From the Guidelines
Burning tongue syndrome, also known as burning mouth syndrome, should be managed with gabapentin, as it has been shown to reduce burning sensation in patients with this condition. This approach is based on the most recent and highest quality study available, which investigated treatment options for oral dysesthesia, including burning mouth syndrome 1. The study found that gabapentin was effective in reducing burning sensation in patients with symptoms of burning in the mouth.
Key Considerations
- Burning mouth syndrome is a chronic condition characterized by a burning sensation in the mouth, particularly on the tongue, without any visible abnormalities.
- The condition often results from nerve damage or dysfunction affecting taste and pain sensations, hormonal changes, or psychological factors.
- Treatment typically involves managing symptoms through several approaches, including:
- Avoiding potential triggers like spicy foods, acidic beverages, alcohol, and tobacco.
- Using over-the-counter pain relievers such as acetaminophen or NSAIDs for temporary relief.
- Prescribing medications like gabapentin (300-900 mg daily) for persistent symptoms.
- Using topical treatments like lidocaine rinses (2% solution used as needed) or capsaicin (0.025% applied to affected areas).
- Staying hydrated, using alcohol-free mouthwash, and practicing stress reduction techniques like meditation can complement medical treatment.
Management Approach
According to the NCCN guidelines, management of oral dysesthesia, including burning mouth syndrome, involves assessing the location and character of pain, ruling out odontogenic or mucosal source, and assessing severity of pain and impact on function 1. For mild cases, dietary modifications and topical measures may be sufficient, while moderate to severe cases may require holding immunotherapy, using gabapentin, high potency topical steroids, or viscous lidocaine.
Quality of Life
While symptoms of burning tongue syndrome may persist for years, proper management can significantly improve quality of life. It is essential to work with a healthcare provider to develop a personalized treatment plan that addresses the underlying causes of the condition and provides relief from symptoms. As noted in a previous study, burning mouth syndrome is a disorder of peripheral nerve fibres with central brain changes, and reassurance that the condition will not get worse is often crucial for patients 1.
From the Research
Burning Tongue Syndrome
Burning mouth syndrome (BMS) is described by an intense burning sensation of the tongue or other oral areas without a clear etiopathology 2. The symptoms of BMS include:
- A burning sensation in the tongue and/or other oral mucosa with no underlying medical or dental reasons 3
- Dysgeusia (taste disturbance) 4
- Xerostomia (dry mouth) 4
- Depression and anxiety 3, 4
Treatment Options
Various treatment options are available for BMS, including:
- Pharmacological approaches:
- Non-pharmacological approaches:
Efficacy of Treatment Options
The efficacy of these treatment options varies, with some studies showing promising results:
- Clonazepam has been shown to be effective in reducing burning pain in BMS patients, especially those with taste disturbances 4
- Alpha-lipoic acid (ALA) has been shown to have a positive effect on pain score improvement, especially in long-term assessment 5
- Cognitive behavior therapy, topical capsaicin, and laser therapy have demonstrated favorable outcomes in both short- and long-term assessments 5
- Gabapentin may provide modest relief of pain in BMS and may also boost the effect of ALA 6