[Burning mouth syndrome]

Burning mouth syndrome (BMS) is characterized by burning sensations of the oral cavity in the absence of abnormalities of the oral mucosa. BMS predominantly affects middle-aged women. This condition has a multifactorial etiology. Multiple approaches to treatment have been described. This article examines BMS, its related factors, and treatment options.

Burning mouth syndrome: an update on recent findings

Burning mouth syndrome (BMS) is characterized by a burning sensation of the oral mucosa in the absence of mucosal abnormality. Various local, systemic and psychological factors are associated with BMS, but its aetiology is not fully understood. Recently, significant inroads have been made, producing a better understanding of this complex condition. The aim of the current paper is to explore the condition of BMS in an educational context with the specific outcome of increasing awareness of the condition.

[Role of various etiologic factors in the development of burning mouth syndrome]

Burning mouth syndrome (BMS) has been comparatively recently isolated as the separate nosologic diagnosis. This disease is characterized by the feeling of burning, dryness, numbness, pricking and seldom by pain in the tongue or mouth cavity area (palate, lips, alveoli) without any changes in mucous membrane. Absence of visible causes of the disease complicates its treatment and makes the patients to address the physicians of various profiles, often without any result. All the above stated made the authors to define the etiologic factors of various clinical versions of BMS and to carry out their differential diagnostics along with the development of pathogenetic therapy of BMS. 30 women of 40 to 70 year of age were examined. According to the anamnesis, BMS was developing gradually and in most cases it was associated with the aggravation of the existing disease (hypertension, diabetes mellitus, aggravation of climacteric state) or with deterioration of psycho-emotional sphere due to conflicting situation. The carried out studies enabled the authors to select and divide patients with BMS into groups according to clinical values and the etiologic factors. In most cases diverse clinical versions of the burning mouth syndrome are cause-and-effect expressions of various somatic diseases, the timely determination and adequate therapy of which give the best results in the struggle against BMS.

Burning mouth syndrome: Clinical presentation, diagnosis and treatment

Burning mouth syndrome is an oral dysaesthesia presenting as a burning sensation of the tongue and less frequently other oral and peri-oral sites. There may be other coincident symptoms and signs, but the defining feature is the absence of any obvious organic cause. Because of this the condition frequently remains unrecognized for extended periods with a variable progression of symptoms. The current paper describes the complex presentation of burning mouth syndrome with the major aim of increasing recognition.

Clinical and therapeutic experience in twenty eight patients with burning mouth syndrome

AIM

Burning mouth syndrome (BMS) is a chronic painful syndrome in clinically normal oral mucosa. There are many local, systemic and/or psychogenic pathological conditions that may clinically appear as burning and painful sensation of the oral mucosa. There are essential or idiopathic BMS and organic or secondary BMS. A diagnostic and therapeutic protocol is proposed by the authors evaluating, the effectiveness of the estroprogestinic replacement therapy in post-menopausal women suffering from idiopathic BMS.

METHODS

A total of 28 patients suffering from persistent burning and painful oral sensation underwent to careful clinical and laboratory examination in order to distinguish primary forms from secondary ones. Patients suffering from primary BMS underwent to incisional biopsy for the research of estrogens receptors.

RESULTS

Only 8 out of the 28 studied patients (28.5%) were negative to the clinical oral and laboratory examinations listed in our protocol and they were diagnosed for primary BMS. All of them were females.

CONCLUSIONS

The use of a valid diagnostic and therapeutic protocol allows a better management of patients suffering from oral pain and a reduction if not a disappearance of the burning symptomatology in most of them. In post-menopausal patients suffering from idiopathic BMS good results may be obtained by an estroprogestinic replacement therapy.

