Burning Mouth Syndrome (BMS)
This is the seventh in a series of posts about orofacial pain with difficult to diagnosis or unusual origin.
- Cracked tooth syndrome
- Trigeminal neuralgia (TN)
- Atypical odontalgia
- Neuralgia-inducing cavitational osteonecrosis or NICO
- Referred pain
- Myofascial pain
- Burning Mouth Syndrome BMS JADA Epstein Dec 2012
- Oral dysesthesia
- First bite syndrome
Burning Mouth Syndrome Etiology and Symptoms
As the name implies, this is a pain that traditionally feels like a burning mouth (often the tongue). It occurs in between .7 and 5 percent of the population. This is a neuropathic pain that often has unknown causes, although local trauma may trigger it. We list some of the possible triggers at the bottom of this post. There are so many triggers that it is likely BMS patients are bound to get the condition, they are simply waiting for any one of the many triggers once they are the right age. 50% have no identifiable triggers at all. 1/3 of patients report the trigger was a dental procedure, medical illness, or medication. At least one trigger is almost certainly hormonal as BMS impacts women 3:1 to 16:1 and is most common in women close to menopause.
The pain occurs on both sides of the front 2/3rds of the top of the tongue, the bottom and sides of the tongue, the front of the roof of the mouth, and the lower lip. The pain is usually a continuous constant burning feeling, however BMS suffers usually have less pain in the morning with increasing intensity throughout the day. Many times a feeling of dry mouth and or taste changes accompany BMS. Dry mouth is also one of the many conditions that we must rule out before a burning mouth syndrome diagnosis is made. The following are conditions that need to be ruled out from Balasubramaniam .
Burning Mouth Syndrome Treatment
This article May June issue 2011 has a great table on differential diagnosis and medications and therapies tried. The most successful seem to be clonazepam and then ALA. The Rx is clonazepam .5mg or 1mg oral tablet, disintegrating to swish the medication in mouth TID for 1-5 minute(s) and then spit it out. Do not swallow. 90 tablets are dispensed so about a month. The tables are allowed to dissolve in mouth without mixing them. There is no guarantee that a single or any treatment will be successful for any individual patient. What works great for one patient may have zero impact on somebody else. Due to the large number of causative factors and the resulting possible treatments, an orofacial pain sub-specialist is usually the best clinician to treat BMS . UofI in Chicago has an excellent program.
There exists several things that you can do to reduce the symptoms of BMS. First of all you can try to limit personal stress and fatigue, because BMS often has a relationship to stress. Another tip is to avoid spicy, hot, and acidic foods, because these will aggravate the condition. Finally, you can chew sugar free gum or take sips of water, which seems to distract from the pain. However, these tips are mostly just treating the symptoms of BMS and are therefore unlikely to fully satisfy your concerns. Another at home remedy that may work for some is putting splenda on your tongue for 60 seconds 4 times a day.
To treat the cause there are three general strategies. A behavioral strategy includes cognitive behavioral and group psychotherapy. A topical approach includes anxiolytics, antimicrobials, antifungals, artificial sweeteners, and low level laser treatment. The systemic approach includes a whole range of drugs: antidepressants, anxiolytics, anticonvulsants, antioxidants, atypical analgesics and antipsychotics, histamine receptor antagonists, monoamine oxidase inhibitors, salivary stimulants, dopamine agonists and herbal supplements.