Burning mouth syndrome: An update

Background: Burning mouth syndrome (BMS) is a chronic and debilitating oral pain of the normal oral mucosa. It mainly affects women in their fifth to seventh decade. Its aetiopathogenesis remains unclear and is probably of multifactorial origin, with increasing evidence that BMS may be a neuropathic disorder. BMS is classified as an idiopathic (nociplastic) orofacial pain with or without somatosensory changes by International Classification of Orofacial Pain (ICOP 2020). The diagnosis of BMS, having excluded ‘oral burning mouth symptoms’, has evolved from basic intraoral exclusion screening to extensive clinical and laboratory investigations, which include the screening of comorbidities and other chronic pains and somatosensory testing. There is no standardised treatment in managing BMS, but a proposed combination of supportive and pharmacological treatment has been recommended. Aim: To review the current concepts of BMS definitions, classifications, aetiopathogenesis, diagnosis techniques, and evidence-based treatments in managing BMS patients. Conclusion: As BMS is a diagnosis by exclusion, thus a stratified approach is required for assessment of patients presenting BMS. A BMS diagnosis protocol is desired using a standardised screening to distinguish BMS from patient’s presenting with ‘oral burning symptoms’, and evaluation of comorbid chronic pain disorders or other medical comorbidities, which will include haematological, fungal, salivary flow, and qualitative sensory testing. Axis II and other additional quantitative sensory testing may further elucidate the causes of this condition. For future BMS prediction and prevention, will be based upon research on the relationship between other chronic pain disorders and familial history, environmental and genetic information.

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Salivary Biomarkers and Their Correlation with Pain and Stress in Patients with Burning Mouth Syndrome

Journal of Clinical Medicine ◽

10.3390/jcm9040929 ◽

2020 ◽

Vol 9 (4) ◽

pp. 929

Author(s):

Pia Lopez-Jornet ◽

Candela Castillo Felipe ◽

Luis Pardo-Marin ◽

Jose J. Ceron ◽

Eduardo Pons-Fuster ◽

...

Keyword(s):

Immunoglobulin A ◽

Salivary Flow ◽

Health Impact ◽

Burning Mouth Syndrome ◽

Salivary Biomarkers ◽

Inflammatory Protein ◽

Whole Saliva ◽

Burning Mouth ◽

Positive Correlations

Objective: To evaluate a panel of salivary analytes involving biomarkers of inflammation, stress, immune system and antioxidant status in patients with burning mouth syndrome (BMS) and to study their relationship with clinical variables. Materials and Methods: A total of 51 patients with BMS and 31 controls were consecutively enrolled in the study, with the recording of oral habits, the severity of pain using a visual analogue scale (VAS), the Hospital Anxiety and Depression (HAD) score and the Oral Health Impact Profile-14 (OHIP14) score. Resting whole saliva was collected with the drainage technique, followed by the measurement of 11 biomarkers. Results: The salivary flow was higher in patients with BMS. Among all the biomarkers studied, significantly higher levels of alpha-amylase, immunoglobulin A (IgA), and macrophage inflammatory protein-4 (MIP4) and lower levels of uric acid and ferric reducing activity of plasma (FRAP) were observed in the saliva of patients with BMS as compared to the controls (p < 0.05 in all cases). Positive correlations were found between pain, oral quality of life and anxiety scores and salivary biomarkers. Conclusions: BMS is associated with changes in salivary biomarkers of inflammation, oxidative stress and stress, being related to the degree of pain and anxiety.

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Update on Burning Mouth Syndrome: Overview and Patient Management

Critical Reviews in Oral Biology & Medicine ◽

10.1177/154411130301400405 ◽

2003 ◽

Vol 14 (4) ◽

pp. 275-291 ◽

Cited By ~ 297

Author(s):

A. Scala ◽

L. Checchi ◽

M. Montevecchi ◽

I. Marini ◽

M.A. Giamberardino

Keyword(s):

