Current management strategies for the pain of elderly patients with burning mouth syndrome: a critical review

Trang T H Tu,Hirofumi Matsuoka,Yuma Aota,Takeshi Watanabe,Yoshihiro Abiko,Miho Takenoshita,Takayuki Suga,Akira Toyofuku

doi:10.1186/s13030-019-0142-7

Abstract

Burning Mouth Syndrome (BMS), a chronic intraoral burning sensation or dysesthesia without clinically evident causes, is one of the most common medically unexplained oral symptoms/syndromes. Even though the clinical features of BMS have been astonishingly common and consistent throughout the world for hundreds of years, BMS remains an enigma and has evolved to more intractable condition. In fact, there is a large and growing number of elderly BMS patients for whom the disease is accompanied by systemic diseases, in addition to aging physical change, which makes the diagnosis and treatment of BMS more difficult. Because the biggest barrier preventing us from finding the core pathophysiology and best therapy for BMS seems to be its heterogeneity, this syndrome remains challenging for clinicians. In this review, we discuss currently hopeful management strategies, including central neuromodulators (Tricyclic Antidepressants - TCAs, Serotonin, and Norepinephrine Reuptake Inhibitors - SNRIs, Selective Serotonin Reuptake Inhibitors - SSRIs, Clonazepam) and solutions for applying non-pharmacology approaches. Moreover, we also emphasize the important role of patient education and anxiety management to improve the patients’ quality of life. A combination of optimized medication with a short-term supportive psychotherapeutic approach might be a useful solution.

Highlights

Burning Mouth Syndrome (BMS), called “stomatodynia” or “glossodynia”, is one of the most common medically unexplained oral symptoms/syndromes (MUOS) [1, 2]
A large number of BMS studies have been conducted about the pathophysiology [3–5], but so far with limited knowledge because of its heterogeneity [6, 7]
Definition The International Association for the Study of Pain (IASP) presents BMS as “a chronic condition characterized by a burning sensation of the oral mucosa for which no cause can be found” [1]

Summary

Introduction

Burning Mouth Syndrome (BMS), called “stomatodynia” or “glossodynia”, is one of the most common medically unexplained oral symptoms/syndromes (MUOS) [1, 2]. It is probably true that some central sensitization might be related to BMS, as are other functional somatic syndromes [28, 29], recent evidence shows its limitations, especially for elderly patients [30, 31]. The pathophysiology should be considered as a pure painful sensation and as oral discomfort that includes dysgeusia and subjective dry mouth [32, 33], which seems to be more common in the elderly.

Results

Conclusion