Burning mouth syndrome: an update on diagnosis and treatment methods

Burning mouth syndrome is characterized by both positive (burning pain, dysgeusia and dysesthesia) and negative (loss of taste and paraesthesia) sensory symptoms involving the lips and tongue, mainly the tip and anterior two-thirds. BMS patients report a persistently altered (metallic) taste or diminished taste sensations. Acidic foods such as tomatoes and orange juice cause considerable distress. Most of the common laboratory tests suggested for BMS patients will be negative as well. BMS is best subcategorized as primary BMS, no other evident disease, and secondary BMS, which is defined as oral burning from other clinical abnormalities. The presence of BMS is very uncommon before the age of 30; 40 years for men. The onset in women usually occurs within three to 12 years after menopause, and is higher in women who have more systemic disease. Quantitative assessment of the sensory and chemosensory functions in BMS patients reveals that the sensory thresholds (significantly higher) are different than in controls. Tongue biopsies have shown that there is a significantly lower density of epithelial nerve fibers for BMS patients than controls. The above data generally support the idea that BMS is a disorder of altered sensory processing which occur following the small fiber neuropathic changes in the tongue. BMS patients frequently have depression, anxiety, sometimes diabetes, and even nutritional/mineral deficiencies, but overall these co-morbid diseases do not fully explain BMS. The management of BMS is still not satisfactory, but because BMS is now largely considered to be neuropathic in origin, treatment is primarily via medications that may suppress neurologic transduction, transmission, and even pain signal facilitation more centrally. Finally, spontaneous remission of pain in BMS subjects has not been definitely demonstrated. The current treatments are palliative only, and while they may not be much better than a credible placebo treatment, few studies report relief without intervention.     

Burning mouth syndrome

Burning Mouth Syndrome (BMS) is a frequent disease characterized by a burning or painful sensation in the tongue and/or other oral sites without clinical mucosal abnormalities or lesions. The etiopathology is unknown although local, systemic and psychological factors have been connected with BMS. As this syndrome is a multifactorial disease, the diagnostic and therapeutic approach should be multidisciplinary. In this paper a review of the literature is presented and the most recent advancement on clinical, etiologic, diagnostic and therapeutic aspects of BMS are discussed.     

Burning mouth syndrome

Burning mouth syndrome is an intraoral pain disorder, stinging and/or itching sensation of the tongue or oral mucous membranes. Numerous causes have been suggested, including local factors such as candidiasis and denture trauma, systemic factor such as nutritional deficiencies, diabetes and climacteric, xerostomia, miscellaneous conditions such as psychogenic factors. A systematic approach for the success in diagnosis and treatment is included history taking, complete mouth examination and laboratory investigation.     

Burning mouth syndrome

In spite of the normal clinical appearance of the oral mucosa, BMS subjects do have demonstrated changes in sensory perception and salivary factors in addition to alterations in psychologic features. Although some of these changes may be suggestive of a peripheral or central dysfunction of small afferent nerve fibres, the extent of this alteration and its cause both remain unclear. The existence of changes other than psychologic, however, do weaken the proposition that BMS has a primarily psychogenic origin and suggests instead that future research should address the question of other organic changes in BMS.     

Burning mouth syndrome: Patient management

Burning mouth syndrome is an underdiagnosed and often poorly managed oral sensory disturbance. This paper discusses the recognition of the condition and suggests clinical approaches to ensure a correct diagnosis and appropriate management. The expansion of the traditional dental rote of the dentist is reviewed in the context of overall oral and general health particularly with respect to the syndrome which demands an intensive workup, open discussions with the patient, and a carefully planned long-term management strategy.     

Burning mouth syndrome: Current concepts

Burning mouth syndrome (BMS) is a chronic pain condition. It has been described by the International Headache Society as “an intra-oral burning or dysesthetic sensation, recurring daily for more than 2 h/day for more than 3 months, without clinically evident causative lesions.” BMS is frequently seen in women in the peri-menopausal and menopausal age group in an average female/male ratio of 7:1. The site most commonly affected is the anterior two-thirds of the tongue. The patient may also report taste alterations and oral dryness along with the burning. The etiopathogenesis is complex and is not well-comprehended. The more accepted theories point toward a neuropathic etiology, but the gustatory system has also been implicated in this condition. BMS is frequently mismanaged, partly because it is not well-known among healthcare providers. Diagnosis of BMS is made after other local and systemic causes of burning have been ruled out as then; the oral burning is the disease itself. The management of BMS still remains a challenge. Benzodiazepines have been used in clinical practice as the first-line medication in the pharmacological management of BMS. Nonpharmacological management includes cognitive behavioral therapy and complementary and alternative medicine (CAM). The aim of this review is to familiarize healthcare providers with the diagnosis, pathogenesis, and general characteristics of primary BMS while updating them with the current treatment options to better manage this group of patients.Key Words: Burning mouth syndrome, neuropathic pain, orofacial pain     

灼口综合征

作者综述了近几年来有关灼口综合病因，发病机理，临床特点，流行病学及治疗方面的研究进展，对几种常用的治疗方法进行评价，并提出在诊断及治疗灼口综合征时应注意的问题。     

Burning mouth syndrome: approach to successful management.

