Burning mouth syndrome
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| Burning mouth syndrome | |
|---|---|
| Specialty | Oral medicine  |
Glossodynia (also termed burning mouth syndrome, BMS, orodynia,[1] oral dysaesthesia,[2] glossopyrosis,[2] stomatodynia,[3] burning tongue,[4] stomatopyrosis,[2] sore tongue,[2] or burning mouth)[2] is the complaint of a burning sensation in the mouth which can be localized to the lips or tongue or be more widespread within the mouth where no underlying dental or medical cause can be identified and no oral signs are found.[2] Burning mouth syndrome may also comprise subjective xerostomia (a dry mouth sensation where no cause can be found such as hyposalivation), oral paraesthesia (e.g. tingling) and altered taste or smell (dysgeusia and dysosmia).[2] A burning sensation in the mouth can be a symptom of another disease when local or systemic factors are found to be implicated, and this scenario is not considered to be burning mouth syndrome,[2] which is a syndrome of medically unexplained symptoms.[3] The International Association for the Study of Pain definition of burning mouth syndrome is ‘a distinctive nosological entity characterized by unremitting oral burning or similar pain in the absence of detectable mucosal changes.’[3]
Classification
A burning sensation in the mouth may be primary (i.e. burning mouth syndrome) or secondary to systemic or local factors.[3] About 50% of cases have no identifiable cause.[3] BMS has been subdivided into three general types, with type two being the most common and type three being the least common.[3] Types one and two have unremitting symptoms, whereas type three may show remitting symptoms.[3]
- Type 1 - Symptoms not present upon waking, and then increase throughout the day
- Type 2 - Symptoms upon waking and through the day
- Type 3 - No regular pattern of symptoms
Signs and symptoms
By definition, BMS has no signs. Symptoms of BMS are variable, but the typical clinical picture is given in the table.[3][2]
| Parameter | Usual findings in burning mouth syndrome |
|---|---|
| Site | Usually bilaterally located on the tongue or less commonly the palate, lips or lower alveolar mucosa |
| Onset | Pain is chronic, and rarely spontaneously remits |
| Character | Burning, scalded or tingling. Sometimes the sensation is described as 'discomfort', 'tender' and 'annoying' rather than pain or burning. |
| Radiation | |
| Associations | Possibly subjective xerostomia, dysgeusia (altered taste), thirst, headaches, chronic back pain, irritable bowel syndrome, dysmenorrhea, anxiety, depression and personality disorders |
| Time course | Type 2 (most common) pain upon waking and throughout day, less commonly other patterns. |
| Exacerbating/Relieving factors | Pain is often relieved by alcohol, or eating and drinking (unlike pain caused by organic lesions) Pain is not often relived by analgesics. |
| Severity | Moderate, rated 5-8 out of 10 |
| Effect on sleep | Does not disturb sleep, or may change sleep patterns. |
| Previous treatment | Often multiple consultations and unsuccessful attempts at dental and/or medical treatment |
Several conditions can give a burning sensation in the mouth without any clinical signs, and therefore may be misdiagnosed as BMS. These include:[3]
- Deficiency of iron, folic acid or vitamin B
- Restricted of the tongue by poorly constructed dentures.
- Parafunctional activity, e.g. nocturnal bruxism or a tongue thrusting habit.
- Neuropathy, e.g. following damage to the chorda tympani nerve.
- Hypothyroidism.
- Medications.
Causes
Pathophysiology
Diagnosis
There are no clinically useful investigations that would help to support a diagnosis of BMS,[2] but a blood test and / or urinalisis may be useful to rule out anemia, deficiency states, hypothyroidism and diabetes. Investigation of a dry mouth symptom may involve sialometry, which objectively determines if there is any reduction of the salivary flow rate (hyposalivation).
Prevention
Treatment
Prognosis
Epidemiology
History
Causes
Possible causes include nutritional deficiencies, chronic anxiety or depression, type 2 diabetes, menopause, oral disorders such as thrush or dry mouth, Sjögren's syndrome, or damaged nerves (specifically, cranial nerves associated with taste).
One cause of burning mouth pain, which may be often misdiagnosed as burning mouth syndrome, is a contact sensitivity Type IV hypersensitivity in the oral tissues to common substances such as sodium lauryl sulfate, a surfactant commonly used in household products, cinnamon aldehyde or dental materials. There are now several toothpastes on the market specifically without sodium lauryl sulfate or other preservatives which have been found to be associated with sensitivities.[4]
Presentation
This condition appears more often in women, especially after menopause, than men. Pain typically is low or nonexistent in the morning and builds up over the course of the day.
Treatment
Low dosages of benzodiazepines, tricyclic antidepressants or anticonvulsants may prove to be an effective treatment.
Alpha-lipoic acid 600 to 800 mg administered daily in three or four doses has been found to reduce symptoms. Trials have been small, but alpha-lipoic acid may be an appropriate adjunctive treatment option.[citation needed]
See also
References
- ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
{{cite book}}: CS1 maint: multiple names: authors list (link) - ^ a b c d e f g h i j Zakrzewska, JM (2005 Jan 25). "Interventions for the treatment of burning mouth syndrome". Cochrane database of systematic reviews (Online) (1): CD002779. PMID 15674897.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ a b c d e f g h i Scully, Crispian (2008). Oral and maxillofacial medicine : the basis of diagnosis and treatment (2nd ed. ed.). Edinburgh: Churchill Livingstone. ISBN 9780443068188.
{{cite book}}:|edition=has extra text (help) - ^ a b James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. p. 63. ISBN 0-7216-2921-0.
{{cite book}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link)
- Scala A, Checchi L, Montevecchi M, Marini I, Giamberardino MA (2003). "Update on burning mouth syndrome: overview and patient management". Crit Rev Oral Biol Med. 14: 275–91.
{{cite journal}}: Cite has empty unknown parameter:|month=(help)CS1 maint: multiple names: authors list (link)
External links
- Glossodynia/BMS in more detail
- Go4Hope - The biggest resource for information about burning mouth syndrome
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