Burning Mouth Syndrome (BMS)

Question 1

What is Burning Mouth Syndrome (BMS)?

Answer 1

• Oral Dysesthesia (abnormal sensation)
  
  • burning/painful
• Normal Clinical Exam
• No Organic Cause
  
  • multi-factoral
    
    • Neurologic
    • psychogenic
    • hormonal
• Diagnosed when everything else is ruled out

Question 2

What are the different names for BMS?

Answer 2

• Orodynia
  
  • burning mouth
• Glossodynia
  
  • burning mouth
• Glossopyrosis
  
  • burning tongue

Question 3

Define BMS: International Headache Society vs International Pain Association

Answer 3

• Headache Society
  
  • Intraoral burning sensation
  • no medical or dental cause
• Pain Association
  
  • burning oral sensation or pain
  • unremitting while in the absence of objective clinical changes in oral mucosa
    
    • Unremitting=never relaxing

Question 4

BMS: Diagnostic Criteria

Answer 4

1. Mouth pain- present daily and persists most of the day
   
   1. Prone Areas: Tongue Tip & Lips
   2. Associated complaints:
      
      1. dry mouth
      2. parasthesia
      3. taste disturbance
   3. Post-Menopause women mainly affected
2. Normal Oral Mucosa Appearance
   
   1. erosive or ulcerated mucosal disease commonly cause burning
3. Local and Systemic Diseases have been excluded
   
   1. Rule out Regional Musculoskeletal diseases

Question 5

BMS Classification

Answer 5

1. Primary
   
   1. essential/idiopathic
2. Secondary
   
   1. determined by local factors, systemic or psychological

Question 6

BMS: Prevalence/Incidence

Answer 6

• Women→Most common
  
  • 50-70 y.o. (<30=rare)
  • 3 years before menopause
    
    • 12 years post-menopause
• Female:Male range
  
  • 3:1 to 16:1

Question 7

BMS: Pathophysiology

Answer 7

• Complex
• Etiologic Factors:
  
  • Hormone Balance
    
    • more frequent during or after menopause
  • Neuropathic
    
    • 3 subclasses:
      
      • Peripheral small-fiber neuropathy
      • Subclinical Major Trigeminal Neuropathy
      • Central Pain related to deficient dopaminergic top-down inhibition
  • Psychological
    
    • personality & mood changes

Question 8

BMS: Etiology

Answer 8

• Local Factors
• Systemic Factors
• Psychological
• Neurological
• Idopathic

Question 9

BMS: Local Factors

Answer 9

• Contact Allergy
  
  • dental material & alloys
  • allergenic foods in hygienic/cosmetic
  • antiseptics
    
    • eugenol
    • chlorehexidine
• Dental Abnormalitities
• Dry Mouth
  
  • Salivary Gland Disorders
  • Drugs
  • Radiotherapy
• Infections:
  
  • Bacterial, Fungal, or Viral
• Irritants:
  
  • mechanical
  • chemical
• Oral Mucosa Lesions:
  
  • Lichen Planus
  • Migratory glossitis
  • Fissured Tongue
• Parafunctional habits
• Trauma

Question 10

BMS: Systemic Factors

Answer 10

• Nutritional Deficiencies:
  
  • Vit B1, B2, B6, B12
  • Folic Acid
  • Iron
  • Zinc
• Endocrine Disorders:
  
  • Diabetes
  • Thyroid disease
  • menopause
  • hormone deficiencies
• Hyposalivation
  
  • associated Autoimmune disease
    
    • Sjogrens syndrome
  • Anxiety/stress
• Drugs:
  
  • ACE inhibitors
  • antihyperglycemics
  • chemotherapeutic agents
  • benzodiazepines
  • neuroleptics
  • antihistamines
• GERD

Question 11

BMS: Psychological Factors

Answer 11

• Depression
• Anxiety
• OCD
• Somatoform Disorders
• Cancer phobia
• Psychosocial stressors

Question 12

BMS: Neurological Factors

Answer 12

• Neuropathy/Neuralgia

Question 13

BMS: Symptoms

Answer 13

• Continuous Daily Oral Mucosal Pain
  
  • burning
• Dysguesia (70%)
  
  • altered taste
    
    • metallic or bitter taste
• Xerostomia (45-65%)
• High psychometric score
  
  • for depression/anxiety
• Symptoms increase when:
  
  • talking
  • eating hot or spicy foods
  • stress
• Symptoms decrease when
  
  • eating or drinking certain foods/drinks
  • Sleep
  • Distraction

Question 14

BMS: Diagnostic Modalities

Answer 14

• Comprehensive History
• Complete physical exam (Extra and intraoral)
• Sialometry
• Biopsy or cytology
• Culture oral samples
• Hematological test: may inclue
• Skin Patch Test
• MRI
• Discontinue Meds
• Psychometric Tests
• Gastric Reflux Studies

Question 15

Sialometry

Answer 15

• eval oral dryness
• unstimulated whole saliva: 1.5ml/15 min
• stimulated whole saliva: 10.5 ml/ 15 min

Question 16

Biopsy or Cytology

Answer 16

• Biopsy minor salivary glands
  
  • suspect sjogren’s syndrome
• Biopsy or Cytology
  
  • oral mucosal lesion included in ddx

Question 17

Culture oral samples:

Answer 17

• rule out fungal or bacterial infection

Question 18

Hematological Test

Answer 18

• complete and differential blood counts
• fasting blood sugar levels
• thyroid panel
• nutritional factors
  
  • rule out deficiencies-B12, iron, folate
• autoimmune panel
  
  • ANA, RF, Anti-SSA, Anti-SSB

Question 19

Skin Patch Test

Answer 19

• rule out allergic rxn

Question 20

MRI

Answer 20

• if neuralgia or Trigeminal nerve neuropathy is in ddx
• rule out systemic conditions

Question 21

Discontinue medicines

Answer 21

• ex: ACE inhibitors:
  
  • known to cause symptoms

Question 22

Psychometric Tests

Answer 22

• eval psychological factors
• multi-dimensional pain inventory
• hospital anxiety and depression scale
• Beck depression Inventory