Understanding "Burning Mouth Syndrome" in Post-Menopausal Women

Linda M. Bartoshuk, Ph.D.,Professor of Surgery

Burning mouth syndrome (BMS), an intense and painful burning sensation in the mouth, occurs predominantly in women after menopause when the incidence rate can be as high as 33 percent. BMS is associated with severe damage to tasting function, often to the part of the tongue that detects bitter tastes. Dr. Bartoshuk’s research on this under-recognized syndrome has led to specific recommendations for treatment.

Highlighted Study Findings

Dr. Bartoshuk suspected that BMS was a sensory phantom (that is, caused by abnormal activation of the part of the brain that recognizes oral pain). Her funded study allowed her to confirm this hypothesis. Two new discoveries emerged from the research, showing that those with BMS had severe taste damage (most typically, they could not taste bitter on the tips of their tongues), and they were also “supertasters,” (individuals born with unusually large numbers of taste buds). To understand why these findings are important, it is helpful to know the sensory system involved in taste. The taste of food activates “taste nerves,” which then carry the sensory information to the brain. In addition to receiving taste input, this same area in the brain is responsible for blocking oral pain. When taste is damaged, this part of the brain no longer inhibits the oral pain. This results in abnormal activity in a specific part of the brain producing oral pain sensations. This type of damage in “supertasters” results in particularly intense BMS. As a result of this work, we now understand why postmenopausal women are at special risk for BMS. First, women are more likely than are men to be “supertasters.” Second, the ability to taste bitter, which functions as a poison detector, varies with the menstrual cycle, peaks in early pregnancy and diminishes after menopause. This pattern suggests that the ability to taste bitter might be protective during pregnancy. However, the loss of the ability to taste bitter at menopause puts supertasting women at special risk for BMS. Dr. Bartoshuk’s findings led to specific recommendations for treatment, using an oral lozenge containing a substance known as capsaicin. This substance, which is commonly found in cayenne pepper, acts by desensitizing the pain receptors in the mouth that are responsible for BMS.