K Bhagwandin
BURNING MOUTH SYNDROME
Burning Mouth Syndrome is a complex, chronic orofacial disorder characterized by generalized or localized intra-oral burning and pain of the mucosa, recurring daily.
It is most common in middle-aged women and typically affects the tongue, hard palate, or lips.
The sensation begins upon waking and worsens throughout the day. The mucosa appears normal.
CAUSES
- Microorganisms (fungi/bacteria)
- Xerostomia (associated with Sjögren’s syndrome)
- Anxiety or drugs
- Nutritional deficiencies
- Hormonal imbalance
- Diabetes
- Association with certain irritants (e.g., amalgam, zinc, mercury)
- Depression
TYPES
- Type 1: No symptoms upon waking, worsens throughout the day with variable night symptoms. This type is related to nutritional deficiencies or endocrine conditions like diabetes mellitus.
- Type 2: Chronic anxiety, with symptoms throughout the day.
- Type 3: Intermittent daytime symptoms, with periods without symptoms. Food allergies may be an underlying mechanism.
CLINICAL FEATURES
Burning Mouth Syndrome has diverse and variable clinical features, often interfering with the quality of life.
Common symptoms include:
- Burning, tingling, or numbness in the oral mucosa
- Common affected areas: tongue, lips, hard palate
- Spontaneous and bilateral onset of pain
- Persistent taste disturbances, such as bitter or metallic taste
- Xerostomia (dry mouth)
DIAGNOSIS
- Thorough and comprehensive history, focusing on the sensation of pain
- Clinical examination of the oral mucosa to rule out local and systemic causes
DIFFERENTIAL DIAGNOSIS
- Geographic tongue
- Lichen planus
- Dry mouth
- Candidiasis
- Glossitis with iron deficiency
- Diabetes
TREATMENT
- Nutritional deficiency: Replacement therapy
- Prosthetic devices: Check fit and tissue base; relining or remaking the denture may help
- Fungal infection: Topical nystatin
- Medications: Consider alternative medications
- Patient support: Offer explanation and support to the patient
- Avoid irritants: Advise avoiding substances that can aggravate symptoms, such as alcohol, citrus drinks, and spices
REFERENCES
Ireland, R. (Ed.). (2006). Clinical textbook of dental hygiene and therapy. Wiley-Blackwell.
Aravindhan, R., Vidyalakshmi, S., Kumar, M. S., Satheesh, C., Balasubramanium, A. M., & Prasad, V. S. (2014). Burning mouth syndrome: A review on its diagnostic and therapeutic approach. Journal of Pharmacology & Bioallied Sciences, 6(Suppl 1), S21–S25. https://doi.org/10.4103/0975-7406.137255
Photo by Anna Shvets: https://www.pexels.com/photo/woman-having-dental-check-up-3845652/