Burning Mouth Syndrome
Ross Hauser, MD, Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
Burning Mouth Syndrome
If we took the combined emails we received about problems of Burning Mouth Syndrome, this common thread of a person’s story goes something like this:
“My mouth and tongue feel like they have been burnt, like from a hot spoon or scolding coffee. I went to the dentist to see if this was a problem with my gums or an infection in my teeth. None of the x-rays showed anything. He told me that he thought it was burning mouth syndrome. Nothing could be done for it except anti-depressants. When I went to my doctor, I was referred to a specialist, a Psychiatrist.”
Fortunately, some people diagnosed with Burning Mouth Syndrome do get benefits from anti-depressants. We see some of these patients as they continue to seek other options. We also see the people for whom anti-depressants did not provide relief. They are looking for something that may help them. In this article, we will explore the possibility that some people with burning mouth syndrome may have its cause in cervical spine instability causing compression on the vagus nerve, the facial nerve, and the glossopharyngeal nerve creating an altered sensation (burning) into the tongue and mouth.
Burning mouth a psychiatric problem?
Why anti-depressants? Anti-depressants can help with nerve pain. They are also seen as a way to “buy time.” People who believe that their problems were related to root canals or extensive dental work are typically given drugs such as Amitripyline or Velanfaxine and given the hope that this will hold them over until the pain goes away by itself. Again, I want to point out that this article will focus on the nerves that run into the cervical spine as a cause of the person’s burning mouth syndrome. Anti-depressants may be offered when someone is diagnosed with idiopathic burning mouth syndrome. Idiopathic meaning no known cause. As we will discuss in this article, one unknown or undiagnosed cause may be with the sensory nerves.
Research published in the Journal of Headache and Pain (1) describes the difficulty doctors face in understanding what Burning Mouth Syndrome is and how to treat it.
Here are some of the bullet points of this study, parenthesis are added for emphasis and understanding.
- Burning Mouth Syndrome is a chronic pain condition characterized by persistent intra-oral burning without related objective findings (no reason) and unknown etiology (We can’t figure out where it comes from) that affects elderly females mostly.
- There is no satisfactory treatment for burning mouth syndrome. (This should be pointed out that this refers to traditional treatments including anti-depressants and pain medications).
- (The researchers) aimed to observe the long-term effectiveness of high velanfaxine doses (Anti-depressant nerve medication that can be prescribed for generalized anxiety disorder, panic disorder, and social anxiety disorder), combined with systemic and topical administered clonazepam (a sedative for seizures, panic disorder, and anxiety. Side-effects include suicidal thoughts and paranoia), in a particular subgroup of burning mouth syndrome patients who do not respond to current clinical management.
- Conclusion: “Refractory burning mouth syndrome deserves bottomless psychiatric evaluation and management when currently available treatments fail. Paraclinical investigation including brain imaging and peripheral facial nerve conduction evaluation may be needed.”
Does anything help?
Recently, doctors and dentists in the United Kingdom released a detailed examination of the conventional treatments available to patients with burning mouth syndrome. (2)
Here is the summary of their findings:
The treatments examined were:
- antidepressants and antipsychotics,
- dietary supplements,
- electromagnetic radiation,
- physical barriers,
- psychological therapies,
- and topical treatments, including capsaicin oral rinse.
They concluded in this group of treatments “evidence for effectiveness was very low for all interventions and all outcomes.”
Many, like you, have many health problems that may be attributed to Burning Mouth Syndrome
Similar to what we see in patients in our clinics are symptoms and health problems noted by researchers in the medical journal Oral diseases.(3) A research group from the School of Dentistry, Complutense University, Madrid, Spain made these observations:
“The relationship of Burning Mouth Syndrome with possible alterations in patients’ general health has been subject of study and controversy during the last years.”
In this paper, the researchers conducted a case-control study to compare the diseases, medications, blood test alterations, disturbances in general health, oral quality of life, xerostomia (dry mouth), sleep quality and psychological status between a group of 20 patients with burning mouth syndrome and a group of 40 patients who did not suffer from this disease.
- Burning mouth syndrome patients suffered more comorbidities and consumed more medications than controls. More mental, behavioural or neurodevelopmental disorders in burning mouth syndrome patients were found, consuming more drugs for nervous and cardiovascular systems, and alimentary tract and metabolism.
Burning mouth a nerve problem or a dental problem?
