Burning Mouth Syndrome

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Burning mouth syndrome
John Buchanan and Joanna Zakrzewska

Definition

Burning mouth syndrome is an idiopathic burning discomfort or pain affecting people with clinically normal oral mucosa, in whom a medical or dental cause has been excluded. [1] [2] [3] Terms previously used to describe what is now called burning mouth syndrome include glossodynia, glossopyrosis, stomatodynia, stomatopyrosis, sore tongue, and oral dysaesthesia. [4] A survey of 669 men and 758 women randomly selected from 48,500 people aged 20–69 years found that people with burning mouth also have subjective dryness (66%), take some form of medication (64%), report other systemic illnesses (57%), and have altered taste (11%). [5] Many studies of people with symptoms of burning mouth do not distinguish those with burning mouth syndrome (i.e. idiopathic disease) from those with other conditions (such as vitamin B deficiency), making results unreliable. Local and systemic factors (such as infections, allergies, ill-fitting dentures, [6] hypersensitivity reactions, [7] and hormone and vitamin deficiencies [8] [9] [10] ) may cause the symptom of burning mouth, and should be excluded before diagnosing burning mouth syndrome. This review deals only with idiopathic burning mouth syndrome.
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Incidence / Prevalence

Burning mouth syndrome mainly affects women, [11] [12] [13] particularly after the menopause, when its prevalence may be 18–33%. [14] One study in Sweden found a prevalence of 4% for the symptom of burning mouth without clinical abnormality of the oral mucosa (11/669 [2%] men, mean age 59 years; 42/758 [6%] women, mean age 57 years), with the highest prevalence (12%) in women aged 60–69 years. [5] Reported prevalence in general populations varies from 1% [14] to 15%. [11] Incidence and prevalence vary according to diagnostic criteria, [4] and many studies included people with the symptom of burning mouth, rather than with burning mouth syndrome as defined above.

Aetiology / Risk factors

The cause is unknown, and we found no good aetiological studies. Possible causal factors include hormonal disturbances associated with the menopause, [12] [13] [14] psychogenic factors (including anxiety, depression, stress, life events, personality disorders, and phobia of cancer), [6] [15] [16] and neuropathy in so-called supertasters. [17] Support for a neuropathic aetiology comes from studies that have shown altered sensory and pain thresholds in people with burning mouth syndrome. [18] Two studies using blink reflex and thermal quantitative sensory tests have demonstrated signs of neuropathy in most people with burning mouth syndrome. [19] [20]

Prognosis

We found no prospective cohort studies describing the natural history of burning mouth syndrome. [21] We found anecdotal reports of at least partial spontaneous remission in about 50% of people with burning mouth syndrome within 6–7 years. [15] However, a recent retrospective study assessing 53 people with burning mouth syndrome (48 women and 5 men, mean duration of burning mouth syndrome 5.5 years, mean follow-up 56 months) found a complete spontaneous resolution of oral symptoms in 11% of people (2/19) who received no treatment. Overall, 30% of people (15/53) experienced a moderate improvement, with or without treatment. [22]

Aims of intervention

To alleviate symptoms, with minimal adverse effects.

Outcomes

Self-reported relief of symptoms (burning mouth, altered taste, dry mouth); incidence and severity of anxiety and depression; quality of life using a validated ordinal scale.

Methods

BMJ Clinical Evidence search and appraisal February 2007. The following databases were used to identify studies for this review: Medline 1966 to February 2007, Embase 1980 to February 2007, and The Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials 2007, Issue 1. Additional searches were carried out using these websites: NHS Centre for Reviews and Dissemination (CRD) — for Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA), Turning Research into Practice (TRIP), and NICE. Abstracts of the studies retrieved from the initial search were assessed by an information specialist. Selected studies were then sent to the author for additional assessment, using pre-determined criteria to identify relevant studies. Study design criteria for inclusion in this reveiw were: published systematic reviews and RCTs in any language, at least single blinded, and containing more than 20 individuals of whom more than 80% were followed up. There was no minimum length of follow-up required to include studies. We excluded all studies described as “open”, “open label”, or not blinded unless blinding was impossible. In addition, we use a regular surveillance protocol to capture harms alerts from organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA), which are added to the review as required. We have performed a GRADE evaluation of the quality of evidence for interventions included in this review ( see table).
References

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