What are alternative treatments for burning mouth syndrome?

Introduction

Burning mouth syndrome (BMS) is a poorly understood condition in which a person experiences ongoing moderate to severe pain in the tongue or mouth, or both. Although the cause of BMS remains unclear, some patterns have become clear to researchers. The pain is generally worse in the late afternoon and early evening but disappears at night. Most often, more than one part of the mouth is involved. Common areas of burning pain include the tongue, the hard palate (the front part of the roof of the mouth), and the lower lip. Many people recover spontaneously within six or seven years. Dry mouth and altered taste sensations often, but not always, accompany the pain.

BMS is thought to fall in the general category of neuropathic pain, meaning
that it probably results from altered nerve function, possibly in the nerves
carrying taste sensation. The use of drugs in the angiotensin I-converting enzyme
(ACE) inhibitor family has been implicated in some cases of
BMS, but the reason for this apparent connection remains unclear.

Conventional treatment for BMS consists of drugs used to treat neuropathic pain
in general, including anticonvulsants, sedatives in the benzodiazepine family, and tricyclic
antidepressants. There is inadequate research to determine
the precise efficacy of these treatments.

Principal Proposed Treatments

The supplement lipoic acid has shown promise for the treatment of diabetic neuropathy, another form of neuropathic pain. Lipoic acid has also been studied for burning mouth syndrome with mixed results.

In a double-blind trial, sixty people with burning mouth syndrome received either lipoic acid (200 milligrams three times daily) or placebo for a period of months. Researchers reported that almost all persons receiving lipoic acid showed significant improvement, while none of those taking placebo improved; relative benefits endured at twelve-month follow-up. The lack of benefit seen in the placebo group is difficult to believe, and it raises concerns about the study’s reliability. Subsequently, two double-blind trials involving fifty-two and thirty-nine persons, respectively, failed to find benefit for lipoic acid and noted a large placebo response.

Other Proposed Treatments

The yeast Candida albicans can infect the mouth, causing a
condition called thrush. Thrush may cause symptoms similar to BMS. Some
alternative practitioners believe that excessive Candida, or
hypersensitivity to it, is the cause of many illnesses. For this reason, they
recommend using antifungals to treat BMS. However, no direct evidence supports
this approach, and it appears that people with BMS are no more likely to have
measurable detectible Candida in the mouth than are people
without BMS.

Inconsistent evidence suggests that people with BMS might have deficiencies in various nutrients, such as vitamins B1, B2, and B6, and zinc. However, no evidence exists to show that supplementation with these nutrients will have any effect on BMS symptoms. Also, a placebo-controlled trial involving thirty-nine persons failed to show any significant benefit for twelve weeks of treatment with Hypericum perforatum extract (St. John’s wort).

Herbs and Supplements to Avoid

Numerous herbs and supplements may interact adversely with drugs used to treat burning mouth syndrome, so one should be cautious when considering the use of herbs and supplements.

Bibliography

Carbone, M., et al. “Lack of Efficacy of Alpha-Lipoic Acid in Burning Mouth Syndrome.” European Journal of Pain 13 (May, 2009): 492-496.

Femiano, F., and C. Scully. “Burning Mouth Syndrome (BMS): Double Blind Controlled Study of Alpha-Lipoic Acid (Thioctic Acid) Therapy.” Journal of Oral Pathology and Medicine 31 (2002): 267-269.

Lopez-Jornet, P., F. Camacho-Alonso, and S. Leon-Espinosa. “Efficacy of Alpha Lipoic Acid in Burning Mouth Syndrome.” Journal of Oral Rehabilitation 36 (2008): 52-57.

Sardella, A., et al. “Hypericum perforatum Extract in Burning Mouth Syndrome.” Journal of Oral Pathology and Medicine 37 (2008): 395-401.

Ship, J. A., et al. “Burning Mouth Syndrome.” Journal of the American Dental Association 126 (1995): 842-853.