What is burning mouth syndrome?
Burning mouth syndrome is characterized by continuous burning sensation of the oral mucosa in the absence of any specific oral lesions.
There is no cause so it is idiopathic and has no definitive cure.
Although the cause is uncertain there are certain factors which seem to be common in patients suffering from burning mouth syndrome.
Factors are highlighted below.
(A) Middle aged women are affected more.
(B) Patients will often have an endocrine disorder like diabetes or psychological disorders such as anxiety and depression.
Lamey and Lewis have classified three subtypes of burning mouth syndrome. Most patients, 55%, are of subtype number 3 which is a continuous burning sensation throughout the day, present on walk waking up and they will have difficulty in getting to sleep.
About a third of patients have the subtype number one which is that they wake up without any symptoms but the symptoms gradually develop and reaching the peak by the evening.
Only 10% of patients have the intermittent burning which may only be present on some of the days.
Therefore most patients will have a continuous burning sensation which gets worse during the day and it is present when they wake up and when they try to get to sleep.
The International Association for the study of pain describes burning mouth syndrome as a burning pain in the tongue or oral mucosa which is not associated with any pathology and it is lasting for more than 4 to 6-months.
Because there is no clinical sign of any abnormality of the oral mucosa, the history that the patient gives you is paramount.
“a dentist who cannot take a good history and a patient who cannot give one or in danger of giving and receiving bad treatment.”
Another important point to note is that many patients also complain of other chronic oral symptoms such as an altered taste sensation and dry mouth.
They may not use the term burning but say it is a hot scalding sensation, annoying tenderness or even numbness.
The most common area is the anterior two-thirds of the tongue. However it can also involve other areas of the tongue such as the dorsum or the lateral borders.
Pain will occur without any warning and they feel that the pain is deep within the mucosa and it will last for at least 4 to 6-months.
Patients will often say that it interferes with their taste and sleep patterns which increases the likelihood of anxiety and depression.
Patients will also say that they have a dry mouth but this is more likely to the side effects of drugs such as anticholinergic, psychotropic drugs, antihistamines and diuretics.
As already stated above, some patients will also have non-specific health disorders such as random headaches, temporomandibular pain syndrome, irritable bowel syndrome, dermatological disorders such as eczema and psychiatric disorders with an increased tendency for allergies.
Because the cause of burning mouth syndrome is unknown, treatment is therefore limited other than reassurance. Some patients think it is cancer but there will obviously be no clinical lesions to look out for.
Various theories have been proposed as to why burning mouth syndrome occurs including changes to nerve fibres leading to their degeneration.
Treatment involves around a good taking of a patient’s history and trying to eliminate other causes such as fungal infection. In addition, the history and presentation of the pain should be recorded so that the condition can be monitored for future visits to see if the condition is getting worse, saying the same or improving over a time.
Common treatments that are used include the following but are generally unsatisfactory. Patients will often go and see many different doctors, physicians and other non-medically qualified people such as herbalists.
Treatments include the use of local anaesthetic gels such as lignocaine appointment but these should not be used for a significant length of time and in any case they wear off fairly quickly. The application of topical aloe vera gel seems to be of some benefit for some patients in reducing the burning on the tongue .There is a mouthwash called Biotene mouthwash which contains lactoperoxidase but it was found to be ineffective. Another one is called Difflam mouthwash which contains Benzydiamine hydrochloride and has an anaesthetic anti-inflammatory effect but the results were very inconsistent. Also has been the application of capsicum gel which inhibits Substance P. Similarly patients get some relief by using TABASCO sauce with water or one of hot pepper and water in an adequate dilution.
Certain systemic medications have been used such as the use of tricyclics antidepressant drugs and CBT therapy. Some anti-psychotic drugs also do seem to be effective but for a short duration.
If there is a hormonal deficiency or a nutritional deficiency like untreated diabetes then this can be addressed accordingly.
Those with anxiety disorders can be prescribed benzodiazepines and systemic capsicun capsules did find to be effective but will result in gastric pain due to its effect on the stomach lining.
Burning Mouth Syndrome is a painful condition and patients often find the lack of treatment frustrating and difficult to accept that there are no physical lesions to see.