Burning Mouth Syndrome

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Burning Mouth Syndrome
By Shirley Gutkowski
The Preventive Angle
Volume 3 Issue 1
Known by any name, Burning
Mouth Syndrome (BMS) is distracting
and uncomfortable. The pain is intense,
similar to the burning effect on oral
soft tissues after eating hot peppers.
After physical reasons for the oral pain
are eliminated, such as trauma or
xerostomia, Burning Mouth Syndrome
becomes the probable diagnosis. Some
general statistics about BMS are shown
in Table 1.
TABLE 1 Û BMS General Statistics
Affected
Population __ Ô 0.7 Ò 2.6% suffer
Gender _____ Ô Most are women who
are peri- or postmenopausal
Affected area Ô Anterior of the
tongue or the
premaxillary gingiva
are most involved
Symptoms __ Ô Burning sensation
that increases as the
day wears on
Ô Negative history or
ongoing trauma
Ô Pain subsides while
eating
Ô No noticeable weight
gain or sleep loss
Stages ______ Ô Type 1 Ò 35% Pain
increases during
the day
Ô Type 2 Ò 55%
Continuous pain
throughout the day
Ô Type 3 Ò 10% Episodic,
some pain-free days
ANATOMY
The innervation of the head and
mouth is worthy of review in this
context. The trigeminal nerve plays the
biggest role in this malady. Recall that
the trigeminal nerve has three
branches. The maxillary nerve branch
(V2) innervates the palate and is entirely
sensory. Most of the tongueÌs sensory
and taste information is carried by the
lingual branch of the mandibular nerve
(V3). The ophthalmic branch (V1) has no
oral ramifications (Figure 1).
The trigeminal nerve originates in
the middle cranial fossa and can be
injured there by a blow to the back of
the head (Figure 2). Each of the
branches is vulnerable to injury
because of trauma or disease at various
places along its path. Viral infections,
for instance, are the major cause of
damage to the taste system. The
mandibular branch of the trigeminal
passes through the middle ear, making
it very vulnerable to disease.
Pain detection occurs at the
peripheral terminals of specialized
pain-receiving neurons called
nociceptors (Vitkow). They move
chemical, mechanical, and thermal
information via Substance P, a pain
neurotransmitter, to the central nervous
system. As reported by Wolf, Dr. Eva
Grushka of Yale University notes that
eating relieves the pain. If the taste
sensors of V3 are damaged, pain
sensors could spontaneously send pain
messages to the brain without
provocation.
When patients eat, the nerve
associated with taste send messages
that block the spontaneous misfirings
(Wolf )2 (Figure 3). From the perspective
of evolution, a damaged tongue
would continue to be functional if
eating caused the pain to subside.
When the taste system is damaged,
certain individuals are more likely to
experience phantom pain. In studies
at Yale on taste and BMS, the researchers
found people suffering with BMS
are often in a category known as
Ïsuper-tastersÓ (Figure 4). Individuals
considered to be super-tasters have
more fungiform papillae per area than
others, containing more taste buds
along with an increased number of
pain receptors. Researchers also found
that more super-tasters are women
(Bartoshuk).3
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