In the above study, it is suggested that peripheral facial nerve conduction evaluation may be needed. This may point to our suggestion that in some patients burning mouth syndrome may be caused by nerve dysfunction.
A March 2020 study in the Journal of Oral Science (4) comes from the Nihon University School of Dentistry in Japan. Again this is a school of dentistry research paper looking for an answer to burning mouth syndrome. Let’s listen to what they are saying.
“Burning mouth syndrome is one of the most frequently seen idiopathic pain (again this is a pain that comes on suddenly without any reason), conditions in a dental setting. Peri- and postmenopausal women are most frequently affected, and patients who experience burning mouth syndrome complain of persistent burning pain mainly at the tip and the bilateral border of the tongue.
Recent studies have assessed whether burning mouth syndrome is a neuropathic pain condition. (Note: This was based on varying factors including abnormal pain responses (or exaggerated pain response), where the patient is having more pain than they should. I want to point out that the patients do suffer from more pain than they should and it is not a psychiatric disorder).
“Somatosensory studies have reported some abnormal findings in sensory and pain detection thresholds with inconsistency; however, the most distinct finding was exaggerated responses to painful stimuli. Imaging and electrophysiologic studies have suggested the possibility of dysregulation of the pain-modulating system in the central nervous system, which may explain the enhanced pain responses despite the lack of typical responses toward quantitative sensory tests.”
This also may point to our suggestion that in some patients, burning mouth syndrome may be caused by nerve dysfunction.
In this video Ross Hauser, MD discusses the problem of Burning Mouth Syndrome and how disruption of the Cranial Nerves, specifically the Vagus Nerve can cause Burning Mouth Syndrome.
A transcript summary and explanation notes are added below.
I remember the first case of burning mouth syndrome I treated, it was about 25 years ago. This patient thought the problem was their teeth, they had a lot of dental work thinking that would rid them of the burning mouth problem they had.
- Following the dental work’s failed pain alleviation, the patient then sought out alternative holistic medicine providers. Here they were suggested to gluten-free and dairy-free diets along with herbal supplementation. They were told to avoid spicy foods, hot foods and beverages, or other foods that may cause them discomfort.
Chiropractor diagnoses patients with upper cervical instability
- When the alternative holistic medicine failed, they sought out care from a chiropractor. The chiropractor felt that the problem was upper cervical instability. The problem of their burning mouth was coming from the neck. That chiropractor did this patient a big favor. This patient came to me, received Prolotherapy treatments and responded very well. As will be explained below Prolotherapy is a series of simple dextrose injections into the cervical spine. The goal of the treatment is to strengthen the cervical spine ligaments and provide stability and a return to the normal cervical spine curve. This will help relieve the possible pressures the vertebrae are causing on the nerves that lead into the mouth, tongue, and face.
The nerves that lead into the mouth, tongue, and face
A study from New York University School of Medicine/Langone Medical Center (5) describes the interaction of the facial nerve (seventh cranial nerve CN VII), the glossopharyngeal nerve (ninth cranial nerve CN IX), and the vagus nerve (tenth cranial nerve CN X) and symptoms of burning mouth syndrome.
“Alterations in taste and quantity of salivation are commonly reported in burning mouth syndrome. The chorda tympani branch of the facial nerve (CN VII) supplies chemoreceptors for taste in the anterior (front) two-thirds of the tongue. The glossopharyngeal nerve (CN IX) provides taste sensation for the posterior (back) third of the tongue. There are also taste receptors on the soft palate supplied by the greater superficial petrosal nerve branch of the facial nerve and on the larynx from the superior laryngeal nerve of the vagus nerve (CN X).”
- Dr. Hauser in the video: The vagus nerve runs right along the anterior border (the front) of the C1-C2 vertebrae, down into the neck and it makes its way to the digestive tract. The cause of burning mouth syndrome can be attributed in some cases to compression or stretching of the vagus nerve along its winding path from neck to stomach. In our practice, we look for compression or stretching of the vagus nerve being caused by excessive movement and instability of the C1-C2-C3 and other cervical vertebrae.
- The vagus nerve has direct connections with the facial nerve and the glossopharyngeal nerve and these three nerves the facial nerve glossopharyngeal nerve and vagus nerves they basically are the nerve supply as far as sensation goes to the tongue. The movement of the tongue, that’s the hypoglossal nerve working. The hypoglossal nerve also comes through the C1-C2 area and it also has connections with the vagus nerve but specifically, the facial nerve CN VII the glossopharyngeal nerve, cranial CN IX and the vagus nerve CN X are interconnected.
