Burning mouth syndrome and menopause: causes, dry mouth and what helps
Burning mouth syndrome is more common in women in or after perimenopause, and changing estrogen may make the mouth more sensitive. It often has a treatable cause such as dry mouth, thrush or low iron, so a dentist or doctor should check first.
See a dentist or doctor about any mouth burning or soreness that does not go away.2 Get checked promptly for a sore, ulcer, lump, or white or red patch that does not heal, for bleeding or receding gums, or for trouble swallowing.
What burning mouth syndrome is
Burning mouth syndrome causes a burning, scalding or tingling feeling, most often on the tongue. It can also affect the lips, gums, roof of the mouth or throat.1,2 The mouth usually looks normal.2
It is uncommon. Estimates range from under 1% to about 4% of people.1,4 It is more likely if you are female, in or past perimenopause, over 50, or a smoker.2,3
The pain may be there from waking, build through the day, or come and go. Eating or drinking can ease it for a while.2
Burning mouth can affect eating, speaking and sleep.3 Without treatment, it can last for months or even years.1
Why menopause may play a part
Falling estrogen may make the lining of the mouth more sensitive to irritation.1 Some research also points to changes in the nerves that carry taste and pain.1,2
Doctors divide burning mouth into two types. In primary burning mouth, no cause is found. In secondary burning mouth, another problem is behind it.1,2 Common causes to rule out include:1,2,3
- Dry mouth, often from medicines.
- Oral thrush, lichen planus or geographic tongue.
- Low iron, zinc, folate or B vitamins.
- Acid reflux.
- Diabetes or thyroid problems.
- Reactions to dental materials, foods or mouth care products.
- Teeth grinding, poorly fitting dentures, or over-brushing.
- Stress, anxiety or depression.
Some blood pressure medicines are linked to it.2 Ask your doctor or pharmacist before changing any medicine.
Dry mouth, gum changes and taste changes
Burning mouth often comes with a dry mouth and more thirst. Many people also notice a bitter or metallic taste, or less taste.1,2
Dry mouth can be part of the problem as well as a symptom. Reduced saliva is one of the recognized causes of secondary burning mouth.1,2
Sore or tender gums can be part of burning mouth.2 But bleeding, swollen or receding gums are signs of gum disease, so see a dentist. Rough brushing, abrasive toothpaste and too much mouthwash can all irritate the mouth.2
Diagnosis and treatment
A dentist is often the first stop. Tests may include blood tests, a mouth swab, a saliva test, allergy tests or, sometimes, a biopsy.1
If a cause is found, treating it may clear the burning.1 Primary burning mouth has no cure, but symptoms can often be managed.1 Your dentist and doctor may work together on this.2
The research is thin. A 2016 Cochrane review found 23 small trials with 1,121 people. It found insufficient evidence to support or refute any treatment.4 Treatments with some signs of benefit, all at very low certainty, included:4
- Clonazepam dissolved in the mouth, a prescription medicine.
- Gabapentin and thin tongue covers, in single trials.
- Psychological therapy and a chili (capsaicin) mouth rinse, in single small trials.
Antidepressants and saliva stimulants did not show benefit in that review. Alpha-lipoic acid supplements caused headaches and stomach upset.4 Mayo Clinic specialists say hormone therapy may be considered when menopause seems to be involved.3
Everyday steps may ease discomfort:1,3
- Sip cold water, suck ice chips or chew sugar-free gum.
- Cut back on acidic, spicy and very hot foods, alcohol and fizzy drinks.
- Avoid tobacco, and cinnamon- or mint-flavored products.
- Use a mild toothpaste and an alcohol-free mouthwash.
What helps: options rated
| Option | Evidence | What the research shows |
|---|---|---|
| Finding and treating an underlying cause | Treating dry mouth, thrush, reflux or a vitamin or iron deficiency can improve secondary burning mouth. This is standard practice rather than trial-based.1,2 | |
| Avoiding mouth irritants | Clinics advise cutting acidic and spicy foods, alcohol, tobacco and harsh mouth products. This is expert advice with few trials.1,3 | |
| Clonazepam dissolved in the mouth | Eased symptoms in small trials, but the Cochrane review rated the evidence very low certainty. Prescription-only.4 | |
| Psychological therapy (such as CBT) | One small trial showed longer-term relief.4 It is also offered because stress and anxiety often go with burning mouth.1 | |
| Capsaicin (chili) mouth rinse | Helped in one small trial of 18 people.4 Specialists sometimes use it to dull burning pain.3 | |
| Hormone therapy (HRT) | Mayo Clinic specialists list it as an option when menopause seems involved, but it was not among the treatments with trial support in the Cochrane review.3,4 | |
| Alpha-lipoic acid and other supplements | Supplements showed no long-term difference from placebo, and alpha-lipoic acid caused side effects in some trials.4 |
Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.