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| {{short description|Human disease}}
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| {{Infobox medical condition (new)
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| | name = Burning mouth syndrome
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| | field = [[Oral medicine]]
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| | synonyms = glossodynia,<ref name="Scully 2008" /> orodynia,<ref name="Bolognia">{{cite book |author=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=978-1-4160-2999-1 |oclc= |doi= |accessdate=}}</ref> oral dysaesthesia,<ref name=McMillan2016 /> glossopyrosis,<ref name=McMillan2016 /> stomatodynia,<ref name="Scully 2008" /> burning tongue,<ref name="Andrews">{{cite book |author=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: Clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |page=63 |isbn=978-0-7216-2921-6 |display-authors=etal}}</ref> stomatopyrosis,<ref name=McMillan2016 /> sore tongue,<ref name=McMillan2016 /> burning tongue syndrome,<ref name="Bouquot 2002">{{cite book|author=Brad W. Neville |author2=Douglas D. Damm|author3=Carl M. Allen|author4= Jerry E. Bouquot|title=Oral & maxillofacial pathology|year=2002|publisher=W.B. Saunders|location=Philadelphia|isbn=978-0721690032|pages=752–753|edition=2.}}</ref> burning mouth,<ref name=McMillan2016 /> or sore mouth<ref name="Mock 2010">{{cite journal|last=Mock|first=David|author2=Chugh, Deepika|title=Burning Mouth Syndrome|journal=International Journal of Oral Science|date=1 March 2010|volume=2|issue=1|pages=1–4|doi=10.4248/IJOS10008|pmid=20690412|pmc=3475590}}</ref>
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| <!-- Definition and symptoms -->
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| '''Burning mouth syndrome''' ('''BMS''') is a burning sensation in the mouth with no underlying known dental or medical cause.<ref name=McMillan2016>{{Cite journal|last=McMillan|first=Roddy|last2=Forssell|first2=Heli|last3=Buchanan|first3=John Ag|last4=Glenny|first4=Anne-Marie|last5=Weldon|first5=Jo C.|last6=Zakrzewska|first6=Joanna M.|date=2016|title=Interventions for treating burning mouth syndrome|journal=The Cochrane Database of Systematic Reviews|volume=11|pages=CD002779|doi=10.1002/14651858.CD002779.pub3|issn=1469-493X|pmc=6464255|pmid=27855478}}</ref> No related [[medical sign|signs of disease]] are found in the mouth.<ref name=McMillan2016 /> People with burning mouth syndrome may also have a subjective [[xerostomia]] (dry mouth sensation where no cause can be found such as reduced salivary flow), [[paraesthesia]] (altered sensation such as tingling in the mouth), or an altered taste or smell.<ref name=McMillan2016 />
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| [[File:Depiction of a person suffering from Burning Mouth Syndrome.png|thumb|500px|Depiction of a person suffering from Burning Mouth Syndrome]] | | [[File:Depiction of a person suffering from Burning Mouth Syndrome.png|thumb|500px|Depiction of a person suffering from Burning Mouth Syndrome]] |
| | {{Short description|Chronic pain disorder causing burning sensation in the mouth}} |
| | '''Burning Mouth Syndrome (BMS)''' is a chronic pain condition characterized by a persistent burning sensation in the mouth without an identifiable underlying cause. It primarily affects the tongue, lips, palate, and inner cheeks, but may also involve the entire oral cavity. The condition is often associated with taste disturbances and dry mouth, despite normal salivary flow. |
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| A burning sensation in the mouth can be a [[medical symptom|symptom]] of another disease when local or systemic factors are found to be implicated, and this is not considered to be burning mouth syndrome,<ref name=McMillan2016 /> which is a syndrome of [[Medically unexplained physical symptoms|medically unexplained symptoms.]]<ref name=McMillan2016 /> The [[International Association for the Study of Pain]] defines burning mouth syndrome as "a distinctive [[nosology|nosological]] entity characterized by unremitting oral burning or similar pain in the absence of detectable [[oral mucosa|mucosal]] changes",<ref name="Scully 2008">{{cite book|title=Oral and maxillofacial medicine : the basis of diagnosis and treatment|last=Scully|first=Crispian|publisher=Churchill Livingstone|year=2008|isbn=9780443068188|edition=2nd|location=Edinburgh|pages=171–175}}</ref> and "burning pain in the tongue or other oral mucous membranes",<ref name="Classification of Chronic Pain" /> and the [[International Headache Society]] defines it as "an intra-oral burning sensation for which no medical or dental cause can be found".<ref name="Mock 2010" />
