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Burning Mouth Syndrome: a Review REVIEW ARTICLES REVIEW ARTICLES Burning Mouth Syndrome: A Review SMA SADATa, NM CHOWDHURYb, RBA BATENc Summary: caused by local, systemic and/or psychological factors. Clinical diagnosis depends on the careful history taking, Burning Mouth Syndrome (BMS) is characterized by chronic oro-facial pain in the absence of specific oral lesions & physical examinations and laboratory findings. Vitamin, clinically apparent mucosal alterations. It is more commonly Zinc or Hormone replacement therapy has been found to be observed in middle aged patients & postmenopausal women. effective with deficiency of the corresponding factors. The It often affects tongue, cheek, lip, hard & soft palate. Usually drug therapy with alpha-lipoic acid, capsaicin, clonazepam, symptoms are better observed in morning, worsen during the benzodiazepines, tricyclic antidepressants, anticonvulsants day and typically subside at night. The condition is may be effective in symptomatic treatment of BMS. But the multifactorial origin, often idiopathic and its treatment is still unsatisfactory and there is no definitive etiopathogenesis remain largely enigmatic. Associated cure. medical conditions may include neurologic and metabolic Keywords: Burning Mouth Syndrome, Glossodynia, Review, disorder, gastrointestinal, urogenital as well as drug Stomatodynia reactions. BMS are of two types, primary & secondary. Primary BMS is essential or idiopathic where secondary BMS is (J Bangladesh Coll Phys Surg 2016; 34: 151-159) Introduction: middle aged or old women with hormonal changes or The international association for the study of pain psychological disorders6-8. BMS can be accompanied (IASP) has identified BMS as a “Distinctive nosological by Dysgeusia (distortion in sense of taste), Glossodynia entity” characterized by “unremitting oral burning or (painful tongue), Glossopyrosis (burning tongue) & similar pain in the absence of detectable oral mucosa Xerostomia (dry mouth). However, careful history taking, physical examination and appropriate laboratory testing change”1. Burning mouth syndrome is typically can be effective in the proper treatment planning of described by the patient as burning, stinging and/or BMS. BMS is usually treated through a multidisciplinary itching of the oral cavity in the absence of any organic approach by antidepressants, analgesics, antiepileptics, disease. It lasts at least for 4-6 months duration and antifungals, antibacterials, sialagogues, antihistamines, typically located on the tongue, particularly in the tip anxiolytic, antipsychotics and vitamin, minerals and and lateral borders, lips, hard & soft palate, alveolar hormonal replacements. Moreover patients need ridges with the buccal mucosa and floor of the mouth psychological support for the long term rehabilitation. being less frequently involved 2-5. BMS mainly affects Discussion: Epidemiology a. Dr. SM Anwar Sadat, Lecturer, Dept. of Oral & Maxillofacial Surgery, Dhaka Dental College, Dhaka, Bangladesh. BMS typically observed in middle age/ old women with 3,9-11 b. Dr. Naim Mahmud Chowdhury, Lecturer, Dept. of Oral & an age range of 38-78 years . The condition is Maxillofacial Surgery, Chittagong International Dental extremely rare in patients under 30 years and never been College, Chittagong, Bangladesh. reported in children and adolescence12. BMS has a c. Dr. Redwan Bin Abdul Baten, Assistant Dental Surgeon, significant female predilection with the ratio is about 7:18- Upozilla Health Complex, Nabinagar, Brahmanbaria, 11,13. These differences between genders may be explained Bangladesh. by biological, psychological & sociocultural factors. Address of Correspondence: Dr. S. M. Anwar Sadat, Lecturer, Prevalences of BMS reported from international studies Dept. of Oral & Maxillofacial Surgery, Dhaka Dental College, ranges from 0.7%- 4.5%11,14-18. Epidemiological studies Dhaka, Bangladesh. Contact No. +880 1711156023, E-mail: [email protected] revealed that this condition is more common in pre and 19 Received: 2 November, 2015 Accepted: 25 February, 2016 postmenopausal women which ranges upto 12-18% . Burning Mouth Syndrome: A Review SMA Sadat et al. Recent analysis showed an increase likelihood of 5. Oral infections: Candidiasis, Infection caused by gastrointestinal & urogenital disease in patient with enterobacter, klebsiella& S. aureous 14,28,29 BMS. Patient with BMS had a statistically higher intake 6. Hormonal change: Dryness of mucosal membrane 2 of medications for gastric disease . from age related reduction in estrogen & Pathophysiology: progesterone levels & increased frequency of Though the pathophysiology of Burning Mouth psychological disorders of middle aged and elderly Syndrome is not well understood, significant differences women, uncontrolled diabetes mellitus, gastro- 11,30 of thermal and nociception thresholds of patients with oesophegial reflux, thyroid dysfunction BMS are established in comparison to control subjects5. 