Who gets burning mouth syndrome?
It's most common in women after menopause. One of the reasons that this problem is found in older women relates to the loss of estrogen that occurs in the menopausal period and that causes a loss of bitter taste buds. We do see men with burning mouth, but it's less common. Sometimes I see younger people with it, but it is usually associated with a benign condition called geographic tongue. Geographic tongue causes inflammation on the surface of the tongue causing red patches that come and go and move around. That might affect the taste buds which then leads to the loss of pain inhibition and burning mouth.
What can increase the risk?
When the bitter taste is lost within the taste bud, the pain fibers surrounding that bud are the ones that experience a loss of inhibition and start becoming painful. An infection, a nutritional deficiency of B12, folate or iron can also damage taste buds.
And just to make it a little bit more complex, the people who are most at risk of developing burning mouth are called super-tasters—people who have the greatest number of taste buds on the tip of the tongue. This is a genetic difference: some people are non-tasters, some are medium-tasters and some are super-tasters. Flavors are much more intense for super-tasters, and they have different taste preferences than non-tasters and medium-tasters. Women are much more likely to be super-tasters than men. So most people with burning mouth syndrome are super-tasters who have had a taste loss for some reason.