Burning mouth syndrome
Burning mouth syndrome | |
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Other names | Glossodynia,[1] orodynia,[2] oral dysaesthesia,[3] glossopyrosis,[3] stomatodynia,[1] burning tongue,[4] stomatopyrosis,[3] sore tongue,[3] burning tongue syndrome,[5] burning mouth,[3] or sore mouth[6] |
Specialty | Oral medicine |
Burning mouth syndrome (BMS) is a burning, tingling or scalding sensation in the mouth, lasting for at least four to six months, with no underlying known dental or medical cause.
A burning sensation in the mouth can be a
Insufficient evidence leaves it unclear if effective treatments exist.[3]
Signs and symptoms
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.
Parameter | Usual findings in burning mouth syndrome.[1][3][8][10][11][12] |
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Site | Usually bilaterally located on the tongue or less commonly the palate, lips or lower alveolar mucosa
|
Onset | Pain is chronic, and rarely spontaneously remits |
Character | Burning, scalded or tingling. Sometimes the sensation is described as 'discomfort', 'tender', 'raw' and 'annoying' rather than pain or burning. |
Radiation | |
Associations | Possibly subjective xerostomia, dysgeusia (altered taste), thirst, headaches, chronic back pain, irritable bowel syndrome, dysmenorrhea, globus pharyngis, anxiety, decreased appetite, depression and personality disorders |
Time course | Type 2 (most common) pain upon waking and throughout day, less commonly other patterns. |
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. |
Severity | Moderate to severe, rated 5-8 out of 10, similar in intensity to toothache |
Effect on sleep | May not disturb sleep, or may change sleep patterns, e.g. insomnia. |
Previous treatment | Often multiple consultations and unsuccessful attempts at dental and/or medical treatment |
Causes
Theories
In about 50% of cases of burning mouth sensation no identifiable cause is apparent;[1] these cases are termed (primary) BMS.[11] Several theories of what causes BMS have been proposed, and these are supported by varying degrees of evidence, but none is proven.[5][11] 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.[5] 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.[5] 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.[5]
Depression and
Chronic low-grade trauma due to
Other causes of an oral burning sensation
Substances capable of causing an oral burning sensation.[1] |
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Foods and additives
Metals Plastics |
Several local and systemic factors can give a burning sensation in the mouth without any clinical signs, and therefore may be
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
- Deficiency of iron,
- chorda tympani nerve.
- Hypothyroidism.
- Medications ("scalded mouth syndrome", unrelated to BMS) -
- Type 2 diabetes[13]
- True Sjögren's syndrome
- Parafunctional activity, e.g. nocturnal tongue thrustinghabit.
- Restriction of the tongue by poorly constructed dentures.
- Geographic tongue.[13]
- Oral candidiasis.[13]
- Herpetic infection (herpes simplex virus).[19]
- Fissured tongue.[1]
- Lichen planus.[1]
- Allergies and contact sensitivities to foods, metals, and other substances (see table).
- Hiatal hernia.[1]
- Human immunodeficiency virus.[1]
- Multiple myeloma[20]
Diagnosis
BMS is a diagnosis of exclusion, i.e. all other explanations for the symptoms are ruled out before the diagnosis is made.[1][16] There are no clinically useful investigations that would help to support a diagnosis of BMS[3] (by definition all tests would have normal results),[1] but blood tests 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.[11] 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.[11] The diagnosis of a people with a burning symptom may also involve psychologic screening e.g. depression questionnaires.[1]
The second edition of the International Classification of Headache Disorders lists diagnostic criteria for "Glossodynia and Sore Mouth":
- A. Pain in the mouth present daily and persisting for most of the day,
- B. Oral mucosa is of normal appearance,
- C. Local and systemic diseases have been excluded.[21]
Classification
A burning sensation in the mouth may be primary (i.e. burning mouth syndrome) or secondary to systemic or local factors.[1] Other sources refer to a "secondary BMS" with a similar definition, i.e. a burning sensation which is caused by local or systemic factors,[16] or "where oral burning is explained by a clinical abnormality".[17] 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.[5]
Some consider BMS to be a variant of
- Type 1 - Symptoms not present upon waking, and then increase throughout the day
- Type 2 - Symptoms upon waking and through the day
- Type 3 - No regular pattern of symptoms
Sometimes those terms specific to the tongue (e.g. glossodynia) are reserved for when the burning sensation is located only on the tongue.[21]
Treatment
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.[11] BMS has been traditionally treated by reassurance and with antidepressants, anxiolytics or anticonvulsants. A 2016 Cochrane review of treatment for burning mouth syndrome concluded that strong evidence of an effective treatment was not available,[3] however, a systematic review in 2018 found that the use of antidepressants and alpha-lipoic acids gave promising results.[24][25]
Other treatments which have been used include
Prognosis
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.[10][28] 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.[5][15] Recovery is often preceded by a change in the character of the symptom from constant to intermittent.[15] No clinical factors predicting recovery have been noted.[15]
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.[5]
Epidemiology
BMS is fairly uncommon worldwide, affecting up to five individuals per 100,000 general population.[3] 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.[1][29] Some report a female to male ratio of as much as 33 to 1.[6] BMS is reported in about 10-40% of women seeking medical treatment for menopausal symptoms, and BMS occurs in about 14% of postmenopausal women.[5][15][contradictory] Males and younger individuals of both sexes are sometimes affected.[10]
Asian and Native American people have considerably higher risk of BMS.[5]
Notable cases
Sheila Chandra, a singer of Indian heritage, retired due to this condition.[30]
References
- ^ ISBN 9780443068188.
- ISBN 978-1-4160-2999-1.
- ^ PMID 27855478.
- ^ ISBN 978-0-7216-2921-6.
- ^ ISBN 978-0721690032.
- ^ PMID 20690412.
- ^ "Burning Mouth Syndrome". www.nidcr.nih.gov. Retrieved 23 March 2022.
- ^ a b "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". IASP. Archived from the original on 19 December 2012. Retrieved 7 May 2013.
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- ^ ISBN 978-1-60327-519-4.)
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- ^ a b "2nd Edition of The International Headache Classification (ICHD-2)". International Headache Society. Archived from the original on 28 September 2013. Retrieved 7 May 2013.
- ISBN 978-0443071065.)
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- ^ "Burning mouth syndrome" (PDF). Oxford Radcliffe Hospitals. Retrieved 23 August 2022.
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- ^ Greenberg MS; Glick M; Ship JA. Burket's Oral Medicine. 11th edition. 2012
- ^ "Sheila Chandra United Kingdom". Real World Records. Retrieved 1 August 2013.
- Scala A; Checchi L; Montevecchi M; Marini I; Giamberardino MA (2003). "Update on burning mouth syndrome: overview and patient management". Crit Rev Oral Biol Med. 14 (4): 275–91. PMID 12907696.