Abstract
Background: Burning mouth syndrome (BMS) is a chronic and debilitating oral pain of the normal oral mucosa. It mainly affects women in their fifth to seventh decade. Its aetiopathogenesis remains unclear and is probably of multifactorial origin, with increasing evidence that BMS may be a neuropathic disorder. BMS is classified as an idiopathic (nociplastic) orofacial pain with or without somatosensory changes by International Classification of Orofacial Pain (ICOP 2020). The diagnosis of BMS, having excluded ‘oral burning mouth symptoms’, has evolved from basic intraoral exclusion screening to extensive clinical and laboratory investigations, which include the screening of comorbidities and other chronic pains and somatosensory testing. There is no standardised treatment in managing BMS, but a proposed combination of supportive and pharmacological treatment has been recommended. Aim: To review the current concepts of BMS definitions, classifications, aetiopathogenesis, diagnosis techniques, and evidence-based treatments in managing BMS patients. Conclusion: As BMS is a diagnosis by exclusion, thus a stratified approach is required for assessment of patients presenting BMS. A BMS diagnosis protocol is desired using a standardised screening to distinguish BMS from patient’s presenting with ‘oral burning symptoms’, and evaluation of comorbid chronic pain disorders or other medical comorbidities, which will include haematological, fungal, salivary flow, and qualitative sensory testing. Axis II and other additional quantitative sensory testing may further elucidate the causes of this condition. For future BMS prediction and prevention, will be based upon research on the relationship between other chronic pain disorders and familial history, environmental and genetic information.
Highlights
Burning mouth syndrome (BMS) remains a challenging disorder for health care providers
Dopamine D2 receptors (DRD2) gene 957C>T Single Nucleotide polymorphism has been associated with the increased availability of DRD2 in human striatum[91] and the presence of 957T allele leads to decrease in synaptic dopamine concentration and reducing dopamine receptors binding.[91]
This study reported a significant decreased in whole salivary proinflammatory interleukins such as tumour necrosis factor-a (TNF-a) and IL-6
Summary
Burning mouth syndrome (BMS) remains a challenging disorder for health care providers. Nigrostriatal dopaminergic pathway plays an important role in central pain modulation, especially in the basal ganglion and sensory cortex.[86] Neurotransmitter positron emission tomography (PET) study has demonstrated the hypofunction of the nigrostriatal dopaminergic system in BMS patients that prompts the hypothesis of reduced efficacy of endogenous pain inhibitory control in the brain dopamine-opioid system.[87,88,89] The increased availability in dopamine D2 receptors reflects the depletion of dopamine levels that may induce chronic neuropathic pain within the trigeminal distribution.[87,90] Dopamine D2 receptors (DRD2) gene 957C>T Single Nucleotide polymorphism has been associated with the increased availability of DRD2 in human striatum[91] and the presence of 957T allele leads to decrease in synaptic dopamine concentration and reducing dopamine receptors binding.[91] A study on the influence of DRD2 957TT genotype in orofacial neuropathic pain which consists of 5 BMS patients, 4 atypical facial pain and post-traumatic trigeminal nerve injury, have low painful and non-painful thermal detection threshold.[92] The prevalence of DRD2 957 TT genotype was significantly approximately twice higher in patients with orofacial neuropathic pain (50%) than the general Finnish population (27%).[92] Patients with 9577TT genotype encounter a twice higher mean numerical rating pain scores than patient with genotype 957CT and 957CC. Oral mucosa diseases/lesions/conditions: Fungal infection: candidiasis Inflammatory conditions: lichen planus; pemphigus/ pemphigoid; geographic tongue
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