Chronic Pain ◽

Patient Management ◽

Current Knowledge ◽

Pain Syndrome ◽

Burning Mouth Syndrome ◽

Nerve Damage ◽

Hormonal Changes ◽

Oral Diseases ◽

Number Of Patients ◽

Burning Mouth

Burning Mouth Syndrome (BMS) is a chronic pain syndrome that mainly affects middle-aged/old women with hormonal changes or psychological disorders. This condition is probably of multifactorial origin, often idiopathic, and its etiopathogenesis remains largely enigmatic. The present paper discusses several aspects of BMS, updates current knowledge, and provides guidelines for patient management. There is no consensus on the diagnosis and classification of BMS. The etiopathogenesis seems to be complex and in a large number of patients probably involves interactions among local, systemic, and/or psychogenic factors. In the remaining cases, new interesting associations have recently emerged between BMS and either peripheral nerve damage or dopaminergic system disorders, emphasizing the neuropathic background in BMS. Based on these recent data, we have introduced the concepts of “primary” (idiopathic) and “secondary” (resulting from identified precipitating factors) BMS, since this allows for a more systematic approach to patient management. The latter starts with a differential diagnosis based on the exclusion of both other orofacial chronic pain conditions and painful oral diseases exhibiting muco-sal lesions. However, the occurrence of overlapping/overwhelming oral mucosal pathologies, such as infections, may cause difficulties in the diagnosis ("complicated BMS"). BMS treatment is still unsatisfactory, and there is no definitive cure. As a result, a multidisciplinary approach is required to bring the condition under better control. Importantly, BMS patients should be offered regular follow-up during the symptomatic periods and psychological support for alleviating the psychogenic component of the pain. More research is necessary to confirm the association between BMS and systemic disorders, as well as to investigate possible pathogenic mechanisms involving potential nerve damage. If this goal is to be achieved, a uniform definition of BMS and strict criteria for its classification are mandatory.

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Psychiatric (axis I) and personality (axis II) disorders in patients with burning mouth syndrome or atypical facial pain

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2011.06.004 ◽

2011 ◽

Vol 2 (4) ◽

pp. 155-160 ◽

Cited By ~ 51

Author(s):

Tero Taiminen ◽

Laura Kuusalo ◽

Laura Lehtinen ◽

Heli Forssell ◽

Nora Hagelberg ◽

...

Keyword(s):

Chronic Pain ◽

Personality Disorders ◽

Psychiatric Disorders ◽

Orofacial Pain ◽

Burning Mouth Syndrome ◽

Atypical Facial Pain ◽

Obsessive Compulsive ◽

Axis I ◽

Chronic Pain Conditions ◽

Chronic Course

AbstractBackground and aimsBurning mouth syndrome (BMS) and atypical facial pain (AFP) are often persistent idiopathic pain conditions that mainly affect middle-aged and elderly women. They have both been associated with various psychiatric disorders. This study examined current and lifetime prevalence of psychiatric axis I (symptom-based) and II (personality) disorders in patients with chronic idiopathic orofacial pain, and investigated the temporal relationship of psychiatric disorders and the onset of orofacial pain.MethodForty patients with BMS and 23 patients with AFP were recruited from Turku university hospital clinics. Mean age of the patients was 62.3 years (range 35–84) and 90% were female. BMS and AFP diagnoses were based on thorough clinical evaluation, and all patients had undergone clinical neurophysiological investigations including blink reflex and thermal quantitative tests. Current and lifetime DSM-IV diagnoses of axis I and II disorders were made on clinical basis with the aid of SCID-I and II-interviews. The detected prevalence rates and their 95% confidence intervals based on binomial distribution were compared to three previous large population-based studies.ResultsOf the 63 patients, 26 (41.3%) had had an axis I disorder that preceded the onset of orofacial pain, and 33 (52.4%) had had a lifetime axis I disorder. Rate of current axis I disorders was 36.5%, indicating that only about 16% of lifetime disorders had remitted, and they tended to run chronic course. The most common lifetime axis I disorders were major depression (30.2%), social phobia (15.9%), specific phobia (11.1%), and panic disorder (7.9%). Twelve patients (19.0%) had at least one cluster C personality disorder already before the emergence of orofacial pain. Patients with cluster C personality disorders are characterized as fearful and neurotic. None of the patients had cluster A (characterized as odd and eccentric) or B (characterized as dramatic, emotional or erratic) personality disorders. The most common personality disorders were obsessive–compulsive personality (14.3%), dependent personality (4.8%), and avoidant personality (3.2%). The majority of the patients (54%) had also one or more chronic pain conditions other than orofacial pain. In almost all patients (94%) they were already present at the onset of orofacial pain.ConclusionsOur results suggest that major depression, persistent social phobia, and neurotic, fearful, and obsessive–compulsive personality characteristics are common in patients with chronic idiopathic orofacial pain. Most psychiatric disorders precede the onset of orofacial pain and they tend to run a chronic course.ImplicationsWe propose that the high psychiatric morbidity, and comorbidity to other chronic pain conditions, in chronic idiopathic orofacial pain can be best understood in terms of shared vulnerability to both chronic pain and specific psychiatric disorders, most likely mediated by dysfunctional brain dopamine activity.