The use of a removable appliance to relieve symptoms of burning lower lip in a dentate patient

The treatment of burning mouth Syndrome, in all its forms, is a challenge to the management of some older patients. The multi-factorial aetiology of this problem requires careful diagnosis and treatment planning to address the major aetiological factors for a given individual. This case report describes the treatment given to an elderly dentate female patient, whose main symptom was intense burning of her lower lip. The patient was aware of tooth clenching and various splints had been provided in the past, with limited improvement in symptoms. A simple removable appliance to prevent trapping of the soft tissues of the lower lip was provided, which produced a rapid and sustained reduction in symptoms.

CLINICAL RELEVANCE

Solutions to some common, yet distressing, problems may well be appropriate for use in the Primary Dental Care setting. This solution to the problem of burning lower lip, may be useful for other patients with similar symptoms. It may be adapted for different clinical situations and is relatively non-invasive and reversible.

Burning mouth syndrome

Start with the simple and eliminate various possibilities. Even if a cause cannot be found, a dentist working with your physician may recommend medications to provide relief of symptoms.

Glossodynie et thérapie cognitive et comportementale

OBJECTIVE

The aim of this study is to present a new approach of burning mouth syndrome treatment by cognitive and behavioral therapy.

METHODS

Cognitive and behavioral therapy in a patient with severe and resistant burning mouth syndrome.

RESULTS

Disappearing of the oral pain of the burning mouth syndrome.

CONCLUSION

After a review of the literature, we propose the treatment of burning mouth syndrome by cognitive and behavioral therapy.

[Burning mouth]

Various conditions of the oral mucosa can give rise to a burning sensation. Candidosis, geographic tongue (erythema migrans), mucocutaneous conditions and stomatitis can all cause mouth burns with visible changes to the oral mucosa. The so-called 'burning-mouth syndrome' (BMS) is a fairly rare but extremely unpleasant condition characterised by a bilateral burning sensation of the oral mucosa in the absence of clinically visible mucosal changes. Frequently-associated symptoms include dry mouth and loss or change of taste. The aetiology is unknown, even though most of the literature focuses on the role of a possible underlying psychogenic disorder. Several mucosal disorders can cause symptoms similar to BMS. Therefore, careful oral examination is required before establishing the diagnosis of BMS. Additional laboratory tests or a specialist examination rarely yield abnormal findings of relevance. Reassurance and understanding are important keywords in the management of patients suffering from BMS. Unless clearly indicated dental or medical treatment should be avoided, even if the patient insists on it, since such treatment is rarely effective.

[Burning-mouth syndrome: consideration of maintenance factors]

Burning-mouth syndrome is characterised by a number of complaints of which the burning sensation in the mouth is the most important but cannot be explained by known medical causes. Although psychological factors can predispose for or trigger physical symptoms without a medical explanation, treatment directed at the proposed psychological causes has not proven to be very effective and is not acceptable for most patients. Treatment directed at reducing the consequences of the complaint that could play a role in maintaining the problem is, however, effective and is accepted by almost all patients. Consequences that could maintain the burning-mouth syndrome are anxiety, depression, selective attention, and measures taken to find relief but which can irritate the oral mucosa. The treating physician should inform the patient and help him to change his behaviour. If patients have become depressed or very anxious as a consequence of the complaints they should be referred to a cognitive-behaviour therapist specialised in the treatment of patients with physical symptoms without a medical explanation.

Interventions for the treatment of burning mouth syndrome

BACKGROUND

The complaint of a burning sensation in the mouth can be said to be a symptom of other disease or a syndrome in its own right of unknown aetiology. In patients where no underlying dental or medical causes are identified and no oral signs are found, the term burning mouth syndrome (BMS) should be used. The prominent feature is the symptom of burning pain which can be localised just to the tongue and/or lips but can be more widespread and involve the whole of the oral cavity. Reported prevalence rates in general populations vary from 0.7% to 15%. Many of these patients show evidence of anxiety, depression and personality disorders.

OBJECTIVES

The objectives of this review are to determine the effectiveness and safety of any intervention versus placebo for relief of symptoms and improvement in quality of life and to assess the quality of the studies.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group Trials Register (20 October 2004), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2004), MEDLINE (January 1966 to October 2004), EMBASE (January 1980 to October). Clinical Evidence Issue No. 10 2004, conference proceedings and bibliographies of identified publications were searched to identify the relevant literature, irrespective of language of publication.

