Burning Mouth Syndrome - Dr. Fine
Burning Mouth Syndrome
This past week my office evaluated a 43 y/o male (physician) and 67 y/o female (housewife) with the same chief complaint,"my mouth burns all the time ". The M.D. had been symptomatic for 4 months with no relief, and the housewife for more than three years. A review of the literature was informative and helpful in treatment. I should like to suggest a diagnostic and treatment protocol which might be of aid to you and your patients as well.
Burning Mouth Syndrome (B.M.S.)is not uncommon. Baskar reported a prevalence of 5.1% in the general dental practice. The vast majority of the affected are older than 50 years. The pain is often present in the morning, persisting throughout the afternoon, with maximum intensity by early evening. The tongue is the most frequently affected site, followed by the upper denture bearing areas, lips, lower denture bearing area, and floor of the mouth. Patients may mention symptoms such as: dry mouth, metallic or bitter, or altered taste sensation.
A multitude of factors have been described. For convenience they can be classified into three main categories: local, systemic, and psychogenic factors.
Local Factors:
Contact allergy-- Substances in denture materials can cause allergic responses. A temporal association between a constant burning pain and denture wear, and diffuse erythema is typical. In contrast, a food-related allergy is intermittent. Other local factors which may also contribute to Burning Mouth Syndrome include: Infection (Moniliasis); Reflux Esophagitis; Geographic Tongue; and Acoustic Nerve Neuroma ( a burning sensation has been described as a common clinical feature).
Systemic Factors:
Menopause (may result in the onset of Burning Mouth Syndrome)
Vitamin Deficiency
Diabetes
Saliva and Medication
Psychogenic Factors:
Anxiety and depression
Treatment: Most treatments are tailored to the causative factors such as: denture adaption, habit control, allergy management, vitamin and hormone replacement with an improvement in pain complaint from 33% to 69%.
Clinical Recommendations: In clinical practice none of the proposed etiologies can be ruled out. A thorough diagnostic approach is suggested. Attention should be focused on location, onset, duration and association with prosthesis wear and intake of certain food. Clinical exam should screen for soft tissue lesions, local factors or trauma, or deficient salivary gland function. Xerostomia has been related to oral burning pain and is commonly a side effect of drug therapy--medications should be reviewed.
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