Burning Mouth Syndrome

Aka: Burning Mouth Syndrome, Oral Dysesthesia, Orodynia, Stomatopyrosis

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II. Epidemiology

  1. Patients are generally older
  2. More common in women by ratio of 7:1
  3. Prevalence: 1 million in U.S. affected

III. Pathophysiology

  1. No clear cause identified
  2. Postulated causes
    1. Nutritional Deficiency
      1. Vitamin B Deficiency
      2. Iron Deficiency Anemia
    2. Major Depresion
    3. Increased Taste Sensation
    4. Xerostomia
    5. Menopause (90% of women are postmenopausal)
    6. Trigeminal Nerve (CN V) Neuropathy
    7. Candidiasis
    8. Dentures
    9. Diabetes Mellitus

IV. Symptoms

  1. Characteristics of pain
    1. Burning pain affecting oropharynx
    2. Pain may be severe Toothache-like pain
  2. Timing
    1. Onset in mid-morning
    2. Progression over course of day
    3. Peaks in late afternoon
    4. Subsides at night (may interfere with going to sleep)
  3. Multiple pain sites often affected
    1. Anterior two-thirds of Tongue
    2. Oral Mucosa (especially anterior Hard Palate)
    3. Lower lip mucosa
  4. Palliative
    1. Pain may be relieved with eating
  5. Provocative
    1. Worse with emotion, speech
  6. Associated symptoms
    1. Dry Mouth (Xerostomia)
    2. Taste disturbance (bitter or Metallic Taste)

V. Signs

  1. No lesions present

VI. Labs

  1. Complete Blood Count
  2. Serum Iron or Ferritin
  3. Serum Vitamin B12
  4. Zinc
  5. KOH and Fungal Culture
  6. Serum Glucose or Hemoglobin A1C

VII. Differential Diagnosis

  1. See Tongue Pain

VIII. Associated Conditions

  1. Mood disturbance including Major Depression

IX. Diagnosis: ICHD-3 Criteria

  1. Oral Pain
    1. Burning quality
    2. Superficially felt in the Oral Mucosa
  2. Timing
    1. Recurrs daily for >3 months
    2. Present for >2 hours/day
  3. Exam
    1. Normally appearing Oral Mucosa
    2. Clinical examination is normal including Sensory Exam
  4. Exclusions
    1. Not explained better by another ICHD-3 diagnosis
  5. References
    1. (2018) Cephalalgia 38(1):1-211 +PMID: 29368949 [PubMed]

X. Course

  1. Spontaneous onset with persistence for years

XI. Management

  1. Treat potential causes of differential diagnosis
    1. Antifungal agent for Oral Candidiasis (Thrush)
    2. Estrogen Replacement for Menopause
    3. B Vitamin Supplementation for B Vitamin Deficiency
    4. Increase Saliva in Xerostomia
    5. Alpha-lipoic acid
    6. Cognitive Behavioral Therapy
  2. Neuropathic Pain Medications
    1. Amitriptyline (Elavil) at bedtime
    2. Clonazepam (Klonopin) at bedtime
    3. Gabapentin (Neurontin) at bedtime
    4. Capsaicin
      1. Start with hot pepper diluted 1:2 with water
      2. Rinse mouth with 1 teaspoon
      3. May decrease dilution to 1:1 as tolerated

XII. References

  1. Muzyka (1999) Cutis 64(1):29-35 [PubMed]
  2. Grushka (2002) Am Fam Physician 65(4):615-20 [PubMed]
  3. Tan (2022) Cephalalgia 42(2):128-61 +PMID: 34404247 [PubMed]
  4. McMillan (2016) Cochrane Database Syst Rev 11(11):CD002779 +PMID: 27855478 [PubMed]

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Related Studies

Ontology: Burning Mouth Syndrome (C0006430)

Definition (NCI) A condition characterized by a burning or tingling sensation on the lips, tongue, or entire mouth.
Definition (NCI_CTCAE) A disorder characterized by a burning or tingling sensation on the lips, tongue or entire mouth.
Definition (MSH) A group of painful oral symptoms associated with a burning or similar sensation. There is usually a significant organic component with a degree of functional overlay; it is not limited to the psychophysiologic group of disorders.
Concepts Disease or Syndrome (T047)
MSH D002054
SnomedCT 111349000, 399165002
English Burning Mouth Syndromes, Mouth Syndrome, Burning, Mouth Syndromes, Burning, Syndrome, Burning Mouth, Syndromes, Burning Mouth, Oral Dysesthesia, Burning Mouth Syndrome, Burning Mouth Syndrome [Disease/Finding], stomatopyrosis, burning mouth syndrome, dysesthesia oral, oral dysaesthesia, Oral dysaesthesia, Oral dysesthesia, BMS - Burning mouth syndrome, Burning mouth syndrome, Orodynia, Burning mouth syndrome (disorder), Stomatopyrosis
Italian Disestesia orale, Sindrome della bocca urente
German orale Dysaesthesie, Syndrom des brennenden Mundes, Orale Dysaesthesie, Mundbrennen
Japanese 口腔知覚不全, ｺｳｺｳﾁｶｸﾌｾﾞﾝ, ｺｳｸｳﾁｶｸﾌｾﾞﾝ, ｺｳｺｳｼｬｸﾈﾂｶﾝｼｮｳｺｳｸﾞﾝ, ｺｳｸｳｼｬｸﾈﾂｶﾝｼｮｳｺｳｸﾞﾝ, 口腔灼熱感症候群
Swedish Burning mouth-syndrom
Czech syndrom pálení v ústech, Orální dysestezie, Syndrom pálení úst
Finnish Suupolteoireyhtymä
Russian ZHZHENIIA RTA SINDROM, ROTOVOI POLOSTI ZHZHENIIA SINDROM, ЖЖЕНИЯ РТА СИНДРОМ, РОТОВОЙ ПОЛОСТИ ЖЖЕНИЯ СИНДРОМ
Spanish Síndrome de la boca ardiente, síndrome de boca ardiente, síndrome de la boca quemante, estomatopirosis, síndrome de la boca quemante (trastorno), síndrome de ardor bucal, síndrome de ardor bucal (trastorno), Estomatodinia, Disestesia oral, Síndrome de Boca Ardiente
Dutch burning mouth-syndroom, orale dysesthesie, Mondbranden
Portuguese Síndrome da boca ardente, Síndrome da Ardência Bucal, Síndrome da Boca Ardente, Síndrome da Boca em Queimação, Disestesia oral
French Syndrome de la bouche brûlante, Dysesthésie orale, Stomatodynie
Polish Stomatodynia, Ból palący w jamie ustnej, Zespół piekącej jamy ustnej, Zespół pieczenia jamy ustnej
Hungarian Égő száj syndroma, Oralis dysaesthesia, Oralis érzészavar
Norwegian Munnsvie, Munnbrann, Brennende munn-syndrom
Derived from the NIH UMLS (Unified Medical Language System)

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