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Burning Mouth Syndrome Online Submissions: http://www.wjgnet.com/esps/ World J Gastroenterol 2013 February 7; 19(5): 665-672 [email protected] ISSN 1007-9327 (print) ISSN 2219-2840 (online) doi:10.3748/wjg.v19.i5.665 © 2013 Baishideng. All rights reserved. MINIREVIEWS Burning mouth syndrome Grigoriy E Gurvits, Amy Tan Grigoriy E Gurvits, Division of Gastroenterology, New York recognition and treatment. University School of Medicine/Langone Medical Center, New York, NY 10016, United States © 2013 Baishideng. All rights reserved. Amy Tan, New York University School of Medicine, New York, NY 10016, United States Key words: Burning mouth syndrome; Glossodynia; Author contributions: Gurvits GE and Tan A contributed equal- Glossopyrosis; Burning tongue ly to this work. Correspondence to: Grigoriy E Gurvits, MD, Division of Gas- troenterology, New York University School of Medicine/Langone Gurvits GE, Tan A. Burning mouth syndrome. World J Gastro- Medical Center, 530 First Ave, SKI - 9N, New York, NY 10016, enterol 2013; 19(5): 665-672 Available from: URL: http://www. United States. [email protected] wjgnet.com/1007-9327/full/v19/i5/665.htm DOI: http://dx.doi. Telephone: +1-212-2633095 Fax: +1-212-2633096 org/10.3748/wjg.v19.i5.665 Received: November 2, 2012 Revised: December 4, 2012 Accepted: December 25, 2012 Published online: February 7, 2013 INTRODUCTION Burning mouth syndrome (BMS) is a chronic pain dis- Abstract order characterized by burning, stinging, and/or itching Burning mouth syndrome is a debilitating medical con- of the oral cavity in the absence of any organic disease. dition affecting nearly 1.3 million of Americans. Its It lasts at least 4 to 6 mo and most often involves the common features include a burning painful sensa- tongue with or without extension to the lips and oral [1,2] tion in the mouth, often associated with dysgeusia mucosa . BMS can be accompanied by dysgeusia (dis- and xerostomia, despite normal salivation. Classically, tortion in sense of taste) and subjective xerostomia (dry symptoms are better in the morning, worsen during mouth). Its onset is spontaneous and the syndrome has the day and typically subside at night. Its etiology is a clear predisposition to peri-/postmenopausal women. largely multifactorial, and associated medical condi- Its secondary form has been associated with a variety of tions may include gastrointestinal, urogenital, psychiat- conditions including thyroid disease, psychiatric illnesses, ric, neurologic and metabolic disorders, as well as drug oral infections, drug use, dental treatment, vitamin/min- reactions. BMS has clear predisposition to peri-/post eral deficiencies, and others[3,4]. menopausal females. Its pathophysiology has not been First described in mid nineteenth century, this con- fully elucidated and involves peripheral and central dition was further characterized in the early twentieth neuropathic pathways. Clinical diagnosis relies on care- century by Butlin and Oppenheim as glossodynia[5]. Over ful history taking, physical examination and laboratory the ensuing years, BMS has been referred to as glosso- analysis. Treatment is often tedious and is aimed at pyrosis, oral dysesthesia, sore tongue, stomatodynia, and correction of underlying medical conditions, supportive [6] therapy, and behavioral feedback. Drug therapy with stomatopyrosis . It was first categorized as a distinct alpha lipoic acid, clonazepam, capsaicin, and antide- disease in 2004 by the International Headache Society, pressants may provide symptom relief. Psychotherapy which defined primary BMS as “an intraoral burning may be helpful. Short term follow up data is promis- sensation for which no medical or dental cause can be ing, however, long term prognosis with treatment is found.” Current diagnostic criteria consist of daily per- lacking. BMS remains an important medical condition sistent pain in the mouth with normal oral mucosa after which often places a recognizable burden on the pa- exclusion of local and systemic diseases[7]. Its etiology is tient and health care system and requires appropriate thought to be multifactorial, involving various local, sys- WJG|www.wjgnet.com 665 February 7, 2013|Volume 19|Issue 5| Gurvits GE et al . Burning mouth syndrome temic, and/or psychogenic causes. Female gender, peri- ANATOMY menopause, depression and anxiety, Parkinson’s disease, and chronic medical conditions including gastrointestinal The oral cavity is primary responsible for the inges- and urogenital diseases are risk factors for developing tion and mastication of food. Its anatomical boundaries BMS[1,8-11]. include the lips anteriorly, the cheeks laterally, the oro- pharynx posteriorly, the palate superiorly, and the floor BMS is an important clinical condition with aggra- [15] vating