Two days. One answer.

Treatment fails when the diagnosis was never made.

Almost everyone who comes here has already been treated. A rinse. A lozenge. Clonazepam. An antifungal. Something for anxiety. Sometimes four or five of these in sequence, each tried for a few weeks and abandoned.

None of it was unreasonable. But it was all aimed at a symptom, because nobody had established what was actually producing the symptom.

Burning mouth and chronic dry mouth are not single conditions. They're a shared endpoint that a long list of different processes can produce — medications, nutritional deficiencies, autoimmune disease, thyroid dysfunction, blood sugar, hormonal change, candida, contact reactions, small-fiber nerve involvement, and combinations of these. The treatment that helps one does nothing for another.

So the first question is not what will make this stop. It's what is causing this.

Before you arrive

The full intake packet. Twenty forms, completed online at home. Symptom history and timeline. Complete medication and supplement list. Symptom-timing pattern — whether you wake with it, whether it builds through the day, whether some days are clear — a genuine diagnostic signal that is almost never asked about properly.

Then the validated instruments: the Xerostomia Inventory, PainDETECT for neuropathic features, PHQ-9 and GAD-7, and a quality-of-life scale. Then a systemic screen covering hormonal and endocrine history, autoimmune and inflammatory history, gastrointestinal and nutritional history, sleep and mouth-breathing, and environmental and product exposure — including dental materials and anything that changed shortly before your symptoms started.

This is done before your visit for a reason. Your chair time is spent examining and testing, not filling out paperwork.

The medication cross-reference. Every drug and supplement you take is checked against a verified database of medications associated with reduced salivary flow, and the start date of each is correlated against when your symptoms began. This is the single highest-yield step in the entire workup and it is routinely skipped, because it takes real time and no one is paid for it. Run a version of it yourself →

Day one — examination and objective measurement

• Soft-tissue examination and red-flag screenThis comes first and it is not negotiable. Unilateral burning, ulceration or induration, unexplained weight loss, difficulty swallowing, one-sided taste loss, or swollen lymph nodes all stop the symptomatic workup and route to imaging or biopsy first. In the overwhelming majority of cases this screen is clear — but it's how you rule out the thing you cannot afford to miss.
• Salivary flow measurementUnstimulated and stimulated flow, over timed collections. Not estimated, not inferred from how dry your mouth feels. Many people with severe burning and severe subjective dryness have entirely normal flow — which points the workup toward nerve involvement rather than the glands. Others who barely mention dryness turn out to be objectively hyposalivating. These lead to opposite treatment plans.
• Salivary pH and buffering capacityAn acidic oral environment aggravates already-sensitized tissue, and low buffering capacity is a caries risk requiring its own protective plan.
• Candida testingChairside antigen testing plus clinical assessment. Common, treatable, and frequently missed — and if burning resolves after treating it, that reclassifies your entire case.
• Cranial nerve examinationFormal testing of the nerves supplying the mouth and face. Any focal deficit or asymmetry changes the workup and triggers neurology referral.
• Sensory testingBedside quantitative sensory testing — calibrated warm and cold thresholds, monofilament, vibration, and pinprick, mapped by region. This is how you find nerve involvement that no visual exam and no standard lab will ever show.
• Taste screenFormal four-taste testing. Taste alteration accompanies burning mouth in a large majority of cases, and one-sided taste loss is a red flag requiring investigation.
• Salivary gland examination, appliance assessment, clinical photographyPalpation and duct expression for enlargement, obstruction, or stones. Denture fit, bruxism, and dissimilar metals where symptoms correlate with dental work. Standardized baseline images for tracking change.

Laboratory work

A core panel is ordered for every patient, run against clinically meaningful thresholds rather than the widest possible normal range: complete blood count, ferritin and iron studies, vitamin B12, folate, zinc, vitamin D, fasting glucose and HbA1c, thyroid function.

Iron deficiency deserves specific mention: it can drive burning mouth without anemia, which means a normal CBC does not rule it out — and a normal CBC is exactly where a lot of workups have stopped.

Sjögren's screening is added whenever measured flow is low, whenever you have both dry eyes and dry mouth, or whenever your history raises an autoimmune flag. If flow is low and anti-SSA/Ro is positive, you're already at the classification threshold, and the correct action is prompt rheumatology referral rather than continuing here.

