Burning Tongue or Mouth Syndrome Treatment

Patients with burning mouth or burning tongue syndrome have essentially two major findings: one, a burning sensation in their mouth and two, a normal appearance of the tongue and mouth. Glossopyrosis is burning limited to the tongue whereas oropyrosis is burning in the entire mouth, including tongue, lips, palette, gums and pharynx.

There unfortunately is no universal understanding nor treatment to address this uncomfortable sensation which suggests a multifactorial etiology. As such, treatment basically entails trying a variety of interventions in the hope that one works for a given patient. Keep in mind that what works for one may not work for another.

Here's the list! Typically, one would try a treatment strategy for ~2 months before deciding whether it is helping or not. Things you can try first without a doctor's visit:

• Multivitamin to help address any vitamin or mineral deficiencies.
• Magnesium Oxide 400mg daily to help replenish any magnesium deficiency within red blood cells (normal magnesium levels typically found in bloodwork).
• Alpha Lipoic Acid 200mg 3x per day and Zinc Gluconate 50mg 3x per day have also had some anecdotal support.
• Iron supplementation if iron deficiency or anemia is present
• Maalox or Mylanta rinses four times a day (avoid eating/drinking for 30 minutes after rinses!)
• Benadryl elixir rinses four times a day (avoid eating/drinking for 30 minutes after rinses!)
• Use only bland toothpaste that does not contain sodium lauryl sulfate (SLS) nor fluoride like Tom's Natural Toothpaste.
• Avoid any chemical mouthwashes like listerine or scope for the same reason.
• Capsaicin rinses 4 times a day. Capsaicin can be found in hot pepper sauces like tabasco. Capsaicin is available in both creams and lozenges, but you can make it yourself by mixing 5-6 drops of tabasco with one teaspoon of water and swishing it in the mouth. Be aware, the burning WILL intensify at first, but should significantly decrease after a few minutes.

Prescription medications that have been tried with only limited success include:

• Magic Mouthwash rinses containing some concoction of steroids and nystatin.

• TCA anti-depressant medications (ie, amitriptyline) or other neuromodulating class of drugs (ie, gabapentin and lyrica) to address any neuropathy that may be causing the burning sensation. (Reference)

• ODT clonazepam 0.125mg tid to be dissolved entirely where the burning sensation is located (meant to be a topical treatment rather than ingested). (Reference)

• Anti-viral medications (Reference)

Good luck!

Of note, there are two clinics in Virginia that specialize in this condition. One is in Washington DC and the other is in Richmond.