Primary Burning Mouth Syndrome Research Articles

Burning Mouth Syndrome: A Review of Recent Literature

Burning mouth syndrome (BMS) is a complex chronic disorder of orofacial sensation that is challenging in both diagnosis and treatment. The diagnosis of BMS is primarily one of exclusion, and recently classification of the disorder has been challenged. Although the exact pathophysiology of primary BMS is unknown, there has been a growing body of work to provide insight into the pathogenesis of the disorder over the past few years. Pharmacological treatments recently reported to have some success in BMS include anxiolytics, anticonvulsants, antidepressants, atypical antipsychotics, histamine receptor antagonist, and dopamine agonists. In addition, other therapies and treatments are being considered. This paper reports many of the most recent data related to BMS and its classification, diagnosis, impact on quality of life, pathophysiology, co-morbidities, and pharmacological and non-pharmacological treatments.

Diagnostic challenges of burning mouth syndrome

This survey presents some modern diagnostic approaches to a painful pathology of oral cavity defined as burning mouth syndrome (BMS). Absence of relevant clinical and laboratory signs hampers the diagnosis and results in delayed proper treatment. Clinicians should distinguish between primary and secondary BMS. Laboratory examinations include haematological screening, salivary analyses, epicutaneous and microbiological tests. Psychological assessments and autonomic nervous system testing play a diagnostic and differential-diagnostic role, too. Application of an interdisciplinary diagnostic approach is justified. Scripta Scientifica Medica 2013; 45(1): 12-16.

“Burning mouth syndrome in Parkinson’s disease: dopamine as cure or cause?” Letter to the Editor Reply

We appreciate Drs. Fortuna and Pollio’s interest in our case report describing a woman with Parkinson’s disease who developed burning mouth syndrome (BMS) with carbidopa/levodopa therapy that resolved after its discontinuation and initiation of a dopamine agonist. The authors bring up an excellent and also contentious point regarding the semantics of burning mouth syndrome [1, 2]. We utilize the current diagnostic criteria from the International Headache Society which classifies primary BMS under “Central causes of facial pain” [3]. The intent of reporting our case was not to define the syndrome, but instead to contribute anecdotal evidence to the hypothesis that the pathophysiology of BMS is related to dopamine dysregulation. We believe our case supports this notion given our patient’s diagnosis of Parkinson’s disease and apparent accentuation of BMS symptoms with administration of carbidopa/levodopa [4–6]. Our speculation is that carbidopa/levodopa’s central action led to the neurophysiological manifestations of BMS. Beyond superficially dismissing our patient’s symptoms as drug induced, the value in our case is related to deeper consideration of the underlying pathogenesis of BMS. Although we agree with the authors that it is quite difficult to delineate the role of depression and anxiety in cases of burning mouth syndrome [7], we did not think these psychiatric factors were of primary relevance in our case as there was no history of such. As outlined in our report, her BMS symptoms precisely correlated to carbidopa/levodopa administration. We appreciate the input of Drs. Fortuna and Pollio and come to the agreement that it is helpful to look at BMS from a multidisciplinary perspective. This approach will only advance our understanding of a disease plaguing patients who seek care from a variety of specialists.

Separating oral burning from burning mouth syndrome: unravelling a diagnostic enigma

Burning mouth syndrome (BMS) is characterized by burning pain in the tongue or other oral mucous membrane often associated with symptoms such as subjective dryness of the mouth, paraesthesia and altered taste for which no medical or dental cause can be found. The difficulty in diagnosing BMS lies in excluding known causes of oral burning. A pragmatic approach in clarifying this issue is to divide patients into either primary (essential/idiopathic) BMS, whereby other disease is not evident or secondary BMS, where oral burning is explained by a clinical abnormality. The purpose of this article was to provide the practitioner with an understanding of the local, systemic and psychosocial factors which may be responsible for oral burning associated with secondary BMS, therefore providing a foundation for diagnosing primary BMS.

Alpha Lipoid Acid in Burning Mouth Syndrome: A Meta-Analysis

Objectives: The objective of this study was to evaluate the current evidence on the efficacy of alpha lipoic acid (thioctic acid) (ALA) in relieving burning symptoms in subjects with primary burning mouth syndrome (BMS).

An open-label, noncomparative, dose escalation pilot study of the effect of paroxetine in treatment of burning mouth syndrome

The objective of this study was to evaluate the effectiveness and tolerability of paroxetine in patients with burning mouth syndrome (BMS). In a 12-week open-label, noncomparative, prospective study, 71 subjects with primary BMS were assigned to receive an initial dosage of paroxetine (10 or 20 mg/day). The dosage was increased to a maximum of 30 mg/day. Of these patients, 52 were available to examine the efficacy of treatment in this study. The cumulative proportion of responders was 80.8% (42/52). Of those responding, complete remission of pain was observed in 70.4% (19/27) of patients by week 12. The effects of paroxetine were dose-dependent. The incidence of adverse reactions for the initial daily dosage of 10 mg (41%) was significantly lower than that for 20 mg (76%) (chi(2) test). No serious safety issues were observed. About 80% of BMS patients experienced pain reduction with 12 weeks of paroxetine treatment with only minor transient side effects. These results suggest that paroxetine may be useful in the treatment of patients with BMS.

Zungenbrennen

Burning mouth syndrome (BMS) is characterized by oral dysesthesia, xerostomia and dysgeusia without visible alterations of oral mucosa. While secondary BMS results from an underlying general condition such as diabetes or iron deficiency, no causal disorder can be identified in primary BMS. The estimated prevalence is 1 - 2%, postmenopausal women are substantially more frequently affected than men. Current etiologic concepts assume a focal peripheral and central neuropathy. Only few controlled drug trials have yet been conducted. Thioctic acid appears the medical treatment of choice due to its comparatively good evidence for efficacy and low incidence of adverse reaction. Gabapentin and pregabalin are modern GABA-analogue anticonvulsants, which are also efficient in the treatment of peripheral neuropathies. Also conceptually appropriate for BMS treatment, current evidence for efficacy in BMS is insufficient. In two trials, local oral treatment with clonazepam has been beneficial in BMS. The efficacy of antidepressants is equivocal.

Management of burning mouth syndrome: systematic review and management recommendations

Primary burning mouth syndrome (BMS) is a chronic, idiopathic intraoral mucosal pain condition that is not accompanied by clinical lesions or systemic disease. There is some uncertainty whether this condition should be referred to as a disease, a disorder, or a syndrome but there are insufficient data to justify any change in taxonomy at present. BMS occurs most often among women and is often accompanied by xerostomia and taste disturbances. More recently a neuropathological basis has been proposed so that BMS may be regarded as an oral dysesthesia or painful neuropathy. However, our incomplete understanding of the epidemiology, etiology, pathophysiology, and lack of diagnostic criteria are barriers to critical investigation and selection of effective treatments. There is only limited evidence to guide clinicians in the management of patients with BMS. Treatable secondary causes should be investigated before diagnosing primary BMS. Topical clonazepam and cognitive therapy have been proven efficacious in some patients. Emerging evidence supports the effectiveness of the antioxidant, alpha lipoic acid, with further studies of this agent being warranted. Additional research into mechanisms, diagnostic criteria, and randomized controlled interventional studies are needed.