SELECTION CRITERIA

Studies were selected if they met the following criteria: study design - randomised controlled trials (RCTs) and controlled clinical trials (CCTs) which compared a placebo against one or more treatments; participants - patients with burning mouth syndrome, that is, oral mucosal pain with no dental or medical cause for such symptoms; interventions - all treatments that were evaluated in placebo-controlled trials; primary outcome - relief of burning/discomfort.

DATA COLLECTION AND ANALYSIS

Articles were screened independently by two reviewers to confirm eligibility and extract data. The reviewers were not blinded to the identity of the studies. The quality of the included trials was assessed independently by two reviewers, with particular attention given to allocation concealment, blinding and the handling of withdrawals and drop outs. Due to both clinical and statistical heterogeneity statistical pooling of the data was inappropriate.

MAIN RESULTS

Nine trials were included in the review. The interventions examined were antidepressants (two trials), cognitive behavioural therapy (one trial), analgesics (one trial), hormone replacement therapy (one trial), alpha-lipoic acid (three trials) and anticonvulsants (one trial). Diagnostic criteria were not always clearly reported. Out of the nine trials included in the review, only three interventions demonstrated a reduction in BMS symptoms: alpha-lipoic acid (three trials), the anticonvulsant clonazepam (one trial) and cognitive behavioural therapy (one trial). Only two of these studies reported using blind outcome assessment. Although none of the other treatments examined in the included studies demonstrated a significant reduction in BMS symptoms, this may be due to methodological flaws in the trial design, or small sample size, rather than a true lack of effect.

AUTHORS' CONCLUSIONS

Given the chronic nature of BMS, the need to identify an effective mode of treatment for sufferers is vital. However, there is little research evidence that provides clear guidance for those treating patients with BMS. Further trials, of high methodological quality, need to be undertaken in order to establish effective forms of treatment for patients suffering from BMS.

The diagnosis of burning mouth syndrome represents a challenge for clinicians

AIMS

To evaluate the occurrence of professional delay in the diagnosis, referral, and treatment of patients with burning mouth syndrome (BMS).

METHODS

Fifty-nine patients (51 women and 8 men; average age, 60.5 years; age range, 32 to 88 years) diagnosed with BMS at our institution were retrospectively studied. Data were collected about the onset of oral symptoms, consultations with medical and dental practitioners, and misdiagnosis before definitive BMS diagnosis and treatment.

RESULTS

The average delay from the onset of the symptoms to definitive diagnosis was 34 months (range, 1 to 348 months; median, 13 months). The average number of medical and dental practitioners consulted by each patient over this period and who initially misdiagnosed BMS was 3.1 (range, 0 to 12; median, 3). Candidiasis and aspecific stomatitis were the most frequent misinterpretations of the symptoms before appropriate referral. In about 30% of cases, no diagnosis of the oral symptoms was made or explanation given.

CONCLUSION

Professional delay in diagnosing, referring, and appropriately. managing BMS patients occurred frequently in the group studied. No significant differences were found in the number of medical and dental practitioners who were consulted. Emphasis must therefore be placed upon educational efforts to improve health care providers' awareness of BMS. This should increase the rate of recognition and appropriate referral or treatment of patients with chronic orofacial pain due to BMS.

