Dr. James C. Burns
Department of Oral Pathology - VCU School of Dentistry
Dr. James C. Burns, Department Chair
315 Lyons Building
School of Dentistry Address
520 North 12th Street
PO Box 980566
Richmond, VA 23298-0566
Virginia Commonwealth University School of Dentistry - Oral and Maxillofacial Pathology - Diagnostic Service
ORAL PATHOLOGY DIAGNOSTIC SERVICE
BURNING MOUTH SYNDROME: DIAGNOSIS AND TREATMENT
Imagine the frustration of having a disorder that can not be definitively diagnosed, interferes with eating, becomes progressively worse with time, has no known cause, and for which there is no effective treatment. Such is the dilemma for both the patient with burning mouth syndrome (BMS) and the doctor who has to treat the case.
Clinical features: BMS is found almost exclusively in postmenopausal females. The most common complaint is a "burning" sensation that is not particularly painful but is annoying. Typically, the tongue is affected, but he anterior palate and lips are also frequently involved. Patients will sometimes describe "bumps" that have been intermittently present in the affected area. Acidic foods such as tomatoes and orange juice cause considerable distress. A "metallic" taste is also a frequent finding. Some degree of xerostomia is usually present. However, the oral mucosa appears normal.
Psychologic features:It has been our experience that BMS patients are very tidy, orderly people who are concerned about their appearance. Usually they are well-educated and often their social history reveals a major change in their lives at the time the symptoms first appeared. Various psychologic profiles have consistently indicated that most BMS patients have significant deviations in certain personality traits.
Diagnosis: It is not possible to establish a diagnosis of BMS by one particular test, but the combination of complaints and lack of mucosal change is highly suggestive. There is no advantage to doing a diagnostic biopsy. Although many of these patients are postmenopausal and are taking estrogen replacements, there does not seem to be much value in doing serum hormone levels because most of them are normal.
Treatment: Reassurance is critical so that the patient understands that this condition is not premalignant and it is not transmissible. However, the patient should be informed of the chronicity of the problem and that there is no "cure". It has been our experience that although the symptoms are cyclical in severity, there is a gradual progression toward greater severity.
Many medications have been used in the treatment of BMS: antidepressants, antifungals, steroids, vitamin supplements, and iron supplements. None of these are uniformly effective and the patient needs to understand that a partial reduction in symptoms is the only reasonable therapeutic goal. Frustration is quite common among BMS patients, which leads to doctor "shopping". For one of our patients, we were the 29th doctor consulted!
Want to learn more about burning mouth syndrome?
Abbey, L.M. Patients with burning mouths. Va Dent J 1991 68(2) 13-17.
Van der Waal. Burning Mouth Syndrome 1993, Munksgaard.