Burning Tongue Diagnosis: Finding Answers for Oral Discomfort

Burning mouth syndrome (BMS), often experienced as a burning tongue, is a complex condition characterized by chronic pain in the oral cavity. Diagnosing burning tongue, or BMS, requires a systematic approach to rule out other potential causes before confirming a diagnosis. This article will guide you through the diagnostic process for burning tongue syndrome, helping you understand what to expect when seeking medical advice for this condition.

Unraveling Burning Tongue Syndrome: The Diagnostic Journey

Diagnosing burning tongue syndrome isn’t straightforward. There’s no single definitive test. Instead, healthcare professionals rely on a process of elimination, carefully considering your symptoms, medical history, and conducting various examinations and tests to exclude other conditions that might mimic burning mouth syndrome.

Your journey to a Burning Tongue Diagnosis typically begins with a thorough evaluation by your dentist or primary care physician. This initial assessment is crucial and usually involves the following steps:

Comprehensive Medical and Dental History Review

Your healthcare provider will start by gathering detailed information about your health history. This includes:

Medical History: They will inquire about any pre-existing medical conditions you have, such as diabetes, nutritional deficiencies, autoimmune disorders, and neurological conditions. These conditions can sometimes contribute to oral discomfort and need to be ruled out.
Medications: A complete list of all medications you are currently taking, including prescription drugs, over-the-counter medications, vitamins, and supplements, is essential. Some medications can have side effects that manifest as oral burning or dryness.
Symptom Description: You’ll be asked to describe your symptoms in detail. This includes the location of the burning sensation (specifically on the tongue, lips, palate, or throughout the mouth), the intensity of the pain, when it started, what makes it better or worse, and if there are any other associated symptoms like taste changes or dry mouth.
Oral Hygiene Habits: Your dentist will discuss your oral hygiene routine, including how often you brush and floss, the type of toothpaste and mouthwash you use, and any habits like teeth grinding or clenching. Certain oral care products or habits could be contributing to your discomfort.

Following the history review, a physical examination, particularly of your mouth, will be performed.

Meticulous Oral Examination

A careful examination of your mouth is a critical step in diagnosing burning tongue. Your dentist or doctor will visually inspect:

Tongue: They will look for any visible abnormalities on your tongue, such as lesions, redness, swelling, or changes in texture.
Oral Mucosa: The lining of your mouth (mucosa), including the cheeks, gums, palate, and throat, will be examined for signs of infection, inflammation, or other lesions.
Saliva: They will assess the moisture level in your mouth, checking for signs of dry mouth, which can be associated with burning sensations.

This initial assessment helps to rule out obvious dental or oral health problems. To further investigate and exclude other medical conditions, your healthcare provider may recommend a series of tests.

Diagnostic Tests to Exclude Underlying Conditions

To arrive at a diagnosis of burning tongue syndrome, it’s crucial to eliminate other potential causes of your oral discomfort. Various tests might be employed, depending on your individual case and suspected underlying factors:

Blood Tests: A Broad Health Overview

Blood tests are frequently ordered to screen for a range of systemic conditions that can manifest as burning mouth symptoms. These tests may include:

Complete Blood Count (CBC): This test evaluates your overall health and can detect signs of infection, anemia, and other blood disorders.
Blood Sugar Level (Glucose): Diabetes can sometimes cause nerve damage (neuropathy), which can lead to burning sensations, including in the mouth.
Thyroid Function Tests: An underactive thyroid (hypothyroidism) can be associated with oral symptoms.
Nutritional Panel: Deficiencies in certain vitamins and minerals, such as vitamin B12, folate, iron, and zinc, can contribute to burning mouth sensations.
Immune System Function Tests: These tests assess how well your immune system is working and can help identify autoimmune disorders that might be related to your symptoms.

Oral Cultures and Biopsies: Investigating Local Infections

If an infection is suspected in your mouth, your doctor may perform:

Oral Culture: A simple swab is used to collect a sample from your mouth. This sample is then sent to a lab to identify any fungal, bacterial, or viral infections. Candidiasis (oral thrush), for example, is a fungal infection that can cause burning sensations.
Oral Biopsy: In some cases, a small tissue sample (biopsy) may be taken from your oral mucosa and examined under a microscope. This can help detect cellular abnormalities, inflammation, or other tissue changes that could be causing your symptoms.

Allergy Testing: Identifying Potential Irritants

Allergic reactions to certain substances can sometimes trigger oral burning. Allergy testing might be recommended to identify potential triggers such as:

Foods and Food Additives: Certain foods or food additives can cause allergic reactions that affect the mouth.
Dental Materials: Some people may be sensitive or allergic to materials used in dental fillings, dentures, or other dental appliances.
Mouth Care Products: Ingredients in toothpaste, mouthwash, or other oral hygiene products can sometimes irritate the oral mucosa.