[Burning mouth syndrome--etiology, differentialdiagnostical aspects and therapy]

Burning Mouth Syndrome (BMS) or glossodynia is a chronic pain syndrome that mainly affects middle-aged/elderly women. This condition is probably of multifactorial origin, often idiopathic, and its etiopathogenesis remains largely enigmatic. Visible pathologic lesions of the oral mucosa or processes are usually not evident. Etiologic factors that have been reported include several disorders (e. g. hematologic disorders, denture factors, the climacteric, infections, endocrinological, neurological or psychiatric disorders). On the other hand psychological factors, such as anxiety, depression and phobias have been reported to play a significant role at the beginning of this nosological entity. BMS related to nutritional deficiency is uncommon. A systemic approach to assessment is essential and the opinion of other specialities, particularly internal medicine, dentistry or neurology, may be of help. Treatment is of the underlying cause but in many cases no specific aetiological factor is identified. Non-indicated substitution therapy of suspected but unproved deficiency states must be avoided. Treatment approaches were divided into topical and systemic strategies. However, there is little research evidence that provides clear guidance for those treating patients with BMS.

Burning Mouth Syndrome: open trial of psychotherapy alone, medication with alpha-lipoic acid (thioctic acid), and combination therapy

OBJECTIVE AND STUDY DESIGN

This open study of 192 otherwise healthy persons with burning mouth syndrome, examined the efficacy on control of symptoms of psychotherapy alone with two hour sessions weekly for two months; alpha lipoic acid (ALA, tioctic acid; Tiobec) 600 mg/day alone for two months; or combination therapy of psychoanalysis and 600 mg/day ALA for two months. Controls received placebo alone.

RESULTS

Most benefit was obtained with combination therapy. Combination therapy of psychoanalysis and alpha lipoic acid (ALA, tioctic acid; Tiobec. 600 mg/day) for two months gave most benefit and significantly more than psychoanalysis alone for two 1 hour sessions weekly for two months (p<0.0005), or ALA 600 mg/day alone for two months (p<0.0005).

CONCLUSION

The present results suggest that alpha lipoic acid may complement psychotherapy and can be an acceptable alternative to psychoactive agents, but trials to compare the two approaches are now warranted.

[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.

Stomatodynia or burning mouth syndrome

We reviewed the literature on stomatodynia particularly to identify the factors associated with this annoying manifestation in order to better understand it and treat it. No consensus was found in the literature regarding etiological factors, associated morbidity, treatment, and definition of the burning mouth syndrome. This review aims at defining the disease, its characteristics, criteria for the diagnosis, and treatment.

[Clinical analysis of the patients with burning mouth syndrome]

OBJECTIVE

Clinical data of burning mouth syndrome were investigated in detail and the relation to pain was analyzed in order to find a clue to clinical treatment.

METHODS

78 patients with burning mouth syndrome were examined carefully and 7 factors that related to the degree of pain were analyzed with multivariate stepwise regression.

RESULTS

The study demonstrated that the psychological disorder, autonomic nerves system abnormity, oral dryness and high-extravasated blood level were positively related to the degree of pain.

CONCLUSION

The study suggested that psychotherapy, improvement of autonomic nerves system, treatment for oral dryness and Chinese traditional therapy of invigoration of blood circulation were of great importance in curing burning mouth syndrome.

[Mouth dryness and burning sensation of the oral mucosa: causes and possibilities for treatment]

Both sets of complaints, mouth dryness and a burning sensation of the oral mucosa, can have a variety of causes. Local and regional as well as systemic causes can be responsible for burning mouth syndrome. Diseases of the oral mucosa can have genetic, inflammatory, or neoplastic origins. Autoimmune diseases and allergies as well as different afflictions relating to internal medicine can be accompanied by a burning sensation in the oral mucosa. Neurological and psychiatric illnesses must be clarified during interdisciplinary diagnostics in order to identify idiopathic forms. The causes of mouth dryness are similarly complex. In addition to inadequate fluid intake, particularly in elderly patients, drug side effects or systemic diseases are frequently also responsible. Treatment is directed at the underlying disease; in ambiguous cases, symptomatic therapy can provide relief for medical complaints.

