By Jeanne Barss, DDS, MS Burning mouth syndrome commonly affects a person’s ability to swallow, eat, speak, and sleep well – making it of wide concern. Many people in the United States may have heard Burning Mouth Syndrome called by different names, like “oral burning,” “tongue pain,” and “burning mouth condition.” Burning Mouth Syndrome (BMS) is an orofacial pain disorder that is characterized by burning in the intraoral and perioral tissues without relevant clinical signs at the time of the examination or laboratory findings to suggest an organic cause. It is a complex chronic neuropathic orofacial pain disorder identified by a generalized or localized burning within the mouth, abnormal sensation, or pain of the oral mucosa. According to the National Institute of Health (NIH), BMS is identified when pain is “recurring daily for more than 2 h per day for more than 3 months, without any evidence of specific mucosal lesions and/or laboratory findings.” The December 30, 2022, Burning Mouth Syndrome: An Overview and Future Perspectives article by Daniela Adamo states that the main symptom reported by the patients is “burning” pain, as the name implies. BMS also goes by various names based on what triggers this medical condition. Multiple factors may contribute to BMS, and addressing each one can improve treatment effectiveness. However, some factors play a more significant role than others. For instance, nutritional deficiencies and systemic diseases rarely contribute to BMS. The cause is unknown. While a general screening is often performed, positive findings are uncommon. Nevertheless, any identified irregularities should be addressed, even if they seem to have minimal impact on symptoms. Similarly, many BMS patients experience xerostomia or mechanical trauma, both of which can be managed. Most patients experience good days and bad days. This fluctuation in symptoms seems to relate most to stress levels, among other factors. BMS often coexists with a host of persistent changes to oral somatosensory and taste perception. These sets of sensory disturbances and the burning pain appear to be connected since they usually both respond to similar treatments, including anticonvulsant analgesics for pain. Often, BMS pain begins suddenly, with intermittent and then constant pain in the oral mucosa. Patients often report the pain is precipitated by antibiotic therapy or dental surgery. Every patient can be unique, with different medical occurrences accompanying their symptoms. The above NIH study also reports that the tongue appears to be the most frequently involved site. The pain may be at one or several of these sites and is frequently bilateral. It is usually not detectable during sleep and on waking but progressively increases throughout the day to a maximal level in the evening. Eating often reduces the pain – although certain foods may exacerbate it. Psychological factors are known to be directly associated with BMS; anxiety is the foremost of these factors. Given the complex connection sometimes found between anxiety, BMS, and facial pain, a treatment approach guided by a multidisciplinary team is often best. When one or more dentists, psychiatrists, orofacial pain specialists, and psychologists evaluate multimorbidity, BMS subjects can gain the best-personalized pain treatment plan. The diagnosis of Burning Mouth Syndrome is often based on history and the absence of clinical findings on examination. Typically, patients complain of burning pain affecting their tongue, anterior palate, lips, and gingival tissue, which is often, but not always, bilateral. Occasionally, patients will complain of burning pain extending from the area of the foliate papillae to the tip of the tongue, or complain of pain localized almost exclusively to the anterior palate behind the upper incisors. In almost all of these instances, no clinical lesions explain the burning pain. MRI and CT imaging studies of the cranial nerves and brain are almost always negative, although central changes compatible with aging may be found in older patients. Unlike most dental pains, oral burning, taste changes, and dryness are typically decreased by chewing gum, candy, food, and sleep. An additional hallmark of this disorder appears to be the pattern of pain and sensory disturbances, which progressively increases over the day until late afternoon or early evening, when it then decreases. The pain and other associated disturbances usually remit during sleep and are at their lowest level each morning. NIH’s September 28, 2022 Worldwide prevalence estimates of burning mouth syndrome: A systematic review and meta-analysis reports the