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Abstract
Burning mouth syndrome (BMS) is an idiopathic condition characterized by a chronic continuous burning sensation of intraoral
soft tissues, typically involving the tongue, with or without extension to the lips and oral mucosa. It is classically accompanied
by gustatory disturbances like dysgeusia and parageusia and subjective xerostomia. This syndrome commonly affects people
all over the world without racial or socioeconomic predilection. Some patients may develop a single episode of burning
sensation while some may show recurrent episodes that last for months or years. It commonly affects perimenopausal and
postmenopausal women. The etiology remains obscure and multifactorial, hence the treatment is complicated with multiple
approaches involving drugs, psychotherapy along with latest techniques like acupuncture and low level laser therapy being
used to treat BMS effectively.
Keywords: Orofacial pain, stomatodynia, glossodynia, neuropathic pain, glossopyrosis, scalded mouth syndrome
B
urning mouth syndrome (BMS) refers to chronic an oral mucosa that appears clinically normal in the
orofacial pain without any visible mucosal absence of local or systemic diseases or alterations.’’2
changes or lesions and laboratory findings. BMS is seen more commonly in postmenopausal
It is also known by various terminologies such as females.3 There is no single accepted treatment for
orofacial pain, stomatodynia, glossodynia, neuropathic BMS and hence there are a variety of therapeutic
pain, glossopyrosis and scalded mouth syndrome. approaches available. This present article focuses on
It is characterized by an intense burning or stinging updated knowledge on etiology, classification of BMS
sensation, preferably on the tongue or in other areas and also adds a note on latest treatment modalities,
of the oral mucosa.1 The etiology has remained unclear home remedies and techniques to cope with BMS
and numerous local, systemic and psychological successfully.
factors have been implicated in the etiology and
current knowledge throws light on the underlying CLASSIFICATION
neurological disorder. The International Association
BMS is classified as follows:
for the Study of Pain and International Headache
Society defines it as a “distinctive nosological entity, Based on etiology as
including ‘all forms of burning sensation in the mouth Primary, where etiology is unknown
with stinging sensation or pain, in association with Secondary, where the etiology is known3,4
Based on symptoms as
Type 1 BMS: Patients have no symptoms upon
*Professor and Head waking but symptoms progress throughout
**Reader the day reaching its peak intensity by evening.
Dept. of Oral and Maxillofacial Pathology
Royal Dental College (KUHS), Chalissery, Kerala
Night-time symptoms are variable. It is linked
†Reader to systemic disorders like nutritional deficiency
Dept. of Oral and Maxillofacial Pathology and diabetes.
AJ Institute of Dental Science, Mangalore
‡Senior Lecturer Type 2 BMS: Patients have continuous
Dept. of Oral and Maxillofacial Pathology, Royal Dental College (KUHS) symptoms throughout the day and are
Chalissery, Kerala
Address for correspondence
symptomatic at night resulting in sleepless
Dr Anuradha Sunil nights. This type is associated with chronic
Professor and Head anxiety due to altered sleep pattern and is
Dept. of Oral and Maxillofacial Pathology, Royal Dental College (KUHS)
Chalissery, Kerala related to use of antidepressant drugs, which
E-mail: anuradhasunil@hotmail.com cause xerostomia.
Indian Journal of Clinical Practice, Vol. 23, No. 3, August 2012 145
clinical practice
Type 3 BMS: Patients have intermittent implicated. Food allergens include peanuts, chestnuts,
symptoms throughout the day with symptom- cinnamon, nicotinic acid and sorbic acid.8
free periods. Usually seen due to anxiety or
allergic reactions especially to food allergens.3 Psychological Factors
Patients with BMS show increase in salivary cortisol
Etiologies
level indicating higher levels of stress.9 However,
Different factors have been proposed for secondary anxiety and depression are considered as exacerbating
BMS as follows: factors rather than the cause of BMS as the symptoms
disappear following their remission.
