Burning Mouth Syndrome ( Glossopyrosis )
Burning Mouth Syndrome ( Glossopyrosis )

Burning in the tongue and on the lips can result from stomatitis, in which case the examining dentist or physician should see abnormalities on oral examination. If no such abnormalities are evident, the disorder is termed the "burning mouth syndrome". No specific cause of this syndrome has been identified. It is believed to result from an interplay of local, constitutional, and psychogenic factors. No absolute cause has been identified. Exacerbating factors can include: dry mouth, ill-fitting dentures, abnormal tongue movements, depression, anxiety, nutritional factors, and systemic disease are some of the things that can be treated in an attempt to alleviate the symptoms. It is a benign disease that generally resolves slowly with conservative measures over a period of 6 months to 5 years. Otolaryngologists or dentists are the experts to consult for this bothersome problem.

I. Epidemiology
A. More common in women by ratio of 7:1
B. Prevalence: I million in U.S. effected
C. More common in elderly; 60 or older. Appears to be most common in postmenopausal women.

II. Pathophysiology
A. No clear etiology identified
B. Postulated etiologies: 1.) Nutritional Deficiency (e.g.. B2 (Riboflavin) Vitamin Deficiency), 2.)Chronic Ebstein Barr Viral infection of basal cell layer of dorsum of tongue. 3.)Gastroesophageal reflux with acid from stomach coating tongue after refluxing causing a chemical long lasting burn while reclined and asleep. 4.) Diabetes. 5.) Major Depression 6.) Increased taste sensation. 7.) Xerostomia. 8.) Menopause (90% of women are postmenopausal). 9.) Trigeminal Nerve (CN V2) neuropathy ( Atypical Trigeminal Neuralgia ). 10.) AIDS.

lII. Symptoms
A. Characteristics of pain
1. Burning pain affecting oropharynx
2. Pain may be severe toothache-like pain
B. Timing
1. Onset in mid-morning
2. Progression over course of day
3. Peaks in late afternoon
4. Subsides at night (may interfere with going to sleep)
C. Multiple pain sites often affected
1. Anterior two-thirds of Tongue
2. Oral Mucosa (especially anterior Hard Palate)
3. Lower lip mucosa
D. Palliative
1. Pain may be relieved with eating
E. Associated symptoms
Dry Mouth (Xerostomia)
Taste disturbance (bitter or metallic taste)

IV. Signs
A. No pathopneumonic lesions present.
B. Geographic tongue results from loss of filiform papillae from patches on the dorsal surface of the tongue.
The location of the patches may appear to shift over a period of weeks.

V. Differential Diagnosis: Oral Herpes, Chronic Ebstein Barr Viral Infection, Phemphigoid, Phemphigus,Squamous cell carcinoma, Oral Candidiasis, Vitamin B6 or B12 deficiency, Hypothyroidism, etc.

VI. Associated Conditions
A. Mood disturbance including Major Depression

VII. Clinical Course
A. Spontaneous onset with persistence for years

VIII. Clinical Treatment
A. Treat potential causes of differential diagnosis.
1.Treatment fo Acid Reflux ( GERD) with head of bed elevation, diet changes, and proton pump inhibitors ( Previcid, Prilosec, etc.)
2. Antifungal agent for Oral Candidiasis (Thrush)
3. Estrogen Replacement for Menopause
4. B Vitamin Supplementation for B Vitamin Deficiency
5. Increase saliva in Xerostomia
6. Treat specific causative factors such as dental problems.
B. Neuropathic pain medications
1. Amitriptyline (Elavil) at bedtime
Clonazepam (Klonopin) at bedtime
Gabapentin (Neurontin) at bedtime
a. St & t with hot pepper diluted 1:2 with water
b. Rinse mouth with 1 teaspoon
c. May decrease dilution to 1:1 as tolerate
Provide symptomatic relief with a one-to-one mixture of Benadryl elixir and Kaopectate,or prescribe viscous lidocaine.

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