Definition

Burning mouth syndrome is characterised by a persistent burning sensation affecting the oral cavity (predominantly the tongue and lips) and the throat.

It is often described as a condition of persistent, unbearable pain occurring mainly in postmenopausal women who have prominent psychogenic features and sometimes cancer-phobia.

BMS is often also called glossodynia or oral dysaesthesia.

Incidence/Age

BMS is a not uncommon condition affecting predominantly postmenopausal women. It is often associated with denture wearers and most sufferers are over 60 years of age.

Causes

There are a multitude of potential causes:

1. Diseases of the lining of the mouth (inflammation of any cause, lichen planus, thrush infection etc).
2. Dry mouth (xerostomia). There are multiple causes of a dry mouth, some of which are treatable.
3. Iron +/- vitamin deficiencies (usually Vit B12).
4. Secondary to depression (psychogenic), studies suggest that this may occur in up to 30% of sufferers.
5. Cancer Phobia, many sufferers are afraid that the symptoms are related to mouth cancer, which is very rarely the case.
6. In the majority of cases no underlying cause is identified.

Symptoms/Signs

Patients often complain quite bitterly of a sore, burning sensation, which has persisted despite various attempts at treatment. Patients often have seen GP's and Dentists prior to assessment by specialists. Occasionally sufferers complain of ulcers or rough patches in the mouth.

The symptoms are often exacerbated by hot or spicy foods.

Examination of the mouth to identify a cause is carried out. There may be signs of some dryness of the lining or signs of inflammation. The majority of patients wear either full or partial denture, many of which are many years old. In most cases, however, examination is normal.

Some patients may have signs and symptoms of a depressive illness (changes in mood, sleep patterns, weight changes, hopelessness & suicidal thoughts etc).

Complications Of Disorder

Depression

Tests

Investigations are undertaken to identify an underlying cause. These are dictated by findings on a clinical examination but may include blood tests (full blood cell count, iron studies, vitamin B12, folate, and zinc levels to identify anemia and evaluate nutritional status, as well as fasting glucose to diagnose diabetes). Further workup may include a biopsy, culture for thrush (candidiasis), and patch testing.

Treatment

Treatment of BMS is essentially the treatment of the underlying disorder if one is found. Re-assurance as to the absence a serious cause, i.e. cancer, is helpful.
The use of a multivitamin supplement and/or Evening Primrose Oil is often beneficial.

Up to 30% of patients have some underlying psychogenic problems (e.g. depression). Recognition and appropriate referral may be beneficial for some patients. It is sometimes very difficult to know whether it is the BMS that causes the depression (because of the relentlessness of the condition) or vice versa.

Outcome/Prognosis

No treatment is of proven efficacy unless underlying causative factors can be identified. BMS does improve in some patients but most have symptoms that last many years. Sufferers often see many different specialists in the hope of finding a cure.


Source: www.privatehealth.co.uk
Last Editorial Review: 25/1/2010