| | BMS is classified into: |
| | | * Primary BMS – Occurs with no identifiable medical or dental cause. |
| <!-- Treatment -->
| | * Secondary BMS – Results from an underlying medical condition such as nutritional deficiencies, diabetes, or hormonal imbalances. |
| Insufficient evidence leaves it unclear if effective treatments exist.<ref name=McMillan2016 />
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| ==Signs and symptoms==
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| By definition, BMS has no signs. Sometimes affected persons will attribute the symptoms to sores in the mouth, but these are in fact normal anatomic structures (e.g. [[lingual papillae]], [[vein|varices]]).<ref name="Treister 2010" /> Symptoms of BMS are variable, but the typical clinical picture is given below, considered according to the [[Socrates (pain assessment)|Socrates pain assessment method]] (see table). If clinical signs are visible, then another explanation for the burning sensation may be present. [[Erythema]] (redness) and [[edema]] (swelling) of papillae on the tip of the tongue may be a sign that the tongue is being habitually pressed against the teeth. The number and size of [[filiform papilla]]e may be reduced. If the tongue is very red and smooth, then there is likely a local or systemic cause (e.g. eythematous candidiasis, [[anemia]]).<ref name="Bouquot 2002" />
| | == '''Symptoms''' == |
| {| class="wikitable"
| | The primary symptom of Burning Mouth Syndrome is a persistent burning sensation in the oral cavity, often described as: |
| |-
| | * Burning or scalding pain (similar to drinking a hot beverage). |
| ! Parameter !! Usual findings in burning mouth syndrome.<ref name="Scully 2008" /><ref name=McMillan2016 /><ref name="Classification of Chronic Pain">{{cite web|title=Classification of Chronic Pain, Part II, B. Relatively Localized Syndromes of the Head and Neck; GROUP IV: LESIONS OF THE EAR, NOSE, AND ORAL CAVITY|url=http://www.iasp-pain.org/AM/Template.cfm?Section=Classification_of_Chronic_Pain&Template=/CM/ContentDisplay.cfm&ContentID=16276|publisher=IASP|accessdate=7 May 2013|url-status=dead|archiveurl=https://web.archive.org/web/20121219110805/http://www.iasp-pain.org/AM/Template.cfm?Section=Classification_of_Chronic_Pain&Template=%2FCM%2FContentDisplay.cfm&ContentID=16276|archivedate=19 December 2012}}</ref><ref name="Treister 2010" /><ref name="Coulthard 2008" /><ref name="Glick 2003" />
| | * Dry mouth (xerostomia), despite normal saliva production. |
| |-
| | * Altered taste perception – Some patients report a metallic or bitter taste. |
| | Site || Usually bilaterally located on the tongue or less commonly the palate, lips or lower [[alveolar mucosa]]
| | * Increased thirst. |
| |-
| | * Tingling or numbness in the mouth. |
| | Onset || Pain is chronic, and rarely spontaneously remits
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| | Character || Burning, scalded or tingling. Sometimes the sensation is described as 'discomfort', 'tender', 'raw' and 'annoying' rather than pain or burning.
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| | Radiation ||
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| | Associations || Possibly subjective [[xerostomia]], [[dysgeusia]] (altered taste), thirst, [[headache]]s, chronic back pain, [[irritable bowel syndrome]], [[dysmenorrhea]], [[globus pharyngis]], [[anxiety]], decreased appetite, [[depression (mood)|depression]] and [[personality disorder]]s
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| | Time course || Type 2 (most common) pain upon waking and throughout day, less commonly other patterns.
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| | Exacerbating/Relieving factors || Possible exacerbating factors (make the pain worse) include tension, fatigue, speaking, and hot, acidic or spicy foods. Possible relieving factors include sleeping, cold, distraction, and alcohol. The pain is often relieved by eating and drinking (unlike pain caused by organic lesions or [[neuralgia]]) or when the person's attention is occupied. Temporary relief while eating is described as "almost [[pathognomonic]]" by the IASP. Pain is not often relieved by systemic analgesics, but can sometimes be relieved by topical anesthetics.
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| | Severity || Moderate to severe, rated 5-8 out of 10, similar in intensity to [[toothache]]
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| | Effect on sleep || May not disturb sleep, or may change sleep patterns, e.g. [[insomnia]].
