Burning Mouth Syndrome

Question 1

BMS

Answer 1

I/O burning or dysaesthesitic sensation, recurring daily for >2 hrs per day, >3 months without clinically evident causative lesions

Question 2

BMS epidemiology

Answer 2

0.7-18%
Incidence increases with age
7F:1M
post menopausal woman
spontaneous burning
poorly localised
bilateral

Question 3

CF BMS

Answer 3

Approx 2/3 reported dysgeusia
subjective dryness reported in 25% cases
Paraaesthesia

Question 4

Classification

Answer 4

Type 1 – comes on as the day goes 35%
Type 2 – on waking and throughout the day. linked to chronic anxiety. v resistant to tx.
Type 3 – no regular pattern. atypical sites

Question 5

Aetiology

Answer 5

3 hypotheses:
1. Peripheral small fibre sensory neuropathy
2. Subclinical mandibular, lingual or trigeminal neuropathy
3. Hypofunction of dopaminergic neurons (affect behavioural processes e.g., mood and stress)

Question 6

Local causation

Answer 6

Dry mouth
Infections
Oral mucosal lesions
Parafunctional habits
Poor denture design
Allergic reactions

Question 7

Systemic causation

Answer 7

Blood disorders
Autoimmune disorders
GORD
Endocrine disorders
Medication eg ACE inhibitors
CNS Changes eg Parkinsons

Question 8

Topical tx

Answer 8

Benzodiazepines eg Clonazepam 300mg
Capsaicin
Analgesics
Laser therapy

Question 9

Systemic tx

Answer 9

Tricyclic antidepressants eg., Amitriptyline and Nortriptyline
Benzodiazepines eg Clonazepam
Anticonvulsants eg Gabapentin
Food supplements eg Alpha lipoic acid

Question 10

Prognosis

Answer 10

Approx 3-50% patients improve spontaneously
3% patients had a complete spontaneous clinical remission within 5 years after the onset of clinical manifestations
moderate improvement seen in 30% of patients