Caring Medical - Where the world comes for ProlotherapyBurning Mouth Syndrome

Prolotherapy Burning Mouth Syndrome

Ross Hauser, MD

New research published in the Journal of Headache and Pain describes the difficulty doctors face in understanding what Burning Mouth Syndrome is and how to treat it.

Before continuing on with this article, do you have a question about Burning Mouth Syndrome or need help? Get help and Information from the Caring Medical staff.

Here are some of the bullet points of this study, I added parenthesis for emphasis and understanding.

  • Burning Mouth Syndrome  is a chronic pain condition characterized by persistent intraoral 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 BMS. (Do not agree see the remainer of this article).
  • (The researchers) aimed to observe the long-term effectiveness of high velanfaxine doses (Anti-depressant nerve medication that can be prescribed for general 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: Difficult to treat Burning Mouth Syndrome deserves bottomless psychiatric evaluation and management.1

In November 2016, doctors and dentists in the United Kingdom released a detailed examination of the conventional treatments available to patients with Burning Mouth Syndrome.

Here is the summary of their findings:

The treatments examined were:

  • antidepressants and antipsychotics,
  • anticonvulsants,
  • benzodiazepines,
  • cholinergics,
  • 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.”2

The difficulties and the necessity for a trusted relationship between the doctor and the patient was described in a recent paper from doctors in India:

“The complex and multifactorial etiology of Burning Mouth Syndrome necessitates systematic and interdisciplinary approach for the proper management of these patients.

Although many drugs, treatment methods have been proposed for the management of BMS, none of them proves to be a gold standard one and are not satisfactory.

Treatment planning should be custom made to each patient.

Obtaining the correct clinical diagnosis of BMS is of paramount importance for the management.”3

Burning Mouth Syndrome a case study not requiring narcotic and anti-depressant medications

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.

If your tongue feels like it is on fire and all your tests come back negative you have probably been diagnosed with burning mouth syndrome (BMS). While this can be the only symptom, in cases that have come to me for an evaluation we usually find other symptomology which lends support to the fact that BMS can be one of the manifestations of Barre-Lieou Syndrome or cervicocranial syndrome, and ultimately due to cervical instability or laxity of the ligaments in the head and neck region.

Regardless of what you call it, the disorder involves the autonomic nervous system. It is yet another disorder where a person has an overactive sympathetic nervous system and because there is no test to “definitively prove” this, the patient goes from doctor to doctor without much help for the symptoms.

Nerve Entrapment Syndromes

Burning Mouth Syndrome involves severe pain in the tongue and oral mucosal surfaces of the mouth. It typically gets worse the more a person talks. Because laboratory and radiological data are often normal, no clear etiological basis for the condition exists. Thus, traditional doctors sometimes believe the symptoms are psychological in nature. We believe the symptoms are an overactive sympathetic nervous system.


BMS occurs most commonly in postmenopausal women with a higher incidence among people aged 50 to 60 years. Those not on natural hormone replacement in my experience have a tendency to have an overactive sympathetic nervous system, thus “hot flashes.” Hot flashes are another manifestation of an overactive autonomic nervous system. Other symptoms include:

• Throat secretions



• Prickling/tingling sensations in the face and down the arms

• Inability to see/focus as well at dusk (or in the dark)

The sympathetic nerves that go to the mouth/face are just anterior to the cervical vertebrae. Any type of excessive movement of these vertebrae anterior could irritate these nerves. Thus, we find a high association of BMS with Barre-Lieou Syndrome.

Diagnosis and Treatment

The first question to ask is are there other symptoms along with the burning mouth? If a person also has TMJ pain (jaw pain) and/or neck pain, then Prolotherapy is done to the neck and/or TMJ. If the person has tenderness of the TMJ, neck or stylomandibular ligament, during physical examination, these structures are treated. The stylomandibular ligament is associated with a condition called Eagle or Ernest’s Syndrome, which also can give symptoms in the mouth, tongue, and throat. Again, Prolotherapy is the best treatment we have found for these symptoms/conditions.

If it appears that the person has other symptoms including sleeplessness, hormone imbalances and mental fatigue and other systemic symptoms, then a comprehensive natural medicine evaluation with potential diet and hormone testing is done. The person is then placed on the appropriate diet, including avoidance of any known allergenic foods. If any hormones are sub-optimal, these are supplemented using natural hormone replacement. If the person has insomnia then this is dealt with by various herbal supplements and if needed medications.

Can Prolotherapy be successful in treating Burning Mouth Syndrome?

Like Barre-Lieou Syndrome, if a person’s autonomic nervous system overactivity is due to a neck instability or other structural lesion, then Prolotherapy is typically very successful at treating this condition. Generally, the person is seen every month for three to six visits. In our experience, one series of injections (3 to 6 visits) is typically all that is needed.

A comprehensive evaluation along with aggressive Prolotherapy to the involved structures would give the person with BMS a great chance at healing.

If you or someone you know has burning mouth syndrome, let them know that Prolotherapy is likely another treatment option, particularly if they have concomitant TMJ, stylomandibular ligament or neck pain, along with the burning mouth

Before continuing on with this article, do you have a question about Burning Mouth Syndrome or need help? Get help and Information from the Caring Medical staff.

1 Mitsikostas DD, Ljubisavljevic S, Deligianni CI. Refractory burning mouth syndrome: clinical and paraclinical evaluation, comorbidities, treatment and outcome. The Journal of Headache and Pain. 2017 Dec 1;18(1):40. [Pubmed] [Google Scholar]

McMillan R, Forssell H, Buchanan JA, Glenny AM, Weldon JC, Zakrzewska JM. Interventions for treating burning mouth syndrome. Cochrane Database Syst Rev. 2016 Nov 18;11:CD002779. [Pubmed] [Google Scholar]

3 Aravindhan R, Vidyalakshmi S, Kumar MS, Satheesh C, Balasubramanium AM, Prasad VS. Burning mouth syndrome: A review on its diagnostic and therapeutic approach. Journal of Pharmacy & Bioallied Sciences. 2014 Jul;6(Suppl 1):S21.  [Pubmed] [Google Scholar]



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