Burning mouth syndrome: a guide for the general practitioner

A commonly misdiagnosed condition, burning mouth syndrome (BMS) is characterized by burning sensations of the oral cavity in the absence of physical abnormalities of the oral mucosa. BMS affects middle-aged women predominantly. This condition has a multifactorial etiology, although several conditions have been associated with BMS, including depression/anxiety, hematinic deficiencies (iron, folate, and vitamin B complex), oral habits such as tongue thrusting and bruxism, and idiopathic BMS. Multiple approaches to treatment have been described in the literature, although few controlled clinical trials have been designed to determine their efficacy. This article examines BMS, its related factors, and treatment options available to the general dentist.

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.

Update on burning mouth syndrome: overview and patient management

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.

[Effect of millimeter therapy in burning mouth syndrome]

OBJECTIVE

To observe the millimeter wave therapy responses in patients with burning mouth syndrome.

METHODS

Eighty patients were randomized divided into 4 groups. The first group was treated with both millimeter wave irradiation and routine medication, the second group with millimeter wave irradiation, the third with pretending millimeter wave irradiation and routine medication and the fourth with routine medication. Pain, extravasated blood level and autonomic nerve system condition were double-blindly evaluated either before or after the treatment.

RESULTS

Statistically significant difference (P < 0.05) was found as the degree of pain was compared before and after treatment of all the 4 groups. The first and second group, which were affected by the millimeter wave irradiation, had obvious improvements in the extravasated blood level and autonomic nerve system condition (P < 0.05). When the 4 groups were compared with each other, there were significant differences (P < 0.05) between the first and the fourth groups, and the second and the fourth groups regarding the reduction of pain. According to extravasated blood level, significant differences (P < 0.05) were found in the first and third or fourth groups, the second and third or fourth groups.

CONCLUSIONS

The irradiation of holographic point by millimeter wave can improve the patients' pain, extravasated blood level and autonomic nerve system condition. It might provide a new treatment method for burning mouth syndrome.

Burning mouth syndrome. A retrospective analysis of clinical characteristics and treatment outcomes

Burning mouth syndrome is a condition characterized by burning sensations of the oral cavity in the absence of physical abnormalities of the mucosa or a detectable underlying medical disorder. It is a multifactorial disorder with unclear etiology, affecting predominatly middle-aged women. Multiple approaches to treatment have been described in the literature, with few controlled clinical trials regarding their efficacy. The objectives of this retrospective study were to: 1. determine the epidemiologic characteristics of BMS patients referred to an oral medicine practice; 2. determine if BMS classification correlates with response to treatment; 3. determine the efficacy of a variety of known therapies for BMS. A database was constructed from the charts of 150 consecutive patients diagnosed with BMS; and these charts were reviewed. Patients were classified according to previously published criteria for BMS. Presumed etiologies were grouped into depression/anxiety-associated; hematinic deficiencies, including iron, folate and vitamin B complex; oral habits: and idiopathic BMS. Treatment approaches were divided into seven categories: soft desensitizing appliance; tricyclic antidepressants (TCA); benzodiazepines (BZD); topical analgesics; hematinic supplements; habit awareness counseling; and multi-modal therapy (combining two or more of the above). Improvement was recorded using a zero to 100% VAS scale and classified as no relief (0%); mild (0-40%); meaningful/moderate (41-80%); and profound relief (81-100%). Burning mouth syndrome without any identifiable cause (idiopathic) was diagnosed in 33 patients (46.6%). Patients were followed up at one month (4 weeks) after the initial visit. Nine patients (12.7%) reported profound relief; 17 patients (23.9%) reported meaningful relief; 39 patients (54.9%) reported mild relief. This retrospective review showed no significant correlation between classification of BMS and response to therapy. The most effective treatment modalities were habit awareness, followed by TCAs.

Interventions for the treatment of burning mouth syndrome: a systematic review

AIMS

To carry out a systematic review of previous studies to determine the effectiveness of any intervention vs placebo for relief of symptoms and improvement in quality of life of patients with burning mouth syndrome (BMS) and to assess the quality of the studies.