7. Drugs: Antihistamine, Neuroleptics, anti- Thus a neuropathic mechanism for BMS is currently hypertensives principally those act on renin favored though the controversy remains exist between angiotensin system (captroplil, enalapril, lisinopril) peripheral and central dysfunction. Central neuropathic & ACE inhibitors8,31-33 mechanisms have been demonstrated following thermal 8. Psychiatric disorders: Anxiety, depression, stimulation of the nerve in patients with BMS. Patients personality disorder, cancerophobia, higher with BMS show patterns of cerebral activity similar to tandency to worry about health34 those that appear in other neuropathic pain disorders, suggesting that the cerebral hypoactivity could be an 9. Salivary dysfunction: Xerostomia, salivary gland important element in the pathogenesis of BMS5. dysfunction, salivary component changes3,7,8,25,35,36. Etiological factors 10. Autoimmune disease: Sjogren’s syndrome, The exact etiology of BMS is unknown. Although there systemic lupus erythematosus, lichen planus 37 is no definitive cause of primary BMS, there are numerous potential secondary causes of the burning 11. Others: Loss of taste buds, depapillation of tongue, mouth syndrome. Several factors play an important role oral desquamation due to agechange, side effects in the etiology of BMS. These are grossly classified to of radiation or chemotheraphy, cranial nerve injury, local, systemic and psychological factors 20. The parkinson’s disease, trigeminal neuralgia, contributing factors may be physical, chemical or glossopharyngeal neuralgia, herpes simplex, herpes 38,39 biological (some bacteria and fungi)14. The important zoster, smoking factors are: 12. Idiopathic factors 1. Mechanical factors: Poorly fitted oral or dental Classification of BMS prosthesis that produce microtrauma or local According to clinical symptoms BMS is classified to 21 erythema primary or essential/ idiopathic and secondary40,41. 2. Parafunctional Habits: Tongue thrust, Bruxism, 1. Primary or essential/ idiopathic: In primary BMS clenching, Continual rubbing over the teeth & organic causes cannot be identified and peripheral prosthesis, buccal, labial, lingual biting & or central neuropathological pathways are involved. compulsive movements of the tongue22 2. Secondary BMS: Result from local or systemic 3. Local allergic reactions: High levels of residual pathological conditions. Causes are local infection, monomers, nylon, ascorbic acid, cinnamon, autoimmune diseases of the oral mucosa (lichen nicotinic acid, dental materials (zinc, cobalt, mercury planus), nutritional and vitamin deficiencies, and palladium). Sodium lauryl sulfate a detergent glossitis, salivary disorders, allergies, irritation in toothpaste may also be involved in the caused by reflux, dental-alveolar diseases, 18,23-25 development of dry mouth . metabolic disorders, candidiasis, nerve damage, 4. Nutritional abnormalities: Vitamin B1, B2, B6, B12 as trauma, diabetes mellitus, gastrointestinal and well as folic acid, pernicious anemia, iron deficiency urogenital diseases or administration of certain anemia, Vitamin E and Vitamin C deficiencies 26,27 drugs. 152 Journal of Bangladesh College of Physicians and Surgeons Vol. 34, No. 3, July 2016 According to pain pattern BMS is classified into three Diagnostic criteria types4,12,14,21,41 Taking a thorough and comprehensive history & 1. Type-I (35%): Characterized by pain free awakening, laboratory findings are the key to diagnosis. Diagnosis of BMS is very much difficult because BMS is positively worsening throughout the day, and receiving its designed only by symptoms without signs or etiologies. peak intensity by evening. This type is usually The symptomatic traid rarely occurs simultaneously in associated with systemic disorders such as one patient. Overlapping stomatitis may confuse the nutritional deficiencies, diabetes mellitus. clinical presentation. However, some diagnostic work 2. Type-II (55%): Characterized by continuous up include oral examination, salivary parameters, symptoms throughout the day but not at night. nutritional parameters, hormonal parameters, medication, This type is usually associated with psychological parafunctional habits, contact allergies, psychological disorders. and psychosocial evaluation. There are various 3. Type-III (10%): Characterized by intermittent investigations that can be used to rule out secondary causes of BMS such as blood count which may reveal symptoms with pain free episodes during the day. infections or anemia, blood level of iron, zinc, folic acid, This type is usually associated allergic reactions.
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