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| | Previous treatment || Often multiple consultations and unsuccessful attempts at dental and/or medical treatment
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| |}
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| ==Causes==
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| ===Theories===
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| In about 50% of cases of burning mouth sensation no identifiable cause is apparent;<ref name="Scully 2008" /> these cases are termed (primary) BMS.<ref name="Coulthard 2008" /> Several theories of what causes BMS have been proposed, and these are supported by varying degrees of evidence, but none is proven.<ref name="Bouquot 2002" /><ref name="Coulthard 2008">{{cite book|last=Coulthard []|first=P|title=Master dentistry.|year=2008|publisher=Churchill Livingstone/Elsevier|location=Edinburgh|isbn=9780443068966|pages=[https://archive.org/details/masterdentistry0000unse/page/231 231–232]|edition=2nd|display-authors=etal|url=https://archive.org/details/masterdentistry0000unse/page/231}}</ref>
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| As most people with BMS are postmenopausal women, one theory of the cause of BMS is of [[estrogen]] or [[progesterone]] deficit, but a strong statistical correlation has not been demonstrated.<ref name="Bouquot 2002" /> Another theory is that BMS is related to [[autoimmunity]], as abnormal antinuclear antibody and rheumatoid factor can be found in the serum of more than 50% of persons with BMS, but these levels may also be seen in elderly people who do not have any of the symptoms of this condition.<ref name="Bouquot 2002" /> Whilst salivary flow rates are normal and there are no clinical signs of a dry mouth to explain a complaint of dry mouth, levels of salivary proteins and phosphate may be elevated and salivary pH or buffering capacity may be reduced.<ref name="Bouquot 2002" />
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| Depression and [[anxiety]] are strongly associated with BMS.<ref name="Bouquot 2002" /><ref name="Kalantzis 2005" /><ref name="Scully 2013" /> It is not known if depression is a cause or result of BMS, as depression may develop in any setting of constant unrelieved irritation, pain, and sleep disturbance.<ref name="Bouquot 2002" /><ref name="Glick 2003" /><ref name="Grushka 2002" /> It is estimated that about 20% of BMS cases involve [[psychogenic disease|psychogenic factors]],<ref name="Scully 2013">{{cite book|author=Scully C|title=Oral and maxillofacial medicine : the basis of diagnosis and treatment|year=2013|publisher=Churchill Livingstone|location=Edinburgh|isbn=9780702049484|edition=3rd|pages=249–253}}</ref> and some consider BMS a [[psychosomatic illness]],<ref name="Bouquot 2002" /><ref name="Kalantzis 2005" /> caused by [[cancerophobia]],<ref name="Kalantzis 2005" /><ref name="Scully 2013" /> concern about [[sexually transmitted infection]]s,<ref name="Scully 2013" /> or [[hypochondriasis]].<ref name="Kalantzis 2005" />
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| Chronic low-grade trauma due to [[parafunctional habit]]s (e.g. rubbing the tongue against the teeth or pressing it against the palate), may be involved.<ref name="Glick 2003" /> BMS is more common in persons with [[Parkinson's disease]], so it has been suggested that it is a disorder of reduced pain threshold and increased sensitivity. Often people with BMS have unusually raised taste sensitivity, termed [[hypergeusia]] ("super tasters").<ref name="Scully 2008" /> [[Dysgeusia]] (usually a bitter or metallic taste) is present in about 60% of people with BMS, a factor which led to the concept of a defect in sensory peripheral neural mechanisms.<ref name="Glick 2003" /> Changes in the oral environment, such as changes in the composition of saliva, may induce neuropathy or interruption of nerve transduction.<ref name="Scully 2008" /><ref name="Coulthard 2008" /> The onset of BMS is often spontaneous, although it may be gradual. There is sometimes a correlation with a major life event or stressful period in life.<ref name="Treister 2010" /> In women, the onset of BMS is most likely three to twelve years following menopause.<ref name="Bouquot 2002" />
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| ===Other causes of an oral burning sensation===
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| {| style="float:right; width:230px; border:1px solid #BBB; font-size:85%; margin:0.46em 0.2em"
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| ! Substances capable of causing an oral burning sensation.<ref name="Scully 2008" />
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| | ''Foods and additives
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| * [[Benzoic acid]] | |
| * [[Chestnut]]s
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| * [[Cinnamaldehyde]]
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| * Instant [[coffee]]
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| * [[Nicotinic acid]]
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| * [[Peanut]]s
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| * [[Sodium metabisulphite]]
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| * [[Sorbic acid]]
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| ''Metals''
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| * [[Cadmium]]
