Magic Mouthwash

Originally, magic mouthwash was used to help people undergoing cancer treatments that were affecting their mouth. But doctors have found that magic mouthwash for burning mouth syndrome can be effective too. The mouthwash has to be compounded (blended) by a pharmacist because of the ingredients. There are a few “recipes” for magic mouthwash. Depending on which one prescribed, the ingredients may include:

• Antihistamines, such as chlorpheniramine or diphenhydramine
• Antibiotics, tetracycline
• Antifungals, such as nystatin or miconazole
• Corticosteroids, such as hydrocortisone or dexamethasoneAntacids, like Maalox
• Anesthetics, like lidocaine

If your doctor prescribes a magic mouthwash, check with your pharmacist for exact instructions on how to use it. Be sure to ask if you should swallow or spit it out. The usual routine is to use it every 4 to 6 hours. Hold the recommended amount of liquid in your mouth for a few minutes, swishing it around. Then either swallow or spit out, according to your pharmacist’s instructions. Avoid eating or drinking anything for a half hour after so the medications in the mouthwash have time to work.

Antidepressants

Doctors learned quite a while ago that some types of antidepressants can also help manage chronic pain. Unfortunately, some people might be reluctant to even discuss taking an antidepressant because they believe that this means the doctor thinks the pain is all in their head. This isn’t true. They do actually treat different types of chronic pain. Some commonly used antidepressants for BMS are amitriptyline, nortriptyline, and fluoxetine, but there are several others your doctor may want to try. Clonazepam is another commonly prescribed medication. You can take it an oral drug or apply it directly through a mouth rinse. Warning: Clonazepam (Klonapin, Rivotril) is a benzodiazepine and is addictive. It should be used with caution.

Antiseizure medications

Gabapentin (Neurontin), originally used to treat seizures, is helpful for treating nerve pain in some people. Some people with BMS find that gabapentin helps relieve their burning pain as well.

Hormone replacement therapy

There are some studies showing moderate response to HRT.

Naltraxone

Naltrexone is used to manage opioid use disorder and alcohol use disorder. Low-dose naltrexone – about one-tenth of the usual dose, has helped some people with BMS.

Methylene blue

Researchers are looking at an old medication called methylene blue, usually used to treat a rare blood condition called methemoglobinemia. A very small case study report (5 patients) showed that it might be helpful.

Nerve block

Doctors sometimes try a nerve block into the nerves that run to the mouth. This case study describes how one patient tried this approach.

Laser therapy

There is new research into using lasers to help relieve BMS pain. It was successful for some patients.

Ablation therapy

I couldn’t find any studies to back this up, but I tried two forms of ablation while I attending the pain clinic. The first time, the anesthesiologist inserted needles into four nerves in my face, (the inner part of each cheekbone and just below the outside of each side of my mouth), and injected an anesthetic. This didn’t give me any relief so several weeks later, they did the same needle insertion but instead of medication, they zapped with a low electrical dose. This did not help either.