Neurological, Behavioural and Psychological Conditions Flashcards
What are the types of burning mouth syndrome?
Can be both primary or secondary.
It doesn’t have a definitive diagnosis and treatment.
What is burning mouth syndrome also called?
Complex oral sensitivity disorder
What are the symptoms of complex oral sensitivity disorder?
“hair in my mouth” “Tingling in my mouth” “burning in my mouth”
Sore mouth
Sore tongue
Glossodynia
Stomatodynia
Oral dysesthesia
What is primary complex oral sensitivity disorder? how is it diagnosed?
A neuropathic disorder, diagnosis requires patients to have:
Pain in the mouth present daily and persisting for most of the day.
Oral mucosa of normal appearance
Local and systemic diseases have been excluded
How is secondary burning mouth syndrome different to primary burning mouth syndrome?
Oral burning is from or is effected by clinical abnormalities.
Secondary BMS improves with treatment of the underlying cause.
How does burning mouth syndrome present clinically?
5th - 7th decade of life uncommon before 30
Spontaneous onset
Increased intensity over time
Pain lasting > 4 months
What are the symptoms of burning mouth syndrome?
Positive sensory symptoms:
Burning pain
Dysgeusia (metallic taste)
Dysesthesia
Negative sensory symptoms:
Loss of taste
Parasthesia
Tongue > Labial mucosa > Hard palate
Exacerbated by acidic foods
What are the secondary causes of BMS?
Dry mouth (xerostomia, salivary gland hypofunction)
Candidal infection
Immune related conditions (geographic tongue and OLP)
Nutritional deficiencies
Allergies
GORD
Certain medications
Endocrine disorders
How are patients with secondary BMS caused by dry mouth managed?
Management is 2 fold:
Stop deleterious effects of dry mouth on oral health (eg fungal infections, CPPACP)
Attempt to provide comfort with salivary substitutes
What should be done for patients with candida infections and symptoms of BMS?
Candida needs to be eliminated as a cause of BMS and some clinicians swab the mouth routinely of BMS patients to ensure that this is not a contributing factor
How is candidiasis managed?
Eliminate co contributing factors such as diabetes, nutritional deficiencies (B12, B6, RBCs, folate, and iron), etc
Assess systemic factors
Antifungals (Topical azoles, amphotericin B, and nystatin)
Systemic antifungals
How should allergies be managed if they are suspected as the cause of BMS?
Conduct a patch test of suspected causes (refer to allerginist)
ACE inhibitors used for the treatment of hypertension have been implicated as causing BMS, changing medication may be an option in patients to assess if this gives any relief.
How can GORD and endocrine disorders be investigated as a cause of secondary BMD?
Patients usually have tell-tale signs of GORD most notably bitter or sour tasting saliva and erosion of teeth.
Diabetes and thyroid problems both hyper and hypo are known to produce peripheral neuropathic pain and generalised hyperalgesia so are worth investigating in certain clinical situations. Again especially with diabetes patients will have other oral signs –periodontal disease for example.
What diagnostic tests can be conducted for BMS?
FBC
Fe studies
Zn studies
Red cell folate
B vitamins
FBG/GTT (Diabetic nephropathy)
Allergy testing
Oral Swab and culture (Candida)
Oral biopsy (Immune mediated, depletion of small nerve fibes)
No test for primary BMS as it is not caused by known medical or dental causes.
Which psychological disorders are seen in patients with BMD?
Anxiety very often
This issue is contentious because no one knows if it is directly caused by BMD or if BMD is caused by the anxiety
Looking at the literature we can see that BMS suffferers often have elevated psychiatric illness be it anxiety or depression but usually not at levels higher than other chronic pain patients.
