For those of you fortunate enough not to have heard of Burning Mouth Syndrome (BMS), let me introduce you to this debilitating pain condition. BMS is characterized by a burning sensation in the tongue and/or other oral mucosal areas. It is often associated with dry mouth and other taste changes.
Who Gets Burning Mouth Syndrome and What Causes It?
There are 2 categories of BMS: Primary (idiopathic = basically no one knows what causes it) and Secondary (there is an obvious cause such as a yeast overgrowth or a medication). Peri and postmenopausal women have a higher risk of developing this disorder. The puzzling part is that no one knows how or why this strikes some people and not others. There are theories that it might be related to hormonal imbalances or increased mental stress. BMS is often associated with other conditions such as sleep disturbances, depression, and anxiety. [1, 2]
One Size Does NOT Fit All
In the case of Primary BMS, because there is no known cause for this disorder, it’s been difficult to come up with one single effective treatment. Certainly not what sufferers of BMS are hoping to hear. But although there currently is not a one size fits all treatment, it is not completely hopeless. There are different treatment options available, and many have been proven to be helpful in many cases. It’s just a matter of having patience and trying to find a treatment that works for you.
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Using Medications: Clonazepam
Currently, the most frequently prescribed first-line therapy for Primary BMS is clonazepam, an anti-anxiety/anti-convulsant medication. Clonazepam is prescribed in very low doses, crushed, mixed with water into a slurry, and held on the affected area for 3 minutes. And all the while, you are expected not to swallow any of this concoction. One study showed a 75% improvement with clonazepam. Because this low-dose clonazepam is being used topically, there aren’t too many major side effects. However, for those hoping for a more natural solution, clonazepam is still a medication, not a naturally occurring substance. Not to mention that the protocol for using clonazepam isn’t the easiest to comply with. So, are there other options? Yes.
Nature Provides Relief: Alpha Lipoic Acid
If you’re like me and prefer to try non-pharmacological treatments, then I’m here to tell you that you do have an option! A nutraceutical called Alpha Lipoic Acid (ALA). ALA is a compound that naturally occurs in nature, it’s made by plants, animals, and humans. It is made in small quantities in human bodies, so most of it has to come from our diet. ALA plays an important role in glucose metabolism and acts as an antioxidant. So, it protects our cells. ALA is already widely used in the treatment and prevention of diabetic neuropathy, a serious complication of diabetes that results in numbness, muscle weakness, and pain.
Is ALA Here to Save the Day?
ALA has been used in several trials to manage the symptoms of BMS and the results have been very promising though more studies are still needed. In one double-blinded controlled study of ALA therapy for BMS, there was a significant improvement in pain, compared with placebo, with the majority of test subjects showing some improvement after 2 months, and more than 70% of the subjects maintained this improvement at 1 year.5 Another study found that 66% of test subjects taking ALA with BMS symptoms reported significant improvements compared with only 15% receiving the placebo. The success of these ALA trials on BMS patients suggests that BMS may be a type of neuropathy (damage or dysfunction of a nerve).
Taste Changes and ALA
Interestingly, there’s only been one study on ALA’s effects on idiopathic dysgeusia (an altered perception of taste). This one study showed that ALA therapy resulted in significant improvements in symptoms, suggesting that dysgeusia may also be a type of neuropathy similar to BMS. It will be interesting to see if ALA might be a viable mode of therapy for the growing number of patients suffering from Covid-19 related taste changes.
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- Reyad AA, Mishriky R, Girgis E. Pharmacological and non-pharmacological management of burning mouth syndrome: A systematic review. Dent Med Probl. 2020 Jul-Sep;57(3):295-304. doi: 10.17219/dmp/120991. PMID: 33113291.
- Imamura Y, Okada-Ogawa A, Noma N, Shinozaki T, Watanabe K, Kohashi R, Shinoda M, Wada A, Abe O, Iwata K. A perspective from experimental studies of burning mouth syndrome. J Oral Sci. 2020 Mar 28;62(2):165-169. doi: 10.2334/josnusd.19-0459. Epub 2020 Mar 11. PMID: 32161235.
- Kuten-Shorrer M, Treister NS, Stock S, Kelley JM, Ji YD, Woo SB, Lerman MA, Palmason S, Sonis ST, Villa A. Topical Clonazepam Solution for the Management of Burning Mouth Syndrome: A Retrospective Study. J Oral Facial Pain Headache. 2017 Summer;31(3):257-263. doi: 10.11607/ofph.1754. PMID: 28738111.
- Salehi B, Berkay Yılmaz Y, Antika G, Boyunegmez Tumer T, Fawzi Mahomoodally M, Lobine D, Akram M, Riaz M, Capanoglu E, Sharopov F, Martins N, Cho WC, Sharifi-Rad J. Insights on the Use of α-Lipoic Acid for Therapeutic Purposes. Biomolecules. 2019 Aug 9;9(8):356. doi: 10.3390/biom9080356. PMID: 31405030; PMCID: PMC6723188.
- Femiano F, Scully C. Burning mouth syndrome (BMS): double blind controlled study of alpha-lipoic acid (thioctic acid) therapy. J Oral Pathol Med. 2002 May;31(5):267-9. doi: 10.1034/j.1600-0714.2002.310503.x. PMID: 12110042.
- Femiano F, Gombos F, Scully C, Busciolano M, De Luca P. Burning mouth syndrome (BMS): controlled open trial of the efficacy of alpha-lipoic acid (thioctic acid) on symptomatology. Oral Dis. 2000 Sep;6(5):274-7. doi: 10.1111/j.1601-0825.2000.tb00138.x. PMID: 11002408.
- Femiano F, Scully C, Gombos F. Idiopathic dysgeusia; an open trial of alpha lipoic acid (ALA) therapy. Int J Oral Maxillofac Surg. 2002 Dec;31(6):625-8. doi: 10.1054/ijom.2002.0276. PMID: 12521319.