Local factors
Systemic factors Iatrogenic Factors
Nutritional factors Drug-associated BMS have been observed with use
Allergic or immunological factors of angiotensin-converting enzyme (ACE) inhibitors
and angiotensin receptor blockers (ARBs).10 The
Psychological factors
product of inflammatory reaction generates increased
Iatrogenic factors bradykinin. The mechanism is clearly not understood
Infections but kallikrein, a molecule active in the kinin pathway,
is increased in the saliva of BMS patients, resulting in
Hormonal imbalances
increased inflammation. Other drugs like antiretrovirals
Neurological disturbances3,5,6 nevirapine and efavirenz may also result in BMS.
However, the mechanism is not clearly understood.
Local Factors
Oral conditions: Lichen planus, geographic tongue Infections
Oral habits: Tongue thrusting, bruxism Few microbes like Candida, Enterobacter,
Excessive mouth irritation: Overbrushing, Fusospirochetes, Helicobacter pylori and Klebsiella are
overuse of mouth washes, overingestion of acidic prevalent in patients with BMS without visible mucosal
drinks.3,5,6 lesions.3,11
146 Indian Journal of Clinical Practice, Vol. 23, No. 3, August 2012
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Indian Journal of Clinical Practice, Vol. 23, No. 3, August 2012 149
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150 Indian Journal of Clinical Practice, Vol. 23, No. 3, August 2012
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Many patients with BMS show reduction or 4. Maltsman-Tseikhin A, Moricca P, Niv D. Burning
disappearance of symptoms during meals or when mouth syndrome: will better understanding yield better
chewing gum or confectionary is used. So the following management? Pain Pract 2007;7(2):151-62.
measures may be taken 5. Klasser GD, Fischer DJ, Epstein JB. Burning mouth
syndrome: recognition, understanding, and management.
Sip water frequently Oral Maxillofac Surg Clin North Am 2008;20(2):
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Symptoms of BMS can be reduced and also prevented 6. Klasser GD, Epstein JB, Villines D. Diagnostic dilemma:
from becoming worse by the enigma of an oral burning sensation. J Can Dent Assoc
2011;77:b146.
Avoidance of tobacco products
7. Koike M. A case of burning mouth associated with
Avoidance of products with cinnamon or mint dental metal allergy. Nihon Hotetsu Shika Gakkai Zasshi
2005;49(3):498-501.
Avoidance of spicy and hot foods
8. Huang W, Rothe MJ, Grant-Kels JM. The burning mouth
Avoidance of acidic foods and liquids
syndrome. J Am Acad Dermatol 1996;34(1):91-8.
Using different brands of toothpastes 9. Amenábar JM, Pawlowski J, Hilgert JB, Hugo FN, Bandeira
Take steps to reduce excessive stress D, Lhüller F, et al. Anxiety and salivary cortisol levels in
patients with burning mouth syndrome: case-control
Some of these adjunct techniques may help patients in study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
coping up with BMS. 2008;105(4):460-5.
Practice of relaxation exercise such as yoga 10. Castells X, Rodoreda I, Pedrós C, Cereza G, Laporte JR.
Joining a pain support group Drug points: Dysgeusia and burning mouth syndrome by
eprosartan. BMJ 2002;325(7375):1277.
Engaging in pleasurable activities such as exercise
11. Terai H, Shimahara M. Glossodynia from Candida-
and hobbies. associated lesions, burning mouth syndrome, or mixed
Making an effort to stay socially active by causes. Pain Med 2010;11(6):856-60.
connecting with understanding family members 12. Välimaa H, Savolainen S, Soukka T, Silvoniemi P, Mäkelä S,
and friends. Kujari H, et al. Estrogen receptor-beta is the predominant
estrogen receptor subtype in human oral epithelium and
Conclusion salivary glands. J Endocrinol 2004;180(1):55-62.
13. Femiano F, Gombos F, Esposito V, Nunziata M, Scully C.
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dental practitioner. It is a clinical diagnosis made and taste. Med Oral Patol Oral Cir Bucal 2006;11(1):
via the exclusion of all other causes. No universally E22-5.
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