METHODS

Electronic databases, conference proceedings, and bibliographies of identified publications were searched (up to September 2001) to identify relevant literature, irrespective of language of publication. Randomized controlled trials and controlled clinical trials of interventions used for the treatment of BMS in comparison to a placebo were included. The primary outcome was relief of burning/discomfort. The screening of studies, validity assessment, and data extraction were undertaken independently and in duplicate. Since statistical pooling of data was inappropriate, a qualitative assessment was undertaken.

RESULTS

Seven trials, evaluating antidepressants, cognitive behavioral therapy, analgesics, hormone replacement therapy, and vitamin complexes, met the inclusion criteria. None of the trials was able to provide conclusive evidence of effectiveness. However, cognitive behavioral therapy may be beneficial in reducing the intensity of the symptoms.

CONCLUSION

Given that the research evidence is, as yet, unable to provide clear, conclusive evidence of an effective intervention, clinicians need to provide support and understanding when dealing with BMS sufferers. Psychological interventions that help patients to cope with symptoms may be of some use, but promising and new approaches to treatment still need to be evaluated in good-quality randomized controlled trials.

Burning mouth syndrome

Burning mouth syndrome is the occurrence of oral pain in a patient with a normal oral mucosal examination. It can be caused by both organic and psychologic or psychiatric factors, which can be broken down into local, systemic. psychologic or psychiatric, and idiopathic causes. The most frequently associated conditions are psychiatric (depression, anxiety, or cancerphobia); xerostomia; nutritional deficiency; allergic contact dermatitis; candidiasis; denture-related pain: and parafunctional behavior. Multiple different factors contributing to the oral pain are common, and a systematic approach to the evaluation is important. Identification of correctable causes of BMS should be emphasized and psychiatric causes should not be invoked without thorough evaluation of the patient. A directed history and careful oral examination must be completed to exclude local diseases and identify clues to potential causes. Assessment of medications, psychiatric history and background, and selected laboratory and patch tests may help identify the etiologies of these symptoms. Treatment should be tailored to each patient and may best be managed in a multidisciplinary approach with input from dermatologists, dentists, psychiatrists. otorhinolaryngologists, and primary care providers. A thoughtful and structured evaluation of the patient with BMS has been associated with improvement in about 70% of patients. The remaining patients may benefit from empiric therapy with a chronic pain protocol and continued supportive interactions.

[Burning mouth syndrome]

Burning mouth syndrome (BMS) is currently described as a burning pain in the tongue or other parts of mucous cavi oris without pathological signs of mucous cavi oris and changes in laboratory blood tests. On the basis of the current literature and our patients' examinations we described the incidence, etiology, symptoms and offered model of treatment of BMS.

[Burning mouth]

BACKGROUND

The complaint of burning mouth is fairly common. Epidemiological studies suggest a prevalence of around 15% in postmenopausal women and between 0,7 and 7,9% for the general population.

PURPOSE

The purpose of this article is to present a review of the literature on epidemiology, clinical symptoms, etiology, diagnosis, treatment and prognosis of burning mouth and burning mouth syndrome.

RESULTS AND CONCLUSIONS

Potential causal factors have been extensively studied and reviewed, suggesting a multifactorial aetiology, that apparently includes local, systemic and psychogenic factors. However, reports of their relative importance are conflicting. Consequently this lack of evidence is reflected in inconsistent guidelines for diagnosis and treatment. Most of the authors emphasize the importance of history taking and clinical intraoral examination for diagnosis. The symptom of burning mouth associated with clinical mucosal abnormality has to be differentiated from burning mouth syndrome (BMS), a condition in which no mucosal abnormality is evident on examination. Whereas the symptom of burning mouth associated with clinical mucosal signs is described to be often manageable by eliminating possible causal factors, the background of most of the proposed treatments for BMS is empiric or even purely anecdotal. Only a few randomised controlled studies have been performed on treatment outcome. Their differing results are presented in a short overview.