Nerve pain from disc compression
- Upper cervical instability can nudge or push on the vagus nerve, this can lead to the development of vagal neuropathy or vagal neuritis or you can get hypoglossal neuritis or facial neuritis all because of upper cervical instability. This can cause the burning, the irritation, the awfulness of that horrible pain in the tongue on the roof of the mouth and in the back of the throat.
- When the pain is just in the tongue is not anywhere else, often that’s irritation of the facial nerve. When there is burning in the back of the throat as well, or in the palette in the roof of the mouth that is indicative glossopharyngeal vagus nerve irritation. Often, this is from upper cervical instability.
Burning mouth syndrome is usually not an isolated problem in upper cervical instability. There are other symptoms.
- In every case I’ve ever seen a burning mouth syndrome the people also have other symptoms, it can be dizziness, ringing in the ears, clicking in the neck, migraine headaches, tension headaches, speech problems, swallowing problems, a lot of these symptoms again are problems with the vagus nerve.
Digital motion X-Ray C1 – C2
How we analyze cases beyond simply physical examination is with Digital Motion X-ray (DMX). The DMX will show upper cervical instability.
The digital motion x-ray is explained and demonstrated below
- Digital Motion X-ray is a great tool to show instability at the C1-C2 Facet Joints
- The amount of misalignment or “overhang” between the C1-C2 demonstrates the degree of instability in the upper cervical spine.
- This is treated with Prolotherapy injections to the posterior ligaments that can cause instability.
- At 0:40 of this video, a repeat DMX is shown to demonstrate the correction of this problem.
In this video, Dr. Hauser explains the tell-tale sign of deviated uvula and its possible clue to Burning Mouth Syndrome
There are various clues that the vagus nerve is involved in burning mouth syndrome. One of them is to actually look at the uvula.
- Go to a mirror, shine a flashlight into your mouth and go “ahhh.” If your uvula deviates to the side, we call that a deviated uvula that is one of the biggest signs that the vagus nerve is not functioning correctly.
One of the ways that we objectively document that a person has vagus nerve problems or disrupted or blocked signals from the vagus nerve is by looking at the uvula at the back of the soft palate. When we ask the patient to say “ahhh,” the uvula (the small finger-like tissue that hangs at the back of the soft palate (often mistaken for the tonsils)) should remain centered in the throat.
See (0:40) of the video: When you say “ahhh,” the uvula should stay in the middle. See (0:48) the uvula deviates to the right. This means that the patient’s levator veli palatini (Levator palati) muscle is not supporting or elevating that side of the uvula. That means that this person likely has vagus nerve degeneration and compromised or blocked nerve impulses from the vagus nerve, more specifically, by the pharyngeal branch of the vagus nerve.
Burning Mouth Syndrome a case study not requiring narcotic and anti-depressant medications. Treatment with Prolotherapy
If a person has burning mouth syndrome Prolotherapy treatments may offer relief. In this treatment, simple dextrose is injected into the cervical spine at the ligament attachments to the bone. The goal of the treatments is to tighten chronically stretched out ligaments.
In a case history from Caring Medical, a patient had a dental procedure for gum disease. She then developed a severe burning mouth and underwent “hell” for the next two years. She had various teeth taken out, chelation for heavy metal poisoning, and a host of other treatments without relief of her burning mouth. Consultation after consultation with other providers continued to suggest a dental problem. That is until she had a Prolotherapy consultation where it was discovered that her pain was due to previously undiagnosed neck instability.
In our discussion with the patient, she revealed that she had a history of “tension headaches” and a clicking in her neck, for which she sought out occasional chiropractic manipulation. Her digital motion x-ray showed evidence of cervical instability in multiple areas. I told her in hindsight that it probably wasn’t the procedures themselves that caused this, but the head and neck position during the procedures that caused the condition.
Most healthcare providers are unaware of the stretching of ligaments that occurs when people are held in unusual or uncustomary positions for a long period of time, as in dental and surgical procedures.
I believe that during the gum procedure, her head was extended and her mouth was held open for over an hour which of course stretched her temporomandibular and upper cervical ligaments. This led to stimulation of the trigeminocervical nucleus in the cervical spinal cord, giving a burning mouth sensation. She had a double whammy, stimulus from the cervical and trigeminal nerves. Fortunately, after five Prolotherapy sessions to her jaw and neck, the patient reported the situation was resolving.
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