The Mystery of Burning Mouth Syndrome

Most people can relate to the uncomfortable feeling that occurs after scalding their mouth on hot soup or coffee. It's a relief when that burnt feeling subsides after several days. But imagine experiencing that burning sensation all day, every day. The condition is called burning mouth syndrome (BMS), and damage to the nervous system during menopause may be to blame, according to an article published in the May/June 2011 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD).

 

BMS affects nearly 5 percent of Americans and causes a constant burning sensation, most commonly on the top of the tongue, lower lip, and roof of the mouth.

 

"The cause of BMS is currently unknown, but our findings support the theory that this is a neuropathic condition," says lead study author Gary D. Klasser, DMD. "For reasons unknown, it seems that the BMS patient's nerves are not sending and/or processing information correctly—there's a short circuit in the nervous system and the brain can't turn off the pain receptors."

 

Although BMS can affect both sexes, the study confirms by a 7:1 ratio that women in their menopausal and post-menopausal years are more likely to be affected by BMS.

 

"For a small percentage of women, it is these hormonal changes that may alter taste and the way in which a person interprets pain," says Dr. Klasser. "The alterations may be enough to start the cascade of events that lead to BMS."

 

With no physical signs, it is very difficult for many health practitioners to recognize, diagnose, and manage BMS. As with most BMS sufferers, the patients in this study experienced oral burning symptoms for several years and visited multiple health practitioners prior to receiving a definitive diagnosis of BMS.

 

"Besides reporting oral burning, patients describe experiencing a dry, gritty feeling in the mouth, as well as alterations in taste," says AGD Spokesperson Eugene Antenucci, DDS, FAGD. "But because many health practitioners are not familiar with BMS and cannot see any physical symptoms, patients often leave the doctor's office frustrated and untreated."

 

Although no cure currently exists, health practitioners who have an understanding of the syndrome can help patients manage their symptoms.

 

"BMS is not a matter of life or death, but it is a matter of quality of life," says Dr. Antenucci. "Patients who believe they suffer from any of these symptoms should speak with their general dentist and seek out a health practitioner who has experience with this condition."

 

Medications, both topical and systemic, are available to treat BMS. Patients should consult their doctor to determine the medication that is best for them.

 

Some helpful ways for patients to alleviate the symptoms of BMS without taking medication are to drink water regularly to keep the mouth lubricated; avoid spicy, hot, acidic foods that can amplify symptoms; chew sugarless gum to increase saliva flow; and avoid tobacco and alcohol products that can cause irritation to the oral tissue.

 

Have a heart to heart with your dentist

Congestive heart failure (CHF), a condition in which the heart cannot pump enough blood to the body's organs, affects more than 3 million people in the United States, with approximately 400,000 new cases each year.

 

People with a history of an untreated or poorly managed CHF, may be at high risk during a dental treatment for infection, cardiac arrest, stroke and heart attack, according to the lead author of a new study that appears in the May/June 2002 issue of General Dentistry, the clinical, peer-reviewed publication of the Academy of General Dentistry (AGD).

 

"Bacteria released during a dental cleaning travels through the bloodstream and to the areas that help pump blood to other organs," says Nelson L. Rhodus, DMD, MPH, lead author of the study. "Patients with untreated CHF are at high risk for infections because the bacteria released can trigger blood clots that may exacerbate the existing condition."

 

Dr. Rhodus hopes his findings help increase patient awareness about getting CHF under control so patients can receive dental treatment.

What is Gum Disease?

Gum disease, or periodontal disease is a chronic inflammation and infection of the gums and surrounding tissue. It is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life. Periodontal diseases include gingivitis and periodontitis.

 

What causes gum disease?

 

Bacterial plaque – a sticky, colorless film that constantly forms on the teeth – is recognized as the primary cause of gum disease. If plaque isn't removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar).Toxins produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets that fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper, and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

 

Are there other factors?

 

Yes. Genetics is also a factor, as are lifestyle choices. A diet low in nutrients can diminish the body's ability to fight infection. Smokers and spit tobacco users have more irritation to gum tissues than non-tobacco users, while stress can also affect the ability to ward off disease. Diseases that interfere with the body's immune system, such as leukemia and AIDS, may worsen the condition of the gums. In patients with uncontrolled diabetes, where the body is more prone to infection, gum disease is more severe or harder to control. Pregnant women experience elevated levels of hormones that cause the gums to react differently to the bacteria found in plaque, and in many cases can cause a condition known as "pregnancy gingivitis."