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| * [[Cobalt chloride]]
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| * [[Mercury (element)|Mercury]]
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| * [[Nickel]]
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| * [[Palladium]]
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| ''Plastics''
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| * [[Benzoyl peroxide]]
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| * [[Bisphenol A]]
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| * [[Epoxy resin]]s
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| * [[Methyl methacrylate]]
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| * [[Octyl gallate]]
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| * [[Propylene glycol]]
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| |}
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| {{see also|Glossitis}}
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| Several local and systemic factors can give a burning sensation in the mouth without any clinical signs, and therefore may be [[misdiagnosis|misdiagnosed]] as BMS. Some sources state that where there is an identifiable cause for a burning sensation, this can be termed "secondary BMS" to distinguish it from primary BMS.<ref name="Maltsman-Tseikhin 2007" /><ref name="Balasubramaniam 2009" /> However, the accepted definitions of BMS hold that there are no identifiable causes for BMS,<ref name="Scully 2008" /><ref name=McMillan2016 /><ref name="Mock 2010" /> and where there are identifiable causes, the term BMS should not be used.<ref name=McMillan2016 />
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| Some causes of a burning mouth sensation may be accompanied by clinical signs in the mouth or elsewhere on the body. For example, burning mouth pain may be a symptom of [[stomatitis#allergic contact stomatitis|allergic contact stomatitis]]. This is a contact sensitivity ([[type IV hypersensitivity]] reaction) in the oral tissues to common substances such as [[sodium lauryl sulfate]], [[cinnamaldehyde]] or dental materials.<ref name="Andrews"/> However, allergic contact stomatitis is accompanied by visible lesions and gives positive response with patch testing. Acute (short term) exposure to the [[allergen]] (the substance triggering the allergic response) causes non-specific inflammation and possibly [[mouth ulcer|mucosal ulceration]]. Chronic (long term) exposure to the allergen may appear as chronic inflammatory, lichenoid (lesions resembling oral [[lichen planus]]), or [[plasma cell gingivitis]], which may be accompanied by glossitis and [[cheilitis]].<ref name="Glick 2003">{{cite book|last=Glick|first=Martin S. Greenberg, Michael|title=Burket's oral medicine diagnosis & treatment|year=2003|publisher=BC Decker|location=Hamilton, Ont.|isbn=978-1550091861|pages=60–61, 332–333|edition=10th}}</ref> Apart from BMS itself, a full list of causes of an oral burning sensation is given below:
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| * Deficiency of iron, [[folic acid]] or various [[vitamin B|B vitamins]] ([[glossitis]] e.g. due to [[anemia]]), or [[zinc deficiency|zinc]]<ref name=Gurvits2013>{{cite journal|last1=Gurvits|first1=GE|last2=Tan|first2=A|title=Burning mouth syndrome.|journal=World Journal of Gastroenterology|date=Feb 7, 2013|volume=19|issue=5|pages=665–72|doi=10.3748/wjg.v19.i5.665|pmid=23429751|pmc=3574592}}</ref>
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| * [[Neuropathy]], e.g. following damage to the [[chorda tympani nerve]]. | |
| * [[Hypothyroidism]].
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| * Medications ("scalded mouth syndrome", unrelated to BMS) - [[protease inhibitor (pharmacology)|protease inhibitor]]s and [[angiotensin-converting-enzyme inhibitor]]s (e.g. [[captopril]]).<ref name="Scully 2008" /><ref name="Bouquot 2002" /><ref name="Kalantzis 2005">{{cite book|last=Kalantzis|first=Crispian Scully, Athanasios|title=Oxford handbook of dental patient care|year=2005|publisher=Oxford University Press|location=New York|isbn=9780198566236|edition=2nd|page=302}}</ref>
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| * [[Type 2 diabetes]]<ref name="Kalantzis 2005" />
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| * True [[xerostomia]], caused by hyposalivation e.g. [[Sjögren's syndrome]]
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| * Parafunctional activity, e.g. nocturnal [[bruxism]] or a [[tongue thrusting]] habit. | |
| * Restriction of the tongue by poorly constructed [[dentures]]. | |
| * [[Geographic tongue]].<ref name="Kalantzis 2005" />
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| * [[Oral candidiasis]].<ref name="Kalantzis 2005" />
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| * Herpetic infection ([[herpes simplex virus]]).<ref name="Zakrzewska 2013">{{cite journal|last=Zakrzewska|first=JM|title=Multi-dimensionality of chronic pain of the oral cavity and face.|journal=The Journal of Headache and Pain|date=Apr 25, 2013|volume=14|issue=1|pages=37|doi=10.1186/1129-2377-14-37|pmid=23617409|pmc=3642003}}</ref> | |
| * [[Fissured tongue]].<ref name="Scully 2008" />
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| * [[Lichen planus]].<ref name="Scully 2008" />
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| * Allergies and contact sensitivities to foods, metals, and other substances (see table).
