Sore Mouth and Burning Mouth Syndrome Flashcards
1
Q
What is burning mouth syndrome?
A
Chronic intraoral burning sensation that has no identifiable cause either local or systemic. It has many features common with atypical facial pain
2
Q
What are the clinical features of BMS
A
- Affects middle-aged or older women
- No visible abnormality or evidence of organic disease
- No haematological abnormality
- No candida or bacterial infection
3
Q
Pain history of BMS
A
- Site: whole mouth or only tongue, floor of mouth characteristically not involved
- Character: burning sensation, teeth feel coated, scalded, feeling of sandpaper
- Onset: bizzarre patterns of pain
- Radiation: inconsistent with neurological or vascular anatomy
- Associations: psychogenic component: anxiety, depression, stress
- Timing: often of months or years
- Exacerbating/relieving factors: none
- Severity: obsession with symptoms may rule pt’s life
4
Q
Classification of BMS
A
- Type 1
- pain-free on awakening
- burning commences in late morning and increases in severity throughout the day reaching peak in evening - Type 2
- continuous symptoms throughout the day - Type 3
- intermittent symptoms
5
Q
Differential Diagnosis of BMS
A
- Exclusion of possible causes are required:
- All visible mucosal disease
- Erythema migrans
- Candida infection
- Iron, vitamin B12 or folate
- Xerostomia
- Menopausal symptoms
- Gastro-oesophageal reflux
- Dental or food irritants
- MS
- Drugs: ACE inhibitors, angiotensin receptor blockers, antiretrovirals, anti epileptic
- Candida infection at low intensity can cause symptoms in absence of physical lesions - should be excluded by smears
6
Q
Treatment of BMS
A
- Reassurance
- Symptomatic
- Antidepressants
- Cognitive behaviour therapy
- Topical analgesics but with little evidence base
7
Q
Remission % of BMS if not treated
A
- 4% complete remission
- 28% moderate improvement
- 49% no change
- 19% worsening
