Causes of the burning mouth syndrome:
(1) candidiasis
(2) geographic glossitis (erythema migrans)
(3) lichen planus
(4) psychogenic
(5) nutritional deficiency states with anemia
(6) diabetes mellitus, possibly from neuropathy
(7) dry mouth (xerostomia)
(8) medications or mouthwashes
(9) denture problems
(10) habits such as chewing on pencils
(11) Parkinson's disease
Geographic glossitis (erythema migrans, benign migratory glossitis) involves a map-like area of erythema and atrophy involving filiform tongue papillae that may come and go rapidly (transient). These areas may be delimited by an irregular, somewhat linear whitish rim and it may be associated with fissures. It should not be confused with cutaneous erythema migrans that occurs in association with Lyme disease.
Oral lichen planus most often involves whitish striae on the buccal mucosa (Wickham's striae), but in more severe disease there may be erythema or even bullae. In addition to the buccal mucosa, lesions may involve the tongue, palate, gingiva or lips. Biopsy of a lesion shows a saw-tooth appearance to the basal layer of the mucosa with an lymphocytic infiltrate.
Psychogenic states may include:
(1) depression
(2) anxiety
(3) hypochondriasis
(4) phobic state (cancerophobia, other)
Nutritional deficiency states with anemia:
(1) folate
(2) vitamin B12
(3) iron deficiency
Xerostomia may be a manifestations of an autoimmune disorder such as Sjogren's syndrome.
