burning mouth syndrome Flashcards
what is the definition of BMS?
> An intraoral burning or dysaesthetic sensation, recurring daily for more than two hours per day over more than three months without clinically evident causative lesions
> pain is burning and is felt superficially in the oral mucosa
> clinical examination and sensory testing is normal
how common is BMS?
> 0.7-18%
> incidence increases with age
is burning mouth syndrome more common in men or women?
> 7F : M
> especially menopausal woman and patients with thyroid conditions
what is the epidemiology behind BMS?
> spontaneous burning/ scalding sensation - can vary throughout the day
> poorly localised
> usually bilateral
> intermittent or continuous - can vary
> varies in intensity
> night wakening uncommon
what location is burning mouth syndrome found?
> tongue
> lips
> palate
> buccal mucosa
> sometimes the entire oral mucosa
what associated symptoms do some patients present with in BMS?
> hyperpathia - high response to low receptive stimuli
> alladinia - pain caused by a non painful stimulus
> taste disturbance
> dry mouth
what are the excerbating symptoms that patients with BMS report?
> cold
> light touch
> emotional stress
> acidic foods
> spicy foods
what is the most common sites affected by BMS?
- dorsal aspect of the tongue
- palate
- lips
- pharynx (bilateral)
how do the vast majority of patients describe their BMS?
> onset - gradual
> character - burning, tingling, abnormal tactile sensation
> radiation - nil
> associated symptoms - xerostomia, sensation, taste
what are the clinical features of BMS?
> approx. 2/3 report with altered taste (dysgeusia)
> 25% report with dry mouth
> some patients present with altered sensations (paraesthesia)
what are the relieving factors of BMS?
> eating relieves symptoms
> sets it aside from geographic tongue
what is type 1 BMS?
> Type 1 - pain comes on as day goes on, unremitting pain
what is type 2 BMS?
> type 2 - pain on waking and throughout the day
> could be linked to chronic anxiety
> most challenging and often resistant to treatment
what is type 3 BMS?
> type 3 - no regular pattern of pain, at atypical sites
> FOM or Buccal mucosa
> . evidence suggests maybe allergies causes these symptoms in patients
what Is the cause of BMS?
> not fully understood
> most likely multifactorial
> Increasing evidence for a neuropathic origin
> Three hypothesis:
1. Peripheral small fibre sensory neuropathy 2. Subclinical mandibular, lingual or trigeminal neuropathy 3. Hypofunction of dopaminergic neurones (effects both mood and stress)
what investigations would you take if a patient presents with BMS? (to exclude other symptoms)
> FBC (anemia)
> haematinics (iron, b12, folate)
> Glucose (blood sugar control)
> thyroid function tests
> antibody screen
> swab/ smear
> salivary flow
> psychological assessment
> patch testing
> biopsy isn’t indicated
when carrying out a physical examination on a patient with BMS what are you looking out for? (to exclude other symptoms)
> massester hyperfunction
> tooth clenching
> tongue scalloping
> linea alba
> soft tissues - ulcerations, erythemia, xerostomia, denture?
what are the local factors which could cause oral burning?
> dry mouth
> infections
> oral mucosal lesions
> parafunctional habits
> poor denture design
> allergic reactions
what systemic factors could cause oral burning?
> blood disorders
> autoimmune disorders
> GORD
> endocrine disorders
> medication
> CNS changes
what are the 3 main treatment categories for BMS?
> topical therapy
> systemic therapy
> behavioural strategies
what topical therapy are on offer for BMS?
> Benzodiazepines - eg topical clonazepam (crush tablet and hold in area for 5mins)
> capsaicin - mouth rinse
> analgesics - eg difflam (mouth rinse or spray)
> laser therapy - eg low level laser therapy
what systemic therapies are on offer for BMS?
> tricyclic antidepressants - eg amitriptyline/ nortriptyline
> benzodiazepines - eg clonazepam
> anticonvulsants - eg gabapentin
> food supplements - eg alpha lipoic acid
what behavioural strategies are on offer for BMS?
> CBT
> Evidence based treatment
> Psychological treatment
> Biofeedback, relaxation, exposure, cognitive restructuring
what is the prognosis for BMS?
> The average duration of BMS is 2 to 3 years
> Approximately 30% to 50% of patients improve spontaneously and may have complete resolution of their clinical manifestations over many years.
> 3% of the patients had a complete spontaneous clinical remission within 5 years after the onset of clinical manifestations.
> A moderate improvement was observed in 30% of the participants, with or without treatment
> In patients with a history of psychiatric illness, such as anxiety and depression, a multidisciplinary approach is needed
