pressure), diuretics, antidepressants, and chemotherapy drugs can cause oral burning.
  • Radiation Therapy:
    • Patients undergoing head and neck radiation often develop oral mucositis, causing soreness and burning.

Symptoms of Sore and Burning Mouth

  • Burning sensation (like hot food burns), especially on the tongue and palate.
  • Soreness or raw feeling in the mouth.
  • Dry mouth or excessive thirst.
  • Altered taste perception (metallic, bitter, or salty taste).
  • Tingling, numbness, or irritation.
  • Worsening symptoms as the day progresses (especially in Burning Mouth Syndrome).

Diagnosis of Sore and Burning Mouth

A comprehensive clinical evaluation is needed to determine the cause.

Diagnostic Tests:

  1. Blood Tests:
    • Check for vitamin deficiencies (B12, iron, folic acid, zinc), diabetes, thyroid function, and autoimmune disorders.
  2. Oral Swab & Biopsy:
    • To rule out oral candidiasis, lichen planus, or precancerous conditions.
  3. Salivary Flow Test:
    • For dry mouth evaluation.
  4. Allergy Testing:
    • If toothpaste, dentures, or food allergies are suspected.
  5. Neurological Examination:
    • If nerve-related burning is suspected.

Treatment & Management of Sore and Burning Mouth

1. Treat Underlying Causes

  • Oral Thrush: Antifungal medications (Nystatin, Clotrimazole).
  • Lichen Planus & OSMF: Topical steroids, mouth rinses.
  • Vitamin Deficiency: Supplements for B12, iron, and folic acid.
  • Diabetes Control: Maintain blood sugar levels.
  • Reflux Disease: Proton pump inhibitors (PPIs) like Omeprazole.

2. Symptomatic Relief for Burning Mouth Syndrome

  • Saliva Substitutes & Hydration:
    • Sugar-free lozenges, frequent water intake, artificial saliva sprays.
  • Topical & Systemic Medications:
    • Lidocaine gel (for temporary pain relief).
    • Capsaicin mouth rinses (reduces nerve pain).
    • Alpha-lipoic acid supplements (helps in nerve regeneration).
    • Low-dose antidepressants (Amitriptyline, Clonazepam, Gabapentin) (for neuropathic pain).
  • Oral Hygiene & Lifestyle Modifications:
    • Avoid tobacco, alcohol, spicy and acidic foods.
    • Use mild toothpaste (avoid sodium lauryl sulfate).
  • Cognitive Behavioral Therapy (CBT) or Stress Management:
    • Helps in cases with anxiety-related burning mouth.

Prevention of Sore and Burning Mouth

  • Maintain Good Oral Hygiene: Brush and floss daily, use alcohol-free mouthwash.
  • Avoid Irritants: Tobacco, alcohol, acidic/spicy foods, excessive coffee intake.
  • Stay Hydrated: Drink plenty of water.
  • Manage Stress: Yoga, meditation, relaxation techniques.
  • Regular Dental Check-ups: Early detection and treatment of any oral conditions.

When to See a Dentist or Specialist?

  • If the burning or soreness persists for more than 2 weeks.
  • If there are ulcers, bleeding, white patches, or thickened mucosa.
  • If the symptoms are progressive and interfering with daily life.
  • If there is sudden onset burning after starting a new medication.

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