Burning Mouth Syndrome
Burning mouth syndrome (BMS) is characterized by a burning sensation in the mouth and/or tongue. It is often accompanied by dry mouth and/or a bitter or metallic taste in the mouth. In some cases, this condition may be associated with vitamin B12 deficiency, oral yeast infection (candida albicans), or irritation from dentures (dental prosthetics). The burning sensation may be aggravated by hot, spicy foods but is not caused by them.
- Site- Usually bilaterally located on the tongue or less commonly the palate, lips or lower alveolar mucosa
- Onset- Pain is chronic, and rarely spontaneously remits
- Character- Burning, scalded or tingling. Sometimes the sensation is described as ‘discomfort’, ‘tender’, ‘raw’ and ‘annoying’ rather than pain or burning.
- Associations – Possibly subjective xerostomia, dysgeusia (altered taste), thirst, headaches, chronic back pain, irritable bowel syndrome, dysmenorrhea, globus pharyngis, anxiety, decreased appetite, depression
- Time course – Type 2 (most common) pain upon waking and throughout day, less commonly other patterns
- Exacerbating/Relieving factors Pain is often relieved by alcohol, or eating and drinking (unlike pain caused by organic lesions or neuralgia) or when the person’s attention is occupied. Pain is not often relived by analgesics. Sometimes eating hot, acidic or spicy food or drink exacerbates pain
- Severity – Moderate to severe, rated 5-8 out of 10, similar in intensity to toothache
- Effect on sleep – May change sleep patterns, e.g. insomni
The Facial pain, often described as burning, aching or cramping, pinching, pulling, occurs on one side of the face, often in the region of the trigeminal nerve and can extend into the upper neck or back of the scalp. Although rarely as severe as trigeminal neuralgia, facial pain is continuous for ATFP patients, with few, if any periods of remission.
- Coulthard [et al.], P (2008). Master dentistry. (2nd ed. ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 231–232. ISBN 9780443068966.
- Glick, Martin S. Greenberg, Michael (2003). Burket’s oral medicine diagnosis & treatment (10th ed. ed.). Hamilton, Ont.: BC Decker. pp. 332–333. ISBN 1550091867.
- Greenberg MS; Glick M; Ship JA. Burket’s Oral Medicine. 11th edition. 2012
- Grushka, M; Epstein, JB; Gorsky, M (2002 Feb 15). “Burning mouth syndrome.”. American family physician 65 (4): 615–20. PMID 11871678.
- Kalantzis, Crispian Scully, Athanasios (2005). Oxford handbook of dental patient care (2nd ed. ed.). New York: Oxford University Press. p. 302. ISBN 9780198566236.
- Treister, Jean M. Bruch, Nathaniel S. (2010). Clinical oral medicine and pathology. New York: Humana Press. pp. 137–138. ISBN 978-1-60327-519-4.
If a cause can be identified for a burning sensation in the mouth, then treatment of these underlying factor(s) will be cause related, and the symptom may resolve or persist despite treatment (which confirms a diagnosis of BMS). BMS has been traditionally treated by reassurance and with antidepressants , anxiolytics or anticonvulsants. However a systematic review of treatments for BMS concluded that clear, conclusive evidence of an effective treatment was not available in published research. There is a suggestion that Alpha lipoic acid and clonazepam (a benzodiazepine) may have some benefit, but the research methods used in these randomized control trials were imperfect or their results have not been corroborated by multiple trials. Similarly with the results of one randomized control trial which reported some evidence that cognitive behavioral therapy may be beneficial