 

What are the warning signs of gum disease?

 

Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, pus between the gum and tooth, persistent bad breath, a change in the way teeth fit together when the patient bites and a change in the fit of dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That's why patients are advised to get frequent dental exams.

 

What does periodontal treatment involve?

 

In the early stages of gum disease, most treatment involves a special cleaning called scaling and root planning, which removes plaque and tartar around the tooth and smoothing the root surfaces. Antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums – sometimes with the assistance of a laser – and removing the hardened plaque build-up and recontouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.

How do you prevent gum disease?

 

Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. Your dentist can design a personalized program of home oral care to meet your needs.

 

What is the role of the general dentist?

 

The general dentist usually detects gum disease and treats it in the early stages. Some general dentists have acquired additional expertise to treat more advanced conditions of the disease. If the general dentist believes that the gum disease requires treatment by a specialist, the patient will be referred to a periodontist. The dentist and periodontist will work together to formulate a treatment plan for the patient.

 

How can I maintain treatment at home?

 

Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of periodontal therapy. Patients should visit the dentist every three to four months (or more, depending on the patient) for spot scaling and root planing and an overall exam. In between visits, they should brush at least twice a day, floss daily and brush their tongue. Manual soft nylon bristle brushes are the most dependable and least expensive. Electric brushes are also a good option, but don't reach any further into the pocket than manual brushes. Proxy brushes (small, narrow brushes) and other interdental cleaners are the best way to clean between the recesses in the teeth and should be used once a day. Wooden toothpicks and rubber tips should only be used if recommended by your dentist.

Mouthguard Warrior Kids

Most people, kids included, have experienced the "weekend warrior" syndrome, where you think your body is invincible to injury and that you do not need protective gear such as helmets for your head and pads for your knees, shins and elbows. In particular, teeth are often forgotten. Although the dental profession unanimously supports the use of mouthguards in a variety of athletic and recreational activities, consumers remain resistant to and ill-informed of the importance and advantages of wearing a mouthguard during their weekend activities.

 

"There are three reasons most people don't wear mouthguards: cost, the ‘headache factor‘ and image," says David Kumamoto, DDS, FAGD. "What people fail to realize is how many serious injuries such as concussions, jaw fractures and neck injuries are prevented by mouthguards."

 

It is estimated that mouthguards prevent more than 200,000 injuries each year. Although orofacial injuries are traditionally associated with contact sports such as football and hockey, findings show that soccer players are more likely than football players to sustain an orofacial injury and basketball players have a risk up to 15 times that of football players. These statistics do not include the number of people participating in leisure sports such as flag football and pick-up basketball games with friends. And, more people currently participate in organized soccer than those participating in competitive football, where mouthguards and face masks are mandatory.

 

"Pick-up games prove more of a risk than supervised sports because there are no officials to enforce game rules," says Dr. Kumamoto. "But even supervised sports have their share of serious injuries due to the lack of protective equipment. Sudden falls and accidental collisions during a game or athletic activity can cause dental injuries."

 

"Of the three types of mouthguards that are currently available, a custom-made mouthguard by your dentist offers the best protection, fit and comfort level because it is made from a cast to fit your teeth," says Dr. Kumamoto. "Mouth-formed guards are available at sporting goods stores and are less expensive than custom-made guards, however the fit is not as good and it will not last as long. A stock mouthguard, the least expensive choice, offers the least protection since little can be done to adjust the fit. However, even the least expensive mouthguard is better than none."

 

The Academy of General Dentistry recommends that players participating in basketball, softball, wrestling, soccer, lacrosse, rugby, in-line skating and martial arts, whether for an athletic competition or leisure activity, wear mouthguards while competing.

Dental Sealants: Is My Child a Candidate?

  By age 19, tooth decay affects nearly 70 percent of America's children, according to the Centers for Disease Control and Prevention (CDC). Left untreated, tooth decay, also known as cavities, may result in pain and infection.

 

One highly effective option to help prevent cavities is dental sealants – a thin plastic film painted on the chewing surface of teeth.

 

Dental sealants have been proven a safe and cost-efficient dental procedure for patients prone to cavities. Even health care task forces are recognizing the benefits of dental sealants, recommending school-based programs.