Burning mouth syndrome is a fairly common condition. Contrary to popular belief, its management is successful in about 70% of cases--provided a structured protocol based on scientific evidence is adopted. Specialist advice must be sought in some cases, but many patients can be successfully treated in the primary care environment.     

Burning mouth (syndrome) disorder.

Burning mouth disorder (BMD) is a chronic, oral pain condition associated with burning sensations of the tongue, lips, and mucosal regions of the mouth. Diagnosis of the condition is complicated by the fact that a variety of systemic and local factors can be contributory. Treatment goals are to reduce symptoms by eliminating identifiable abnormalities. Secondary lines of therapy include pharmacotherapeutic approaches that target neuropathologic mechanisms that appear to be active.     

Burning mouth syndrome: prevalence and associated factors

Burning mouth syndrome (BMS) is characterized by a burning sensation in the oral cavity although the oral mucosa is clinically normal. The syndrome mostly affects middle-aged women. Various local, systemic and psychological factors have been found to be associated with BMS, but its etiology is not fully understood. Oral complaints and salivary flow were surveyed in 669 men and 758 women randomly selected from 48,500 individuals between the ages 20 and 69 years. Fifty-three individuals (3.7%), 11 men (1.6%) and 42 women (5.5%), were classified as having BMS. In men, no BMS was found before the age group 40 to 49 years where the prevalence was 0.7%, which increased to 3.6% in the oldest age group. In women, no BMS was found in the youngest age group, but in the age group 30 to 39 years the prevalence was 0.6% and increased to 12.2% in the oldest age group. Subjective oral dryness, age, medication, taste disturbances, intake of L-thyroxines, illness, stimulated salivary flow rate, depression and anxiety were factors associated with BMS. In individuals with BMS, the most prevalent site with burning sensations was the tongue (67.9%). The intensity of the burning sensation was estimated to be 4.6 on a visual analogue scale. There were no increased levels of depression, anxiety or stress among individuals with more pain compared to those with less pain. It was concluded that BMS should be seen as a marker of illness and/or distress, and the complex etiology of BMS demands specialist treatment.     

Burning mouth syndrome: a review and update

Burning mouth syndrome (BMS) is characterized by the presence of burning sensation of the oral mucosa in the absence of clinically apparent mucosal alterations. It occurs more commonly in middle‐aged and elderly women and often affects the tongue tip and lateral borders, lips, and hard and soft palate. In addition to a burning sensation, the patients with BMS may also complain unremitting oral mucosal pain, dysgeusia, and xerostomia. BMS can be classified into two clinical forms: primary and secondary BMS. The primary BMS is essential or idiopathic, in which the organic local/systemic causes cannot be identified and a neuropathological cause is likely. The diagnosis of primary BMS depends mainly on exclusion of etiological factors. The secondary BMS is caused by local, systemic, and/or psychological factors; thus, its diagnosis depends on identification of the exact causative factor. When local, systemic or psychological factors are present, treatment or elimination of these factors usually results in a significant clinical improvement of BMS symptoms. Vitamin, zinc, or hormone replacement therapy has been found to be effective for reducing the oral burning or pain symptom in some BMS patients with deficiency of the corresponding factor. If patients still have the symptoms after the removal of potential causes, drug therapy should be instituted. Previous randomized controlled clinical trials found that drug therapy with capsaicin, alpha‐lipoic acid, clonazepam, and antidepressants may provide relief of oral burning or pain symptom. In addition, psychotherapy and behavioral feedback may also help eliminate the BMS symptoms.     

Burning mouth syndrome and psychological disorders

Burning mouth syndrome (BMS) is an oral dysaesthesia that causes chronic orofacial pain in the absence of a detectable organic cause. The aetiology of BMS is complex and multifactorial, and has been associated in the literature with menopause, trigger events and even genetic polymorphisms. Other studies have found evidence for mechanisms such as central and peripheral nervous system changes, with clinical and laboratory investigations supporting a neuropathologic cause. These physiological explanations notwithstanding, there is still much evidence that BMS aetiology has at least some psychological elements. Somatoform pain disorder has been suggested as a mechanism and factors such as personality, stress, anxiety, depression and other psychological, psychosocial and even psychiatric disorders play a demonstrable role in BMS aetiology and symptomatology. In order to treat BMS patients, both physiological and psychological factors must be managed, but patient acceptance of possible components of psychological disease basis is a major hurdle. Clinical signs of patient stress, anxiety or depression are a useful reinforcement of clinical discussions. The current paper proposes a number of clinical signs that may be useful for both clinical assessment and subsequent patient discussions by providing visible supportive evidence of the diagnosis.