Salivary Flow Measurements: Assessing Dry Mouth

Dry mouth (xerostomia) is a common symptom reported by individuals with burning mouth syndrome. Salivary flow tests can objectively measure the amount of saliva your mouth produces to determine if reduced saliva production is a contributing factor.

Gastric Reflux Testing: Ruling Out Acid Reflux

Gastroesophageal reflux disease (GERD), or acid reflux, can sometimes cause oral symptoms, as stomach acid can irritate the mouth and throat. Gastric reflux tests can determine if stomach acid is flowing back into your mouth and contributing to your burning sensation.

Imaging Studies: Exploring Deeper Issues

In some instances, your healthcare provider might recommend imaging tests, such as:

MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) Scan: These imaging techniques can provide detailed pictures of your head and neck, helping to rule out structural abnormalities or other underlying medical conditions that might be causing nerve-related oral pain.

Medication Review and Change: Identifying Drug-Related Causes

If you are taking medications, especially new ones, your doctor will review them carefully, as some drugs can have side effects that manifest as oral discomfort. In some cases, they may suggest:

Dose Adjustment: Lowering the dose of a medication might alleviate the burning sensation if it is a side effect.
Medication Switch: Changing to a different medication within the same class or to an alternative drug might resolve the issue.
Temporary Discontinuation (Under Supervision): In certain situations, and always under medical supervision, temporarily stopping a medication might be suggested to see if the burning sensation subsides. Never stop taking prescription medications without consulting your doctor.

Mental Health Assessment: Considering Psychological Factors

Burning mouth syndrome is sometimes linked to psychological factors like anxiety, depression, and stress. You may be asked to answer questionnaires or undergo a mental health evaluation to assess your psychological well-being and determine if these factors are contributing to your condition. It’s important to note that this does not mean the pain is “all in your head,” but rather that psychological factors can influence the perception and experience of chronic pain.

Reaching a Diagnosis

After a thorough evaluation and the necessary tests, your healthcare provider will analyze all the information to determine the most likely cause of your burning tongue symptoms. If other conditions have been ruled out and your symptoms align with the characteristics of burning mouth syndrome, a diagnosis of BMS, or burning tongue syndrome, may be made.

It’s important to remember that diagnosing burning tongue syndrome can be a process. Be patient and work closely with your healthcare team to navigate the diagnostic journey and find appropriate management strategies to improve your comfort and quality of life.

Lifestyle Adjustments and Home Care

Alongside medical diagnosis and treatment, certain lifestyle adjustments and home care strategies can help manage burning tongue symptoms:

Hydration: Drink plenty of fluids, especially water, to combat dry mouth. Sucking on ice chips can also be soothing.
Dietary Modifications: Avoid acidic foods and drinks (citrus fruits, tomatoes, carbonated beverages, coffee), spicy foods, alcohol, and tobacco, as these can irritate the oral mucosa.
Oral Hygiene Product Review: Switch to mild, flavor-free toothpastes and mouthwashes, avoiding products with cinnamon or mint.
Stress Reduction: Practice relaxation techniques like yoga, meditation, or deep breathing exercises to manage stress, which can exacerbate symptoms.

If you are experiencing persistent burning tongue discomfort, seeking professional medical advice is the first and most important step towards finding relief and managing your condition effectively.

Request an appointment

References:

AskMayoExpert. Burning mouth syndrome (adult). Mayo Clinic; 2021.
Burning mouth syndrome. National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/health-info/burning-mouth. Accessed Nov. 7, 2022.
Burning mouth syndrome. Merck Manual Professional Version. https://www.merckmanuals.com/professional/dental-disorders/lip-and-tongue-disorders/burning-mouth-syndrome. Accessed Nov. 7, 2022.
Teruel A, et al. Burning mouth syndrome: A review of etiology, diagnosis, and management. General Dentistry. 2019;67:24.
Klein B, et al. Burning mouth syndrome. Dermatologic Clinics. 2020; doi:10.1016/j.det.2020.05.008.
Reyad AA, et al. Pharmacological and non-pharmacological management of burning mouth syndrome: A systematic review. Dental and Medical Problems. 2020; doi:10.17219/dmp/120991.
Orliaguet M, et al. Neuropathic and psychogenic components of burning mouth syndrome: A systematic review. Biomolecules. 2021; doi:10.3390/biom11081237.
Burning mouth syndrome. American Academy of Oral Medicine. https://www.aaom.com/index.php?option=com_content&view=article&id=81:burning-mouth-syndrome&catid=22:patient-condition-information&Itemid=120. Accessed Nov. 7, 2022.
Nosratzehi T. Burning mouth syndrome: A review of therapeutic approach. Journal of Complementary and Integrative Medicine. 2022; doi:10.1515/jcim-2021-0434.
Davis DMR (expert opinion). Mayo Clinic. Nov. 11, 2022.