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| * [[Hiatal hernia]].<ref name="Scully 2008" />
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| * [[Human immunodeficiency virus]].<ref name="Scully 2008" />
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| * [[Multiple myeloma]]<ref>{{cite journal | doi=10.1016/j.ooe.2003.11.003 | volume=40 | title=Burning mouth syndrome as the initial sign of multiple myeloma | journal=Oral Oncology Extra | pages=13–15| year=2004 | last1=Vučićević-Boras | first1=V. | last2=Alajbeg | first2=I. | last3=Brozovic | first3=S. | last4=Mravak-Stipetic | first4=M. }}</ref>
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| ==Diagnosis==
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| BMS is a [[diagnosis of exclusion]], i.e. all other explanations for the symptoms are ruled out before the diagnosis is made.<ref name="Scully 2008" /><ref name="Maltsman-Tseikhin 2007">{{cite journal|last=Maltsman-Tseikhin|first=A|author2=Moricca, P |author3=Niv, D |title=Burning mouth syndrome: will better understanding yield better management?|journal=Pain Practice|date=June 2007|volume=7|issue=2|pages=151–62|pmid=17559486|doi=10.1111/j.1533-2500.2007.00124.x}}</ref> There are no clinically useful investigations that would help to support a diagnosis of BMS<ref name=McMillan2016 /> (by definition all tests would have normal results),<ref name="Scully 2008" /> but [[blood test]]s and / or [[urinalysis]] may be useful to rule out anemia, deficiency states, hypothyroidism and diabetes. Investigation of a dry mouth symptom may involve [[sialometry]], which objectively determines if there is any reduction of the salivary flow rate (hyposalivation). Oral candidiasis can be tested for with use of a swabs, smears, an oral rinse or saliva samples.<ref name="Coulthard 2008" /> It has been suggested that allergy testing (''e.g.'', [[patch test]]) is inappropriate in the absence of a clear history and clinical signs in people with a burning sensation in the mouth.<ref name="Coulthard 2008" /> The diagnosis of a people with a burning symptom may also involve psychologic screening e.g. depression questionnaires.<ref name="Scully 2008" />
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| The second edition of the [[International Classification of Headache Disorders]] lists diagnostic criteria for "Glossodynia and Sore Mouth":
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| ::A. Pain in the mouth present daily and persisting for most of the day,
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| ::B. Oral mucosa is of normal appearance,
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| ::C. Local and systemic diseases have been excluded.<ref name=ICHD-2>{{cite web|title=2nd Edition of The International Headache Classification (ICHD-2)|url=http://ihs-classification.org/en/02_klassifikation/04_teil3/13.18.05_facialpain.html|publisher=International Headache Society|accessdate=7 May 2013|archive-url=https://web.archive.org/web/20130928060317/http://ihs-classification.org/en/02_klassifikation/04_teil3/13.18.05_facialpain.html|archive-date=28 September 2013|url-status=dead}}</ref>
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| ===Classification===
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| A burning sensation in the mouth may be primary (i.e. burning mouth syndrome) or secondary to systemic or local factors.<ref name="Scully 2008" /> Other sources refer to a "secondary BMS" with a similar definition, i.e. a burning sensation which is caused by local or systemic factors,<ref name="Maltsman-Tseikhin 2007" /> or "where oral burning is explained by a clinical abnormality".<ref name="Balasubramaniam 2009">{{cite journal|last=Balasubramaniam|first=R|author2=Klasser, GD |author3=Delcanho, R |title=Separating oral burning from burning mouth syndrome: unravelling a diagnostic enigma.|journal=Australian Dental Journal|date=December 2009|volume=54|issue=4|pages=293–9|pmid=20415926|doi=10.1111/j.1834-7819.2009.01153.x}}</ref> However this contradicts the accepted definition of BMS which specifies that no cause can be identified. "Secondary BMS" could therefore be considered a misnomer. BMS is an example of [[dysesthesia]], or a distortion of sensation.<ref name="Bouquot 2002" />