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A Case of Vestibular Schwannoma with Oral Burning Sensation: Surgical Complication or Burning Mouth Syndrome?

10.21203/rs.3.rs-34585/v1 ◽

2020 ◽

Author(s):

Takayuki Suga ◽

Miho Takenoshita ◽

Trang T.H Tu ◽

Chaoli Hong ◽

Chihiro Takao ◽

...

Keyword(s):

Vestibular Schwannoma ◽

Facial Pain ◽

Somatic Symptom ◽

Bitter Taste ◽

Surgical Complication ◽

Exceptional Case ◽

Burning Mouth Syndrome ◽

Burning Sensation ◽

Burning Mouth ◽

Oral Burning

Abstract Background: Vestibular schwannoma (VS) or acoustic neuroma is a benign brain tumor. Despite improvements in surgical technique, the removal of VS is related to some complications of which the recovery is difficult and sometimes lead to permanent deficits. About 10.7% of complication of vestibular schwannoma surgery is reported to affect facial or tongue area, including numbness of pain, which is similar to a typical symptom of burning mouth syndrome (BMS). However, up to our knowledge, there is no documented case of BMS either comorbid with vestibular schwannoma or occur due to surgery complications. Clinical Presentation: A 46-year-old woman complained about left-sided facial pain, a burning sensation on the left side of her tongue and maxilla, and a spontaneous bitter taste. Four years before her first visit to our clinic, left-sided facial pain and burning sensation on the left side of the tongue suddenly became severe. She visited a neurosurgeon and VS was found in the left cerebellopontine angle. After the tumor was removed, facial pain, burning sensation of the tongue, and bitter taste improved simultaneously but quickly recurred after a while. The patient had a panic attack because of severe pain and started visiting a psychiatrist. The psychiatrist diagnosed her as having somatic symptom disorder and depression, prescribing sertraline 100 mg, zolpidem 5 mg, and lorazepam 1.0 mg and referred her to our clinic. At the first visit, no abnormal intraoral nor extraoral findings were detected. Based on the characteristics of the pain, we made a diagnose of BMS. Amitriptyline was initiated at 10 mg/day and increased to 30 m. Within 1.5 months, the pain and burning sensation of the tongue and maxilla almost remitted completely, whereas bitter taste showed moderate improvement. Conclusions: Our case suggests there might be an exceptional case in which BMS and VS can occur simultaneously. Specifically, an oral burning sensation and dysgeusia after VS surgery are not always a case of surgical complication or untreatable.

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Burning Mouth Syndrome pada wanita Menopause dengan Hiposalivasi, Coated Tongue dan Gangguan Pengecapan serta Penatalaksanaannya

Majalah Kedokteran Gigi Indonesia ◽

10.22146/majkedgiind.15920 ◽

2012 ◽

Vol 19 (1) ◽

pp. 82

Author(s):

Sri Hadiati

Keyword(s):

Oral Cavity ◽

Postmenopausal Women ◽

Vitamin B1 ◽

Burning Mouth Syndrome ◽

Burning Sensation ◽

Chewing Gum ◽

Affected Patient ◽

Burning Mouth ◽

Oral Burning

Blackground: Burning mouth syndrome (BMS) is a disorder that is characterized by a burning sensation of the oral cavity in the absence of visible local or systemic abnormalities. Affected patient often present with multiple oral complaints, including burning, dryness and taste alterations. The exact cause of burning mouth syndrome often is difficult to pin point. Conditions that have been reported in association with burning mouth syndrome include menopause, hyposlivation, coated tongue, taste alterations and psychologic condition. Objective: To report a case of burning mouth syndrome in postmenopausal women with hyposalivation, coated tongue, taste alterations and psychologic condition and its management. Case and management: a case of burning mouth syndrome in women with menopause, hyposalivation, coated tongue, and taste alterations, was managed effectively by gabapentin 100mg, probiotic chewing gum, diazepam 2mg and vitamin B1, B6, B12. Conclusion: Oral burning appears to be most prevalent in postmenopausal women often present with multiple oral complaints, including burning, dryness and taste alterations, in this case was managed effectively by gabapentin 100mg, prebiotic chewing gum, diazepam 2mg and vitamin B1, B6, B12.

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