 

However, an article in the February 2006 issue of AGD Impact, the Academy of General Dentistry's (AGD) monthly newsmagazine, cites several reports that explain dental sealants are still underused, despite their advantages in averting tooth decay for an average of five to seven years.

 

"Studies show that many children are exceptional candidates for dental sealants.," says AGD spokesperson Mark Ritz, DDS, MAGD. "Parents should consider sealants as a preventive measure in their child's oral health and discuss this option with their dentist."

 

Surveys show the majority of all cavities occur in the narrow pits and grooves of a child's newly erupted teeth because food particles and bacteria are not easily cleaned out. A risk assessment by a dentist best determines if a child is a candidate for dental sealants.

 

Dental sealants act as a barrier to "seal-off" space between the tooth surface and any small food particles or bacteria that may otherwise cause a cavity in an "unsealed" tooth.

 

Paired with twice-daily brushing with a fluoridated toothpaste, a healthy diet and visiting the dentist twice a year to monitor the sealants' placement or bond on the tooth, properly applied dental sealants are 100-percent effective in preventing cavities.

 

"Remember that dental sealants do not protect against gum disease such as gingivitis, oral cancer or many common dental conditions," says Dr. Ritz. "Regular dental checkups are vital to monitor overall oral health."

 

Benefits of dental sealants:

 

• Paired with good oral health care, sealants are 100-percent effective against cavities in teeth that are sealed and properly maintained.
• Minimally invasive, safe and effective preventive procedure.
• Costs less than getting a cavity filled.

Taking Herbal Supplements? Tell Your Dentist

Alternative medicine isn't so alternative anymore. Once dismissed as a fad or fringe movement, alternative medicine has become an increasingly popular component of mainstream health care, including dentistry.

 

But patients need to use caution when using any alternative, "natural" treatments, including herbal supplements.

 

"'Stop, look and listen' applies to the health-food counter as much as the intersection," says Academy of General Dentistry spokesperson Eric Z. Shapira, DDS, MAGD. Most patients neglect to include vitamins and herbal remedies when listing their medications for their dentist or physician. But even the most common herbs, such as St. John's wort and ginkgo biloba, can cause serious health problems if taken in combination with other drugs or taken in extreme dosages.

 

"People think herbs are harmless because they are considered 'natural,' and they think, if one is good, 10 are better," said Dr. Shapira. But overdoing it with supposedly safe herbs can cause health problems as serious as internal bleeding and heart arrhythmia, Dr. Shapira warns.

 

He also points out that all drugs are natural. "Almost all medicines start out as plants, but established drugs have the benefit of being standardized and regulated by the Food and Drug Administration," he says. Herbal medications are not standardized or regulated in any way.

 

Dr. Shapira urges patients to be well informed before taking any herbal concoction or embarking on an alternative therapy such as acupuncture, chiropractic or even aromatherapy. That means more than reading the manufacturers' promotional material or Internet sites.

 

 

 

Recommendations for some natural remedies for oral health:

 

Fluoride – This naturally occurring mineral has been proven to protect teeth from decay. Many municipal water supplies contain fluoride. Other sources are fluoride toothpaste, mouthwash and topical rinses and pastes applied in the dental office.

 

Alcohol-free mouthwash – Some common mouthwashes contain alcohol to cover up the smell of plaque. But alcohol dries out the mouth, which can cause discomfort and create an environment for more plaque to thrive.

 

Tea – A folk remedy that works, wet tea bags can provide relief from canker sores, swollen gums and toothache.

 

Zinc – This mineral is widely available in lozenges that can relieve the pain of a sore throat, but use sparingly. As with any herb, vitamin or mineral, patients need to follow directions and inform their dentist of its use.

The importance of x-rays

Radiographic, or X-ray, examinations provide your dentist with an important tool that shows the condition of your teeth, its roots, jaw placement and the overall composition of your facial bones. X-rays can help your dentist determine the presence or degree of periodontal (gum) disease, abscesses and many abnormal growths, such as cysts and tumors. X-rays also can show the exact location of impacted and unerupted teeth. They can pinpoint the location of cavities and other signs of disease that may not be possible to detect through a visual examination.

Your radiographic schedule is based on your dentist's assessment of your individual needs, including whether you're a new patient or a follow-up patient, adult or child. In most cases, new patients require a full set of mouth X-rays to evaluate oral health status, including any underlying signs of gum disease, and for future comparison. Follow-up patients may require X-rays to monitor their gum condition or their chance of tooth decay.