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| Some consider BMS to be a variant of [[atypical facial pain]].<ref name="Porter 2002">{{cite book|last=Porter|first=R.A. Cawson, E.W. Odell; avec la collab. de S.|title=Cawsonś essentials of oral pathology and oral medicine.|year=2002|publisher=Churchill Livingstone|location=Edinburgh|isbn=978-0443071065|edition=7.|page=216}}</ref> More recently, BMS has been described as one of the 4 recognizable symptom complexes of chronic [[orofacial pain|facial pain]], along with atypical facial pain, [[temporomandibular joint dysfunction]] and [[atypical odontalgia]].<ref name="Aggarwal 2011">{{cite journal|last=Aggarwal|first=VR|author2=Lovell, K |author3=Peters, S |author4=Javidi, H |author5=Joughin, A |author6= Goldthorpe, J |title=Psychosocial interventions for the management of chronic orofacial pain.|journal=Cochrane Database of Systematic Reviews|date=Nov 9, 2011|issue=11|pages=CD008456|doi=10.1002/14651858.CD008456.pub2|pmid=22071849}}</ref> BMS has been subdivided into three general types, with type two being the most common and type three being the least common.<ref name="Scully 2008" /> Types one and two have unremitting symptoms, whereas type three may show remitting symptoms.<ref name="Scully 2008" />
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| * Type 1 - Symptoms not present upon waking, and then increase throughout the day | | Symptoms may: |
| * Type 2 - Symptoms upon waking and through the day | | * Be constant or intermittent. |
| * Type 3 - No regular pattern of symptoms | | * Worsen throughout the day. |
| | * Persist for months or even years. |
| | * Improve with eating or drinking. |
|
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| Sometimes those terms specific to the tongue (e.g. ''glossodynia'') are reserved for when the burning sensation is located only on the tongue.<ref name=ICHD-2 />
| | == '''Causes and Risk Factors''' == |
| | The exact cause of Burning Mouth Syndrome is not well understood, but multiple factors may contribute to its development. |
|
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| ==Treatment== | | === Primary BMS (Idiopathic BMS) === |
| If a cause can be identified for a burning sensation in the mouth, then treatment of this underlying factor is recommended. If symptom persist despite treatment a diagnosis of BMS is confirmed.<ref name="Coulthard 2008" /> BMS has been traditionally treated by reassurance and with [[antidepressant]]s, [[anxiolytic]]s or [[anticonvulsant]]s. A 2016 [[Cochrane (organisation)|Cochrane review]] of treatment for burning mouth syndrome concluded that strong evidence of an effective treatment was not available, <ref name=McMillan2016 /> however, a systematic review in 2018 found that the use of antidepressants and alpha-lipoic acids gave promising results.<ref>{{Cite journal|last=Souza|first=Isadora Follak de|last2=Mármora|first2=Belkiss Câmara|last3=Rados|first3=Pantelis Varvaki|last4=Visioli|first4=Fernanda|title=Treatment modalities for burning mouth syndrome: a systematic review|journal=Clinical Oral Investigations|language=en|volume=22|issue=5|pages=1893–1905|doi=10.1007/s00784-018-2454-6|pmid=29696421|issn=1432-6981|year=2018}}</ref><ref name="ouh">{{cite web |title=Burning mouth syndrome |url=https://www.ouh.nhs.uk/patient-guide/leaflets/files/110407burningmouth.pdf |accessdate=1 February 2019}}</ref>
| | * Neuropathic dysfunction – Damage or dysfunction in sensory nerves of the mouth and tongue. |
| | * Altered pain processing in the central nervous system. |
|
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| Other treatments which have been used include [[atypical antipsychotic]]s, [[histamine receptor antagonist]]s, and [[dopamine agonist]]s.<ref name="Charleston2013">{{cite journal|last1=Charleston L|first1=4th |title=Burning mouth syndrome: a review of recent literature.|journal=Current Pain and Headache Reports|date=June 2013|volume=17 |issue=6 |pages=336|doi=10.1007/s11916-013-0336-9|pmid=23645183}}</ref>
| | === Secondary BMS (Underlying Medical Causes) === |
| | Secondary BMS may be linked to: |
| | * Hormonal imbalances – Common in menopausal women due to estrogen changes. |
| | * Nutritional deficiencies – Low levels of: |
| | * Vitamin B12 |
| | * Folate |
| | * Iron |
| | * Zinc |
| | * Diabetes Mellitus – Poorly controlled blood sugar may contribute to nerve dysfunction. |
| | * Oral infections – Such as oral candidiasis (yeast infection). |
