Revisiting Burning Mouth Syndrome
Burning mouth syndrome (BMS) presents as an unexplained pain, dysesthesia, or burning in a clinically normal and healthy oral mucosa.1, 2 A diagnosis is made if the symptoms recur daily for more than 2 h/d and for at least 3 months as per the definition from the Committee of the International Headache Society.3 It is a diagnosis of exclusion, and other systemic, local medical or dental sources of pain must be ruled out.4
- Zakrzewska JM. Facial pain: an update. Curr Opin Support Palliat Care 2009;3: 125–30.
- Buchanan J, Zakrzewska J. Burning mouth syndrome. BMJ Clin Evid 2008;1301.
- Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 2013;33:629–808.
- Klasser GD, Grushka M, Su N. Burning mouth syndrome. Oral Maxillofac Surg Clin North Am 2016;28:381–96.
The disorder is more common among postmenopausal middle-aged-women, with a male to female ratio of 1:5 to 1:71,2 and prevalence of 1%.3
Although the cause is unknown, some associated factors, such as stress, hormonal dysfunction, parafunctional habits, anxiety, depression, psychiatric disorders, and neuropathy, might play a role in the syndrome onset and/or
- Kohorst JJ, Bruce AJ, Torgerson RR, et al. A population-based study of the incidence of burning mouth syndrome. Mayo Clin Proc 2014;89: 1545–52.
- Coculescu EC, Tovaru S, Coculescu BI. Epidemiological and etiological aspects of burning mouth syndrome. J Med Life 2014;7: 305–9.
- Ja¨a¨skela¨inen SK, Woda A. Burning mouth syndrome. Cephalalgia 2017;37: 627–47.
- Klasser GD, Grushka M, Su N. Burning mouth syndrome. Oral Maxillofac Surg Clin North Am 2016;28: 381–96.
Patients with BMS report a spontaneous onset of continuous scalding, rawness, and annoying burning pain. Sensation can vary in intensity during the day, and usually occurs bilaterally. The most common site is the tip of tongue, but it can present on other oral mucosal surfaces.
Some patients report a temporary relief of symptom with food in the mouth, whereas some report aggravation with spicy and acidic foods or alcohol.
There is no investigation diagnostic for BMS; however, the following tests can help rule out other systemic or local causes of oral burning:
- Gram stain and culture to rule out candidiasis.
- CBC, folate, ferritin, iron, B12 to exclude anemia or nutritional deficiency.
- Salivary flow test to rule out xerostomia.
There are also no positive findings on imaging.
Patients with this condition occasionally present with cancer phobia and typically have been to multiple providers before the diagnosis is established.
The first step in managing these patients is to reassure them that there is no association with cancer and the condition can be managed with conservative means.
Topical or systemic pharmacologic agents have been successful in managing or distracting some patients with BMS. These agents include alpha lipoic acid, low-dose clonazepam, which should be discontinued with caution as a result of associated withdrawal syndrome (suicidal tendencies); topical capsaicin; gabapentin; amitriptyline; and doxepin. Other treatment strategies used are low-level laser therapy, stress, and behavioral management.
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CDA Oasis Team