Additional testing when your findings indicate it: candida culture and speciation, celiac screening, H. pylori, hormonal panels where the timeline correlates and the result would change the plan, allergy patch testing when symptoms began after dental work or a new product, salivary gland ultrasound, and neurology referral for focal findings.

Laboratory work is billed separately at cost. Nothing is marked up.

Day two — synthesis

Day two is where the workup becomes a diagnosis. Every finding is placed into a structured classification:

• Primary or secondarySecondary means an identifiable cause was found — a medication, a deficiency, an infection, an autoimmune process. That is the better answer, because causes can be addressed. Primary means the workup was complete and no external cause was found, which points to a neuropathic process and a different treatment path entirely.
• Your timing patternWaking with symptoms, building through the day, or intermittent with clear days. Each carries different associations and directs the workup differently.
• Where the nerve involvement sitsWhen the picture is neuropathic — peripheral, central, or undetermined, based on your sensory testing and PainDETECT results.
• Whether hyposalivation is presentObjectively, and what's driving it.

You get this in writing, along with the reasoning, the complete results, what was ruled out and how, a prioritized treatment plan, and specific questions and tests to bring to your other providers.

The document is yours. It's written to be handed to your physician, your rheumatologist, or your own dentist, and to be usable by any of them whether or not you ever return here.

Four honest outcomes

• A specific, correctable cause is foundA medication, a deficiency, candida, thyroid dysfunction. Addressing it often produces substantial improvement, sometimes resolution. The best outcome, and it happens more often than people expect — which is precisely why the workup is worth doing before any treatment.
• Something is found that belongs to another specialtySjögren's, an autoimmune process, a systemic neuropathy. You get the documentation and a proper referral. That is a real result, not a failure — it's a four-year question finally answered.
• No external cause is found and the picture is neuropathicThe workup was complete and the exclusion is now meaningful rather than assumed. This is where the Treatment Intensive is relevant, and where honest expectations matter: the realistic goal is meaningful symptom reduction, not zero.
• Occasionally, nothing conclusive emergesUncommon after a workup this thorough, but it happens, and I'll tell you plainly if it does rather than manufacture a diagnosis to justify the fee.

There is no obligation to book treatment. Roughly half of what makes this work is that you're buying an answer, not a commitment.

Who this is and isn't for

Built for you if

Your symptoms have persisted for months or longer. You've seen multiple providers without a clear answer. Your exams and standard labs came back normal. You've tried treatments that didn't work, or worked briefly. You take medications and no one has systematically reviewed them against your symptom timeline. You want to understand what's happening rather than try another product.

Not the right fit if

Your symptoms started within the last few weeks — some resolve on their own, and a thorough workup this early may be premature. You have an obvious untreated cause a local dentist or physician can address directly. You're looking for a guaranteed cure, which I can't offer. Or the cost means real financial strain — in which case the membership covers a great deal of the same educational ground for a fraction of the price, and it's a legitimate place to start.

I would rather tell you on a call that this isn't right for you than take your money and have you fly here to find out.

Before you book a flight

Patients travel here from out of state. What that actually involves — flights, how many days, hours per day, and what to bring. And the questions people actually ask, including the awkward ones about cost and guarantees.

What it costs

I do not publish a figure on this page, and I would rather explain why than leave you guessing.

It is not because the number is a secret. You will have exact figures on the first call, before committing to anything, and there is no obligation attached to asking.

It is because a number on its own arrives with no context. What is included at each stage, why two days rather than one appointment, what the laboratory work adds, what happens if the diagnosis points somewhere else entirely, and what payment options exist — those determine whether this makes sense for you, and none of them fit inside a figure.

Who you talk to about it

My treatment coordinator handles this, and she is better at it than I am. She will walk you through what is included at each stage, what the sequence looks like, what laboratory costs typically run, and what the payment options are.

That conversation is free and carries no obligation. She will not pressure you, and if the answer is that this is not right for you she will say so — the same way I will on the clinical call.

Payment and financing

This is a cash-pay practice. You pay at the time of service and receive a superbill to submit to your own insurance; some components may be reimbursable, though I cannot predict what any individual plan will do.

Financing is available through Proceed and Sunbit, and most patients use it. A monthly figure looks considerably different from a total, and my coordinator will show you the actual numbers rather than leaving you to work them out.

Laboratory work and biopsy, where indicated, are billed separately at cost. Nothing is marked up.