| | * Dry mouth (Xerostomia) – Due to medications, dehydration, or autoimmune conditions like Sjögren’s syndrome. |
| | * Allergic reactions – To dental materials, toothpaste, or mouthwashes. |
| | * Psychological factors – Stress, anxiety, and depression are commonly associated with BMS. |
|
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| === Initial visit ===
| | == '''Diagnosis''' == |
| ==== ''Topical'' ====
| | Burning Mouth Syndrome is a diagnosis of exclusion, meaning other potential causes must be ruled out. |
| # Capsaicin gel 0.025%
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| # Alpha-lipoic acid as mouthrinse b.i.d./1–2 months
| |
| ==== ''Systemic:'' ====
| |
| # Multivitamins – B12, methyl cobalamin and folic acid
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| === Chronic cases === | | === Diagnostic Approach === |
| ==== ''Systemic'' ====
| | 1. Detailed Medical and Dental History |
| # Amitriptyline 25 mg b.i.d. for 15 days, o.d. for 15 days
| | 2. Clinical Examination |
| # Gabapentin 300 mg 1st day 300 mg, 2nd day 300 mg b.i.d., 3rd day 300 mg t.i.d. and then maintain the dosage. It can be given to a maximum of 2400 mg/day
| | * Inspection of the oral cavity, tongue, and mucosa for signs of infection or irritation. |
| C. Alprazolam 0.25 mg b.i.d. for a week and slowly withdraw the drug
| | 3. Laboratory Tests |
| D. Clonazepam 2 mg o.d. at bed time for 15 days
| | * Blood tests to check for nutritional deficiencies, diabetes, and hormonal imbalances. |
| E. Nortriptyline 25 mg o.d. for not more than 3 months (trip)
| | * Salivary flow tests to evaluate xerostomia. |
| | * Allergy testing for possible contact hypersensitivity. |
| | 4. Neurological Testing |
| | * Sensory nerve function tests to identify neuropathic causes. |
| | 5. Biopsy (if necessary) |
| | * To rule out oral cancer or other mucosal diseases. |
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| | == '''Treatment and Management''' == |
| | There is no single cure for BMS, and treatment focuses on symptom relief and managing underlying conditions. |
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| ==Prognosis== | | === 1. Medications === |
| BMS is benign (importantly, it is not a symptom of [[oral cancer]]), but as a cause of chronic pain which is poorly controlled, it can detriment [[quality of life]], and may become a fixation which cannot be ignored, thus interfering with work and other daily activities.<ref name="Treister 2010" /> Two thirds of people with BMS have a spontaneous partial recovery six to seven years after the initial onset, but in others the condition is permanent.<ref name="Bouquot 2002" /><ref name="Grushka 2002" /> Recovery is often preceded by a change in the character of the symptom from constant to intermittent.<ref name="Grushka 2002" /> No clinical factors predicting recovery have been noted.<ref name="Grushka 2002" />
| | * Neuropathic pain medications: |
| | * Gabapentin or pregabalin – Helps modulate nerve pain. |
| | * Tricyclic antidepressants (Amitriptyline, Nortriptyline) – Alters pain perception. |
| | * Clonazepam – A benzodiazepine that reduces neuropathic pain. |
| | * Saliva substitutes and oral moisturizers – Helps relieve dry mouth symptoms. |
| | * Capsaicin oral rinses – Reduces burning sensations by desensitizing nerve receptors. |
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| If there is an identifiable cause for the burning sensation, then psychologic dysfunctions such as anxiety and depression often disappear if the symptom is successfully treated.<ref name="Bouquot 2002" />
| | === 2. Lifestyle Modifications === |
| | * Avoid irritants – Such as spicy foods, acidic beverages, alcohol, tobacco, and excessive caffeine. |
| | * Stay hydrated – Drink plenty of water to alleviate dry mouth. |
| | * Practice stress management – Engage in relaxation techniques, such as yoga, meditation, and cognitive behavioral therapy (CBT). |
| | * Improve oral hygiene – Use non-alcoholic mouthwash and gentle toothpaste. |
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| ==Epidemiology== | | === 3. Nutritional Therapy === |