symptoms, directly and indirectly impacting the of the mouth inferiorly . The oral cavity contains sev- eral structures, including upper and lower dentition, the quality of life, which often places a recognizable burden [16] on the patient and health care system. Clinical consulta- tongue, salivary glands, and mucosal glands . It is lined by non-keratinized stratified squamous epithelium, which tions with a practicing gastroenterologist are common [17] practice in today’s medicine for the patients with BMS. is moistened by secretions from various salivary glands . This review focuses on various aspects of BMS, includ- The neuroanatomy of the oral cavity, particularly ing its epidemiology, pathophysiology, etiology, clinical somatosensory innervation, has been implicated in the presentation, differential diagnosis, classification, clinical pathophysiology of BMS. The maxillary (V2) and man- diagnosis, current treatment, and general prognosis. dibular (V3) branches of the trigeminal nerve supply most of the somatosensory innervation in the oral cav- ity, with some contribution from the glossopharyngeal EPIDEMIOLOGY nerve (cranial nerve Ⅸ). In regards to the tongue, the The estimated prevalence of BMS in the general popula- most commonly affected area in BMS, the lingual branch tion varies widely in the literature. Tammiala-Salonen et of V3 innervates the anterior two-thirds of the tongue al[12] reported a rate of 15% of burning mouth symptoms while the glossopharyngeal nerve innervates the posterior in Finnish adult population, though half of the patients third of the tongue. Together, they innervate the recep- tors on the papillae of the tongue, which are sensitive to had visible oral mucosal lesions. In a cross-sectional [17] analysis of over 1000 randomly selected Swedish patients mechanical, thermal, and tactile stimuli . from Public Dental Health Service registers, 3.7% of Alterations in taste and quantity of salivation are com- subjects were diagnosed with BMS after reporting burn- monly reported in BMS. The chorda tympani branch of ing mouth symptoms and undergoing a subsequent phys- the facial nerve (Ⅶ) supplies chemoreceptors for taste in ical examination[8]. In contrast, Lipton et al[13] reported a the anterior two-thirds of the tongue. The glossopharyn- prevalence of 0.7% based solely on self-reported symp- geal nerve (Ⅸ) provides taste sensation for the posterior toms from over 45 000 American households. Haberland third of the tongue. There are also taste receptors on the et al[14] noted that 10% of new patients observed in his soft palate supplied by the greater superficial petrosal nerve branch of Ⅶ and on the larynx from the superior practice were diagnosed with BMS. Most recently, a large laryngeal nerve of the vagus nerve (Ⅹ). The salivary reflex retrospective study of over 3000 Brazilian patients re- begins with afferent inputs from taste and mechanorecep- ferred to an oral pathology service reported a prevalence [1] tors in the mouth that reach the brainstem salivatory cen- of about 1% . These highly variable rates are attributed ters. Parasympathetic and sympathetic fibers then supply to the wide age disparities of the examined population [15] the efferent fibers that act on the salivary glands . (typically, prevalence of BMS dramatically increases with age) as well as previous lack of universally accepted di- agnostic criteria for BMS. Although further studies are PATHOPHYSIOLOGY needed with satisfactory criteria to determine the true The pathophysiology of BMS has not been fully elucidat- prevalence of BMS, this data illustrates that the disease ed. Various studies have shown significant differences in is an important medical condition that may be often en- thermal and nociception thresholds of patient with BMS countered in the clinical practice. compared to control subjects[18,19]. Thus, a neuropathic BMS has a clear predisposition to gender and age. mechanism for BMS is currently favored. However, con- Women are 2.5 to 7 times more commonly affected than [1,8,10] troversy remains over whether a peripheral or central men . Furthermore, up to 90% of female patients dysfunction is responsible for BMS. with BMS are perimenopausal women with typical onset Evidence in the literature links BMS to a peripheral from 3 prior- to 12 years post- the beginning of meno- neuropathy. Superficial biopsies of the anterolateral [9] pause . BMS may affect any age group, with patients tongue from BMS patients showed a significantly lower age ranging from 27 to 87 years of age, and a reported density of epithelial and subpapillary nerve fibers than mean age of 61 years. Recent analysis by the same group controls. Morphologic changes were consistent with axo- showed an increased likelihood of gastrointestinal and nal degeneration.
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