Burning Mouth Syndrome Symptoms and Treatment

Burning mouth syndrome is a chronic condition causing a burning pain sensation in the mouth—often on the tongue or mucous membranes—without another identifiable cause. In most cases, people with burning mouth syndrome are evaluated by many doctors and are told that there is no reason for their symptoms, and therefore may even be labeled as having a psychiatric condition. Many cases of burning mouth syndrome can last for years.

Burning mouth syndrome occurs most commonly in postmenopausal women, and often occurs as a sudden onset of symptoms. Many people with this condition relate their symptoms to a recent trip to the dentist, a recent illness or course of antibiotic therapy.

Woman in bed with hand on her face in pain
 Nattakorn Maneerat / Getty Images


Symptoms include a burning sensation on the tongue, most often the front of the tongue, roof of the mouth, or inside the lower lip—and often the condition affects more than one of these locations. The skin on the face is not affected as a result of burning mouth syndrome. The symptoms are often worse in the afternoon and evening, and mild or absent at night and in the morning. Some people also notice a change in taste sensation (including bitter and metallic tastes) and dry mouth as part of their symptoms. While many people can notice a slow, gradual, partial improvement—symptoms may last for many years.

Possible Causes

Burning mouth syndrome has not been linked to any particular medical condition, although may be associated with other chronic pain conditions, such as headaches. There are inconsistent associations between diabetes and nutritional deficiencies, such as vitamins B1, B2, B6, B12, zinc and folate. Other conditions, such as oral candidiasis, geographic tongue, aphthous ulcers, pemphigus vulgaris, Sjögren’s syndrome, and allergic contact dermatitis to dental materials and toothpaste may mimic burning mouth syndrome but aren’t thought to be the cause of it.

There are some cases of burning mouth syndrome being related to taking angiotensin-converting enzyme (ACE) inhibitors—a number of different blood pressure medications ending in “-pril”—and stopping these medications resulted in slow improvement of symptoms over a number of weeks.


If there is an underlying cause of burning mouth syndrome found (as described above), then treatment of that condition may be helpful to reduce or eliminate symptoms—such as appropriate nutritional supplements to treat a specific deficiency, treatment with topical antifungals to eliminate oral candidiasis, avoidance of contact allergens, etc.

However, if no underlying condition can be identified, then burning mouth syndrome should be treated symptomatically. Medications used to treat neuropathic pain conditions, such as tricyclic antidepressants, benzodiazepines and gabapentin may be helpful in lessening symptoms. Various mouthwashes made by local compounding pharmacies, termed “Magic Mouthwashes”, containing different medications such as viscous lidocaine, diphenhydramine, Maalox, and topical steroids, topical antibiotics and topical antifungals, can be used multiple times a day for the symptomatic relief of burning mouth syndrome. Finally, the use of capsaicin mouth rinses (made from a dilution of hot pepper and water), may be helpful to reduce symptoms over time, possibly with long-term benefits.

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  • Grushka M, Epstein JB, Gorsky M. Burning Mouth Syndrome. Am Fam Physician. 2002;65:615-22.
  • Magic Mouthwash Recipes. Pharmacist’s Letter/Prescriber’s Letter. 2009;25 (11): 251103.

By Daniel More, MD
Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California.