| BMS is fairly uncommon worldwide, affecting up to five individuals per 100,000 general population. <ref name=McMillan2016 />People with BMS are more likely to be middle aged or elderly, and females are three to seven times more likely to have BMS than males.<ref name="Scully 2008" /><ref>Greenberg MS; Glick M; Ship JA. Burket's Oral Medicine. 11th edition. 2012</ref> Some report a female to male ratio of as much as 33 to 1.<ref name="Mock 2010" /> BMS is reported in about 10-40% of women seeking medical treatment for [[menopause|menopausal]] symptoms, and BMS occurs in about 14% of postmenopausal women.<ref name="Bouquot 2002" /><ref name="Grushka 2002">{{cite journal|last=Grushka|first=M|author2=Epstein, JB |author3=Gorsky, M |title=Burning mouth syndrome.|journal=American Family Physician|date=Feb 15, 2002|volume=65|issue=4|pages=615–20|pmid=11871678}}</ref> Males and younger individuals of both sexes are sometimes affected.<ref name="Treister 2010">{{cite book|last=Treister|first=Jean M. Bruch, Nathaniel S.|title=Clinical oral medicine and pathology|year=2010|publisher=Humana Press|location=New York|isbn=978-1-60327-519-4|pages=137–138}}</ref>
| | If deficiencies are detected, supplementation with: |
| | * [[Vitamin B12]] |
| | * [[Iron]] |
| | * [[Folate]] |
| | * [[Zinc]] |
| | may improve symptoms. |
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| Asian and Native American people have considerably higher risk of BMS.<ref name="Bouquot 2002" />
| | === 4. Behavioral Therapy === |
| | * Cognitive Behavioral Therapy (CBT) – May help patients cope with chronic symptoms. |
| | * Support groups and counseling – Useful for patients with associated anxiety or depression. |
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| ==Notable cases== | | == '''Prognosis''' == |
| [[Sheila Chandra]], a singer of [[Indian people|Indian]] heritage, retired due to this condition.<ref>{{cite web|title=Sheila Chandra United Kingdom|url=https://realworldrecords.com/artist/498/sheila-chandra/|publisher=Real World Records|accessdate=1 August 2013}}</ref>
| | The prognosis for Burning Mouth Syndrome varies: |
| | * Some patients experience spontaneous resolution. |
| | * Others have long-term symptoms requiring ongoing management. |
| | * Secondary BMS has a better prognosis if the underlying cause is identified and treated. |
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| ==References== | | == '''Prevention Strategies''' == |
| {{Reflist}}
| | While Burning Mouth Syndrome cannot always be prevented, the following measures may reduce risk: |
| | * Maintain good oral hygiene. |
| | * Avoid irritating foods and beverages. |
| | * Stay hydrated. |
| | * Manage stress and anxiety effectively. |
| | * Address any vitamin or mineral deficiencies early. |
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|
| *{{cite journal |author=Scala A |author2=Checchi L |author3=Montevecchi M |author4=Marini I |author5=Giamberardino MA |title=Update on burning mouth syndrome: overview and patient management |journal=Crit Rev Oral Biol Med |volume=14 |issue= 4|pages=275–91 |year=2003 |pmid= 12907696|doi=10.1177/154411130301400405}}
| | == '''See Also''' == |
| | * '''[[Xerostomia]] (Dry Mouth)''' |
| | * '''[[Oral candidiasis]]''' |
| | * '''[[Neuropathic pain]]''' |
| | * '''[[Vitamin B12 deficiency]]''' |
| | * '''[[Sjögren’s syndrome]]''' |
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| == External links == | | == '''External Links''' == |
| {{Medical resources
| | * [https://www.ncbi.nlm.nih.gov/pubmed/?term=burning+mouth+syndrome NCBI - Research on Burning Mouth Syndrome] |
| | DiseasesDB =
| | * [https://www.aaom.com/burning-mouth-syndrome American Academy of Oral Medicine - BMS Information] |
| | ICD10 = {{ICD10|K|14|6|k|00}}
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| | ICD9 = {{ICD9|529.6}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus =
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| | eMedicineSubj =
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| | eMedicineTopic =
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| | MeshID = D005926
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| | Orphanet = 353253
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| }}
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| {{Oral pathology}} | | {{Oral pathology}} |
| {{stub}} | | {{stub}} |
| | {{DEFAULTSORT:Burning Mouth Syndrome}} |
| | [[Category:Oral diseases]] |
| | [[Category:Chronic pain syndromes]] |
| | [[Category:Neurological disorders]] |
| | [[Category:Sensory system diseases]] |
| [[Category:Symptoms]] | | [[Category:Symptoms]] |
| [[Category:Syndromes]] | | [[Category:Syndromes]] |