[Burning mouth syndrome--etiologic, diagnostic and therapeutic considerations]

Burning mouth syndrome represents a chronic orofacial pain disorder without an apparent lesion of oral mucosa. It affects 0.71-3.4% of general population. Although a lot of scientific and clinical effort has been undertaken, its genesis still remains an enigma. Potential etiologic roles of various oral and systemic factors have been implicated, such as oral candidiasis, hormonal, neurological, nutritive and psychiatric disorders. In spite of different treatment approaches and medications, therapeutic success is limited. Although in our country most of the patients are treated by dentists specialized in oral medicine, medical doctors should be more involved in diagnosis and treatment of the disease. Article describes etiologic factors, diagnostic and therapeutic means in the burning mouth syndrome.

Burning mouth syndrome

Burning mouth syndrome is characterized by a burning sensation in the tongue or other oral sites, usually in the absence of clinical and laboratory findings. Affected patients often present with multiple oral complaints, including burning, dryness and taste alterations. Burning mouth complaints are reported more often in women, especially after menopause. Typically, patients awaken without pain but note increasing symptoms through the day and into the evening. Conditions that have been reported in association with burning mouth syndrome include chronic anxiety or depression, various nutritional deficiencies, type 2 diabetes (formerly known as non-insulin-dependent diabetes) and changes in salivary function. However, these conditions have not been consistently linked with the syndrome, and their treatment has had little impact on burning mouth symptoms. Recent studies have pointed to dysfunction of several cranial nerves associated with taste sensation as a possible cause of burning mouth syndrome. Given in low dosages, benzodiazepines, tricyclic antidepressants or anticonvulsants may be effective in patients with burning mouth syndrome. Topical capsaicin has been used in some patients.

Burning mouth syndrome

A critical component of the dental hygiene process of care is assessment of the oral and general health conditions of clients. Some clients present with burning and painful sensations in the oral cavity in the absence of any noticeable disease. This condition has been referred to as burning mouth syndrome (BMS), an often complicated condition. Various local, systemic, and psychological factors have been linked with BMS, but its etiology is not fully understood. Yet as many as one million people are affected by it in the United States, and it is an increasingly-common problem in the aging population. Middle-aged women, mostly postmenopausal, are diagnosed with symptoms seven times more frequently than men. Careful diagnosis and treatment are necessary to alleviate the symptoms of this condition. Referral to a physician is warranted in some cases. The purposes of this course are to review the etiologic factors and clinical implications related to this condition and to discuss appropriate dental hygiene interventions. Collaboration among the client, dental hygienist, dentist, and physician provides for interdisciplinary actions that can lead to palliation of symptoms and evaluation of the possible underlying factors contributing to the condition.

A literature review and pilot study to characterise the treatment of burning mouth syndrome

Although the definition of burning mouth syndrome (BMS) can vary, the most commonly accepted is that of a burning sensation of normal appearing oral mucosa with no apparent underlying local or systemic contributing factors. The condition can be classified according to the patterns of burning experienced, the severity of the burning, as well as the pattern of onset. The management of these patients is difficult, since they are often seen by numerous clinicians and many unnecessary tests are performed in the hope of finding an underlying physical cause for the burning. No precise information pertaining to the natural history of BMS could be found. This paper consists of a selective review of the literature on BMS as well as a pilot study involving the standardised collection of data on 10 patients (9 women and 1 man) with BMS. These patients will be followed up in the long term in order to gather information pertaining to the natural history of this condition. No detectable local or systemic cause for the burning sensation could be found for any of the 10 subjects. The role of somatisation as a mechanism for burning sensation was investigated and certain proposals have been put forward regarding the management of such patients.

[Burning mouth syndrome]

Symptoms of a burning sensation of the oral mucosa mainly occur in the elderly, more often in women than in men. Often accompanying symptoms are complaints of a dry mouth and taste disturbances, all together referred to as the burning mouth syndrome. In the majority of cases there is no detectable cause. Although a psychogenic aetiology has often been put forward, no scientific evidence has ever been provided on this matter. In the majority of patients the burning mouth syndrome will disappear spontaneously, although this may take many years.

