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Burning Mouth Syndrome

Burning mouth syndrome is a condition causing continuous burning sensation of the mucosa of the mouth, typically involving the tongue, lips and oral mucosa. It occurs most commonly in peri-menopausal and postmenopausal women.Women are 3-7 times more likely than men of a similar age to experience burning mouth syndrome (BMS) symptoms.It is rarely observed in patients younger than 30 years of age.

Symptoms

  • The main symptom of burning mouth syndrome is pain in the mouth that is burning, scalding, or tingling. Other symptoms include dry mouth or altered taste in the mouth.

It is a painful condition. Usually, the tongue is affected, but the pain may also be in the lips or roof of the mouth, or throughout the mouth.

  • BMS pain can last for months or years. Some people feel constant pain every day. For others, pain increases throughout the day. For many people, the pain is reduced when eating or drinking.

History is the cornerstone of diagnosis.Although burning mouth syndrome is a diagnosis of exclusion, several elements are supportive:

  • Bilateral mouth discomfort (burning/pain)

  • Pain deep in the oral mucosa

  • Symptoms present for at least 4-6 months

  • Xerostomia

  • Dysgeusia

  • Symptoms that are nearly constant throughout the day

  • No clear precipitating factors

  • Alleviated or aggravated by drinking/eating

  • Mood or personality disruptions

Causes

The cause of burning mouth syndrome can be classified as either primary or secondary.

Primary burning mouth syndrome

When no clinical or lab abnormalities can be identified, the condition is called primary or idiopathic burning mouth syndrome. Some research suggests that primary burning mouth syndrome is related to problems with taste and sensory nerves of the peripheral or central nervous system.

Secondary burning mouth syndrome

Sometimes burning mouth syndrome is caused by an underlying medical condition. In these cases, it’s called secondary burning mouth syndrome.

Underlying problems that may be linked to secondary burning mouth syndrome include:

  • Dry mouth (xerostomia),which can be caused by various medications, health problems, problems with salivary gland function or the side effects of cancer treatment

  • Other oral conditions,such as a fungal infection of the mouth (oral thrush), an inflammatory condition called oral lichen planus or a condition called geographic tongue that gives the tongue a map-like appearance

  • Nutritional deficiencies,such as a lack of iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12)

  • Dentures,especially if they don’t fit well, which can place stress on some muscles and tissues of your mouth, or if they contain materials that irritate mouth tissues

  • Allergies or reactionsto foods, food flavorings, other food additives, fragrances, dyes or dental-work substances

  • Reflux of stomach acid (gastroesophageal reflux disease or GERD)that enters your mouth from your stomach

  • Certain medications,particularly high blood pressure medications

  • Oral habits,such as tongue thrusting, biting the tip of the tongue and teeth grinding

  • Endocrine disorders,such as diabetes or underactive thyroid (hypothyroidism)

  • Excessive mouth irritation,which may result from overbrushing your tongue, using abrasive toothpastes, overusing mouthwashes or having too many acidic drinks

  • Psychological factors, such as anxiety, depression or stress

Diagnosis

BMS is hard to diagnose. One reason is that people with BMS often don’t have a mouth problem that the dentist can see during an oral examination. The dentist will review your medical history and examine your mouth. A lot of tests may be needed. Tests may include:

  • Blood tests to check for certain medical problems

  • Oral swab tests

  • Allergy tests

  • Salivary flow test

  • Biopsy of tissue

  • Imaging tests

Primary and Secondary BMS

Primary BMS: If tests do not reveal an underlying medical problem, the diagnosis is primary BMS. Experts believe that primary BMS is caused by damage to the nerves that control pain and taste.

Secondary BMS: Certain medical conditions can cause BMS. Treating the medical problem will cure the secondary BMS. Common causes of secondary BMS include…

  • Hormonal changes (such as from diabetes or thyroid problem)

  • Allergies to dental products, dental materials (usually metals), or foods

  • Dry mouth, which can be caused by certain disorders (such as Sjögren’s syndrome) and treatments (such as certain drugs and radiation therapy)

  • Certain medicines, such as those that reduce blood pressure

  • Nutritional deficiencies (such as a low level of vitamin B or iron)

  • Infection in the mouth, such as a yeast infection

  • Acid reflux

Treatment

Medicine can help control pain and relieve dry mouth.Because BMS is a complex pain disorder, the treatment that works for one person may not work for another.Symptoms of secondary BMS go away when the underlying medical condition, such as diabetes or yeast infection, is treated.

To help ease the pain of BMS, sip a cold beverage, suck on ice chips, or chew sugarless gum.

Avoid irritating substances, such as;

  • Tobacco

  • Hot, spicy foods

  • Alcoholic beverages

  • Mouthwashes that contain alcohol

  • Products high in acid, such as citrus fruits and juices

Currently, no definitive cure exists; many treatments have been tried with variable success. Attempting combinations of therapies may be appropriate; in particular, cognitive therapy may be synergistic with other agents.Additionally, it may be worth empirically treating for other conditions that cause secondary burning mouth syndrome based on the nature of symptoms or exam findings.

Dr Benley George

Vice Principal, Pushpagiri College of Dental Sciences, Tiruvalla,

Kerala

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