Doctor K: Several things may cause burning mouth

DEAR DOCTOR K: For months, my mouth has been painfully burning and tingling. What could be causing my symptoms? Are there any treatments for it?

DEAR READER: Several conditions can cause a burning sensation in the mouth. Some nutritional deficiencies – particularly of B vitamins, iron and zinc – can cause it. These problems can be detected by simple blood tests.

Medicines that cause the mouth to become dry (due to decreased saliva production) can result in mouth irritation. There are too many of these medicines to list here, but check a reliable website that provides information about drugs and their side effects.

Sometimes a person can develop an allergy to dentures and related adhesive creams, toothpastes or mouthwashes that produce irritation of the tissues of the mouth. You can experiment by seeing what happens when you stop using one of these potential allergy triggers (and substituting a different brand).

Conditions that damage small nerves, such as diabetes, can cause mouth pain. So can mouth infections, particularly with fungus (yeast).

There also is a condition called burning mouth syndrome (BMS) that produces a burning – sometimes scalding – sensation on the lips and tongue and throughout the mouth. In BMS, the pain is present for at least some part of every day, the tissues of the mouth look normal (not irritated or inflamed) to the doctor or dentist, and the conditions I have mentioned already are not present.

Doctors don’t know what causes BMS. Some think it is a psychiatric condition, but I’m dubious about that. I think that when doctors don’t understand the cause of a person’s symptoms, we sometimes think (and say to our patient) that the symptoms are just imaginary. That may make us feel better, but it doesn’t make the patient feel so great. And if there really is a problem that we’re ignoring, we have failed.