Interventions for the treatment of burning mouth syndrome

BACKGROUND

The complaint of a burning sensation in the mouth can be said to be a symptom of other disease or a syndrome in its own right of unknown aetiology. In patients where no underlying dental or medical causes are identified and no oral signs are found, the term burning mouth syndrome (BMS) should be used. The prominent feature is the symptom of burning pain which can be localised just to the tongue and/or lips but can be more widespread and involve the whole of the oral cavity. Reported prevalence rates in general populations vary from 0.7% to 15%. Many of these patients show evidence of anxiety, depression and personality disorders.

OBJECTIVES

The objectives of this review are to determine the effectiveness and safety of any intervention versus placebo for relief of symptoms and improvement in quality of life and to assess the quality of the studies.

SEARCH STRATEGY

Electronic databases (The Cochrane Library, the Cochrane Oral Health Group's Specialised Register, MEDLINE, EMBASE), Clinical Evidence Issue No. 3, conference proceedings and bibliographies of identified publications were searched to identify the relevant literature, irrespective of language of publication.

SELECTION CRITERIA

Studies were selected if they met the following criteria: study design - randomised controlled trials (RCTs) and controlled clinical trials (CCTs) which compared a placebo against one or more treatments; participants - patients with burning mouth syndrome, that is, oral mucosal pain with no dental or medical cause for such symptoms; interventions - all treatments that were evaluated in placebo-controlled trials; primary outcome - relief of burning/discomfort

DATA COLLECTION AND ANALYSIS

Articles were screened independently by two reviewers to confirm eligibility and extract data. The reviewers were not blinded to the identity of the studies. The quality of the included trials was assessed independently by two reviewers, with particular attention given to allocation concealment, blinding and the handling of withdrawals and drop-outs. Due to differences in patient type, treatment and outcome measures, statistical pooling of the data was inappropriate.

MAIN RESULTS

Six trials were included in the review. The interventions examined were antidepressants (two trials), cognitive behavioural therapy (one trial), analgesics (one trial), hormone replacement therapy (one trial) and vitamin complexes (one trial). The participants included in the six identified trials reported suffering from BMS from six months to 20 years. Diagnostic criteria were not always clearly reported. Out of the six trials included in the review, only two interventions demonstrated a reduction in BMS symptoms; vitamin complexes and cognitive behavioural therapy. Neither of these studies reported using blind outcome assessment. Although none of the other treatments examined in the included studies demonstrated a significant reduction in BMS symptoms, this may be due to methodological flaws in the trial design, or small sample size, rather than a true lack of effect.

REVIEWER'S CONCLUSIONS

Given the chronic nature of BMS, the need to identify an effective mode of treatment for sufferers is vital. However, there is little research evidence that provides clear guidance for those treating patients with BMS. Further trials, of high methodological quality, need to be undertaken in order to establish effective forms of treatment for patients suffering from BMS.

[How I investigate...a burning mouth]

Burning mouth is a symptom typical for the oral mucosa. In contrast, pruritus is absent at this site. The situation which is the reverse on the skin can be explained by microanatomical differences in the sensorial innervation and by a different balance between neuromediators. Burning mouth sensation calls for the search of a series of diseases. However, it is most often a monosymptomatic expression of a minimal lichenoid stomatitis.

A review of burning mouth syndrome

Burning mouth syndrome is a complicated, poorly understood, predominantly oral condition that affects more than 1 million people in the United States. Women are particularly affected by the condition; they are diagnosed with symptoms seven times more frequently than males. Burning mouth syndrome is characterized by a burning, painful sensation of the oral mucosa that most commonly involves the anterior tongue. Many precipitating factors to burning mouth syndrome have been proposed, and treatment addressing these factors has had limited success. Patients with burning mouth syndrome are more likely to be evaluated by physicians, and therefore it is advantageous for the physician to be familiar with this oral condition. This paper reviews burning mouth syndrome, associated causative factors, and treatment strategies for the physician.