The hygienist could tell that her patient was extremely uncomfortable. In her opening questions, the hygienist asked the patient if she was experiencing any pain. The hygienist didn't expect to see tears well up in her patient's eyes. Apparently, the hot, searing pain in the woman's mouth had been steadily increasing since her last exam, and she felt absolutely miserable. Unfortunately, she didn't alert her dentist early on. She told her hygienist the feeling was like scalding her mouth on hot tea.

What are these—fire ants on my tongue?: Although the number of people who report and seek treatment for this condition is small, from 1–5%, it is traumatic to the sufferers, and for many, prevents them from enjoying the quality of life that most of us take for granted. This condition is commonly called "burning mouth" or BMS, Burning Mouth Syndrome. BMS is also called "glossodynia" — tongue pain and "stomatodynia" — mouth pain.

The curious circumstance about BMS is that there is no one factor that a healthcare professional can point to as the cause. According to the American Dental Association (ADA), in 70% of the patients who seek treatment, healthcare professionals simply do not know why the symptoms appear. On top of that, they can only guess how to treat BMS! The only common denominator that dentists and doctors know for certain is that BMS affects significantly more women than men by a 10-to-1 ratio. In fact, research performed at the Mayo Clinic showed that BMS typically strikes people 60 years old and older, and 10–40% of the woman are post-menopausal. The American Academy of Oral and Maxillofacial Pathology notes that BMS is an equal opportunity condition; it affects people worldwide of all ages, races, backgrounds and socio-economic levels.

n There are numerous symptoms associated with this strange phenomenon, including:

n moderate-severe burning sensation in the mouth, throat, lips and tongue

n pain that intensifies from mild in the morning to extreme by evening

n a tingling or numbness on the tip of the tongue

n a bitter or metallic taste

n inability to correctly taste bitter or salty foods

n dry mouth, or xerostomia

n mood changes that a patient didn't exhibit before the onset of BMS

n feeling irritable over minor occurrences

n feelings of depression, such that the person avoids interactions with other people

n a restless feeling, can't seem to sit still or concentrate for any length of time

n inability to fall asleep

n Finding the needle in the haystack

With all of those symptoms, one would think it would be easier to identify BMS than if there were only one or two symptoms, but curiously, the lining of the mouth doesn't show any abnormal signs that produce the burning sensation. Like other examinations, the dentist or hygienist begins by performing a visual exam and asks the patient many questions. After all other conditions have been ruled out, the last condition on the list, so-to-speak, is BMS. Identifying BMS is much like sifting soil on a screen. After much shaking, all that is left on the screen is a large clump of soil. BMS is the only "clump" that didn't eliminate itself and pass through the screen. As you can imagine, identifying BMS is a tedious process of elimination exercise.

Dentists and physicians can take only educated guesses about the causes of BMS. It is generally accepted that BMS is not caused by only one factor; it is likely the result of several factors crashing headlong into each other, including:

n dry mouth—a condition that is related to certain medications, aging or an autoimmune disease.

n thrush—a yeast infection that occurs when an antibiotic kills bacteria that usually keep the yeast in check. Thrush can also be caused by diabetes, dentures, or from "geographic tongue," (The tongue has "bald" patches on it.).

n overuse of mouthwashes and sprays as well as excessive brushing of the tongue and drinking too many acidic fluids.

n sensitivity to certain foods, food preservatives and agents that keep food moist, chicle (gum ingredient), and spices such as cinnamon and mint.

n nutritional deficiencies—iron, zinc, vitamins B1, 2, 9, and 12, which can result in anemia.

n poorly fitting dentures, which can cause stress on facial muscles and tissues in the mouth. Sometimes the person is sensitive to the materials used to create the denture.

n poor oral habits such as clenching and grinding the teeth (bruxism) or pushing the tongue forward through the teeth (tongue thrusting) can irritate tissues.

n allergic reactions to foods, fragrances or dyes.

n medications used to treat high blood pressure.

n acid reflux disease—stomach acids that enter the mouth can cause a burning sensation.

n nerve damage to the nerves in the tongue.

n diabetes and an underactive thyroid.

n changes in hormones during menopause could cause a chemical change in saliva and result in a burning sensation.

Interestingly, about one-third of the patients reported that they noticed a burning sensation after they had a dental procedure, an illness or had taken medications a short time before the symptoms appeared.

Part 2 will discuss treatment for this condition.