Burning Mouth Syndrome

Burning mouth syndrome (BMS) is a poorly understood pain condition. It is likely related to a variety of conditions. BMS is classified as primary or idiopathic burning month syndrome, and secondary burning mouth syndrome. Prevalence rates in general populations vary from 0.7% to 15%.

Cause

The causes of burning mouth syndrome are not known. It is a type of trigeminal sensory nerve pathology that a neuropathic imbalance between gustatory and sensory systems may be present. Other studies suggest that neurodegenerative alterations in peripheral and central small nerve fibers may be the underlying cause of burning mouth syndrome for some patients.

Symptoms

BMS is a spontaneous onset burning surface pain localized to part, but not all of the intraoral tissues. It usually affects the anterior 2/3 of tongue, anterior hard palate, and lower lip. It commonly presents with a bilateral symmetric distribution. Burning mouth syndrome is more common in females in their 5th decade. The onset of symptoms can be spontaneous or related to a trigger. Other characters of symptoms include:

  • Continuous presence without remission for months or years
  • Minimal symptoms upon awakening but symptoms gradually increase during the day to peak in the evening
  • Intensifies by personal stressors and fatigue or certain foods

Diagnosis

The diagnosis of burning mouth syndrome is achieved by ruling out other possible causes such as vitamin-iron deficiency, candidiasis, lingual nerve trauma, diabetes, tumor, and immune associated mucosal diseases. Diagnostic tests that can be performed include:

  • Thorough clinical exam
  • Blood test
  • Fungal culture
  • Saliva flow test
  • Psychometric evaluations

Treatment

Managements of secondary BMS are based on the primary etiology. Management options of primary burning mouth syndrome are limited. The following strategies are commonly used:

  • Cognitive behavior therapy
  • Topical anxiolytics and analgesics
  • Systemic medications such as antidepressants, anxiolytics, anticonvulsants
  • Low-level laser therapy

References

  1. Orofacial Pain: guidelines for assessment, diagnosis, and management. American Academy of orofacial pain. Fifth edition. Reny De Leeuw, DDS, PhD, MPH and Gary D. Klasser, DMD
  2. Bell’s oral and facial pain. 7th edition. Jeffrey P. Okeson, DMD
  3. American Association of Dental Sleep Medicine


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