prevalence of burning mouth syndrome was 1.73% in the general population, and 7.72% in clinical patients. The percentage of individuals suffering from BMS depends on the definition used in specific studies and the purpose of the study (e.g. General practice, tertiary care, medical practice, etc.). With the increase of our aging population, BMS will present with increasing frequency. The Minnesota Head & Neck Pain Clinics have found cevimeline or pilocarpine have been very effective in correcting dryness of the mouth. A 2023 Jan 18 NIH report found thatpsychotropics, gastroprotectors and gastrointestinal tract (GI)-associated drugs, and antihypertensives were the three most commonly used drugs among the BMS patients studied. Most BMS patients (82.5%) take at least one medicine. [4] “Medications, especially multiple medications, may play an important role in the development of BMS, especially for the older female BMS patients.” – Association of medications with burning mouth syndrome [4] It is possible that several underlying mechanisms may be related to the development of BMS. The thoroughness in identifying and addressing each contributing factor will improve the overall effectiveness of treatment. However, some factors play a more significant role in clinical practice than others. For example, very few patients with oral burning who have had problems with nutritional deficiency or other systemic disease that contributes to their condition. While a general screening is often done for systemic causes, the expectation of positive findings appears to be very low. Any irregularity should be treated, although it appears to make little difference in symptom presentation. Likewise, many patients with BMS experience xerostomia or mechanical trauma, both of which are common factors that contribute to BMS and can be treated. People suffering from BMS benefit from improved educational materials to ensure an early diagnosis. We trust this article helps explain when to call and make an appointment and what to expect. If you have additional questions or want to schedule an appointment with one of our clinic’s BMS pain specialists, we are eager to make a difference in your daily life. Plymouth: (763) 577-2484 St. Paul: (651) 332-7474 Burnsville: (952) 892-6222 St. Cloud: 763-233-7252 Jeanne Barss, DDS, MS is a specialist in Periodontics and practices Oral Medicine. She has had BMS herself and is very aware of the quality of life challenges it presents. References: [1] N. Treister, SB Woo and the AAOM Web Writing Group, “Burning Mouth Syndrome by the American Academy of Oral Medicine,” Updated 2022, https://maaom.memberclicks.net/index.php?option=com_content&view=article&id=81:burning-mouth-syndrome&catid=22:patient-condition-information&Itemid=120 [2] Mayo Clinic research dept, “Burning mouth syndrome – Diagnosis and treatment,” Feb 2023, https://www.mayoclinic.org/diseases-conditions/burning-mouth-syndrome/diagnosis-treatment/drc-20350917 [3] Jääskeläinen, Satu K, “Is burning mouth syndrome a neuropathic pain condition?”, March 2018, https://journals.lww.com/pain/abstract/2018/03000/is_burning_mouth_syndrome_a_neuropathic_pain.25.aspx [4] Yu-Hsueh Wua, and Chun-Pin Chiangc, “Association of medications with burning mouth syndrome in Taiwanese aged patients,” Jan 2023, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10068492/Burning Mouth Syndrome
BMS has gained recognition due to growing interest in neuropathic pain and its prevalence in older adults.
Medical professionals also have their own terminology:
What is Burning Mouth Syndrome?
What Causes Burning Mouth Syndrome?
Commonly known triggers of BMS:
What are Common Symptoms of Burning Mouth Syndrome?
Oral manifestations of BMS typically include the following:
Burning mouth syndrome subtypes based on cause:
Common parts of the mouth that feel burning mouth pain:
Common foods that may make BMS worse:
Can anxiety cause burning mouth syndrome?
How is Burning Mouth Syndrome Diagnosed?
During diagnosis and diagnostic criteria for BMS the following are typical: [2]
How common is burning mouth syndrome?
What are Common Treatments for Burning Mouth Syndrome?
Treatment depends on whether you have primary or secondary burning mouth syndrome. [2]
Burning mouth syndrome treatment options may include:
Rationale for BMS treatment due to the disorder’s pathophysiology
As some BMS subtypes are also considered psychophysiologic disorders, psychoanalytic therapy may be recommended.
Pearls of Wisdom: thoroughness in identifying and addressing BMS
SUMMARY: Prognosis and Treatment of Burning Mouth Syndrome Patients
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