Burning mouth syndrome

What is burning your mouth? syndrome?

Burning mouth syndrome is a chronic pain syndrome strictly defined as a burning sensation and pain in the mouth (oral dysesthesia) with normal clinical examination and without obvious organic cause. Therefore, it is a diagnosis made only after excluding the recognized organic causes of oral pain.

Currently thought to be neurological originally, and not psychogenic as previously believed. Many other names have been given for this condition, including orodynia (burning in the mouth) and glossodynia (burning on the tongue).

Who gets Burning Mouth Syndrome?

Burning mouth syndrome is seen predominantly, but not exclusively, in peri and postmenopausal women. Males can be affected. the incidence increases with advancing age. It is rarely seen before the age of 30. No racial or ethnic differences have been reported. It probably affects approximately 1% in the general population, increasing to 30% in selected populations, such as postmenopausal women.

Burning mouth syndrome can be associated with personality or mood disorders, particularly anxiety and depression. It is not clear if they are due to oral symptoms or if they contribute to the development of the problem. Teeth grinding, tongue thrusting, and jaw clenching are also commonly associated and can only be identified by asking family members.

What are the clinical features or burning mouth syndrome?

History and symptoms

A careful history is important, as the underlying organic causes must be sought and excluded to make this diagnosis. The questions should cover the following points.

• Medications: some dry the mouth
• Dental care - dental hygiene
• General health, especially diabetes risk
• Skin conditions: can affect the mouth
• Diet: iron and vitamins are required for good oral health
• Hormonal state: Burning mouth may start around menopause

The three key symptoms of burning mouth syndrome are:

1. Oral pain
2. Abnormal taste
3. Dry mouth

In burning mouth syndrome, symptoms persist for many months and often years. Not all people with this condition describe the three key symptoms, and the absence of any one of these does not exclude the diagnosis.

Many other symptoms can also be described and can include:

• Complaint that dentures do not fit properly even if the dentist finds them right
• Aggravation or relief of symptoms with specific foods.
• Bad breath (halitosis): must be confirmed by questioning family members, as this can be socially disabling for the patient
• Difficulty to swallow (dysphagia)
• A feeling of having a lump in the throat when there is nothing there.
• Symptoms of clenching the jaw or grinding the teeth can present as headache, earache, pain in the muscles or joints around the jaw, face, and neck.
• Language ulcers usually related to the inflamed tongue papillae.

Examination of the mouth

A comprehensive clinical examination should be performed, including the oral cavity, where local organic causes, such as oral and thrush Cancer, must be excluded. The upper part of the tongue must have a complex architecture (that is, it must not be smooth as seen in anemia) All surfaces in the mouth must be checked ulceration which can represent a spectrum of causes of trauma, idiopathic recurrent aphthous stomatitis, autoimmune diseases such as pemphigus to oral cancer.

Skin examination and nail must search systemic causes of oral pain, including nutritional deficiencies, lichen planus, and hormonal disorders (eg, diabetes mellitus, thyroid disease).

Oral mucous membrane it looks normal in burning mouth syndrome. Clues may be seen on the exam that may help confirm the diagnosis.

• Worn teeth or damaged tooth enamel may indicate grinding and clenching of teeth
• Scallops along the sides of the tongue caused by the thrust of the tongue
• Protruding teeth or malocclusion may indicate thrusting of the tongue
• Sensitive muscles around the jaw and neck due to clenched jaw
• Foamy saliva accumulates on the floor of the mouth indicating excessive mucous submandibular saliva that is not easily cleared by swallowing
• Mild redness in symptomatic areas such as the tongue, hard palate, inside the lower lip near the incisors.
• Exhibition of the filiform papillae (taste buds) on the tongue due to traumatic abrasion on teeth

How is burning mouth syndrome diagnosed?

Burning mouth syndrome is a diagnosis of exclusion, therefore history taking, clinical examination, and testing aim to find an organic explanation for the symptoms.

Exams based on history and exam findings may be required. However, in burning mouth syndrome all of these are normal / negative.

Investigations may include:

• Detection of nutritional deficiencies (folic acid, iron, vitamin B12, zinc)
• Hormonal levels (especially for thyroid and menopause), autoimmune conditions
• Blood sugar - diabetes mellitus
• Mucous membrane scraping for candida
• Patch contact tests allergy
• Sialometry for the production of saliva.
• Mucous membrane biopsy, but this is rarely indicated.

What is the treatment of burning mouth syndrome?

In a small number of patients (3%) the condition resolves spontaneously. Over 6-7 years, half or two thirds of patients experience some improvement. There is no definitive cure.

A list of symptoms and signs of burning mouth syndrome can help the patient accept the diagnosis, as this is an important step to progress. For some, only recognition and explanation is required.

For many, the condition is disabling and active treatment is required. Realistic expectations of response to treatment are important. Often the first sign response is an improvement in altered taste. However, the improvement is unpredictable: it can be incomplete and slow, which can take several years. The feeling of dryness (xerostomia) is often resistant to therapy. Referral to a specialized multidisciplinary oral medicine unit may offer the best opportunity for relief in the medium and long term.

Few studies have been done on treatment and only cognitive behavioral therapy, current Clonazepam, oral capsaicin, and alpha lipoic acid (+/- cognitive behavioral therapy) have been shown to have a positive impact in properly conducted trials. Oral capsaicin causes significant abdominal pain that can outweigh any benefits. Cognitive behavioral therapy can exert its effect through better mechanisms for dealing with pain.

PlaceboControlled studies have failed to show any benefit from using topical steroids, benzydamine hydrochloride oral rinses, or trazodone (serotonergic antidepressant), causing most patients to withdraw from the trial due to side effects, particularly dizziness.

The reported treatments include:

• Other medications
  • Antidepressants, particularly tricyclics, are the most widely used treatment and should be started at low doses, since dry mouth is a common side effect, e.g. amitriptyline starting with 10 mg before bed, slowly increasing to a maximum of 150 mg as tolerated or required.
  • Anxiolytic medications such as benzodiazepines, in low doses, may be helpful in confirming the diagnosis, as there is generally a perceived slight improvement, for example, clonazepam starting with 0.25 mg before bedtime, increasing to a maximum of 2 mg as prescribed. tolerated or required
  • Anticonvulsants, for example gabapentin, which begins with 100 mg before bedtime and increases as tolerated or required.
  • Hormone replacement therapy
  • Topical local anesthetics
  • Capsaicin topical
• Behavioral therapies, including relaxation and exercise therapies.
• Physical therapies including massage, acupuncture, and To be
• Empirical treatment for known causes of oral pain, such as nystatin for candidiasis.

These treatments can be used alone or in combination, particularly with cognitive behavioral therapy.