Burning Mouth Syndrome (BMS): what should you know?

This Dental Urgent Care Scenario (USC) is adapted and presented by the JCDAOASIS team in collaboration with Dr. Deepika Chugh and Dr. David Mock

You can find the full USC on JCDAOasis Mobile

Context

Burning Mouth Syndrome (BMS) is an idiopathic burning sensation of the oral mucosa with no apparent underlying cause. Although the origin of the condition is unknown, there is possible evidence of a neuropathic basis.

BMS is most found in middle-aged and elderly people, predominantly in perimenopausal and postmenopausal women.

Signs & Symptoms

• Usually, onset is spontaneous, but previous trauma or dental treatment may be precipitating factors
• Most commonly a bilateral continuous burning sensation of the tongue, lips, and/or hard palate
• Often presents with xerostomia
• Can be associated with anxiety, depression, and/or poor “quality of life”
• Sensations may be described as dry, sandy, or numb; may be associated with other dysethetic changes
• Pain may be mitigated by eating or chewing gum
• Often associated with loss of taste or changes in taste (e.g., phantom taste)

Investigation

• Thoroughly review the patient’s medical history for diseases and disorders with related oral symptoms.
• Perform an oral examination, including adjunctive laboratory studies when indicated (i.e., biopsy, fungal smear, blood test, etc.) to diagnose mucosal changes and assess and/or rule out systemic conditions which may cause the burning sensation of the oral mucosa.

Diagnosis

Based on clinical examination and adjunctive laboratory assessments, if all local and systemic causes for burning pain can be excluded, a diagnosis of idiopathic burning mouth syndrome may be determined.

Differential Diagnosis

• Muccosal irritation
• Hyposalivation
• Mucocutaneous conditions (e.g., lichen planus, benign mucous membrane pemphigoid, pemphigus, migratory glossitis)
• Candidiasis
• Vitamins and minerals feficiency (e.g., vitamin B₁₂, folic acid, iron, zinc)
• Endocrine issues (e.g., diabetes, hypothyroidism)

Treatment

Recommend supportive measures:

• Sucking on ice chips
• Frequently drinking cold water
• Avoiding alcohol and food/oral products/habits which may exacerbate symptoms

Alternatively: 

• Cognitive behavioural therapy (CBT), clonazepam, and possibly alpha-lipoic acid have shown to be effective in reducing symptoms.
• Antidepressants and anticonvulsants are commonly prescribed; however, there is a lack of experimental evidence to support their effectiveness in the treatment of idiopathic burning mouth.

Advise the patient:

• Acknowledge and reassure the patient: patient frustration and dissatisfaction is very common.
• Treatment is known to be difficult and challenging. Refer patient to a clinically-active specialist in oral medicine/oral pathology is recommended, with further medical management if the patient has other complex issues which may be contributing to the pain.
• Set realistic treatment goals. The management of this condition is primarily supportive and aimed at reducing symptom  rather than eliminating them .

Follow-up: What further information would you like on this topic? Email us at jcdaoasis@cda-adc.ca

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