From the Guidelines
Burning tongue syndrome, also known as burning mouth syndrome, is a chronic condition characterized by burning of the tongue and other parts of the oral mucosa without any visible abnormalities, and its management typically involves reassurance that it will not worsen, as suggested by the study published in the British Journal of Anaesthesia 1. The condition is seen predominantly in peri- and post-menopausal women, and its prognosis is poor with only a small number resolving fully. Some key points to consider in the management of burning tongue syndrome include:
- Neurophysiological testing, biopsies, and functional MRI suggest that it is a disorder of peripheral nerve fibres with central brain changes, as noted in the study 1.
- Secondary causes of burning mouth syndrome, such as oral candidiasis, mucosal lesions, haematological disorders, auto-immune disorders, and pharmacological side-effects, should be ruled out.
- While there is no cure, patients can be reassured that the condition will not get worse, which is often crucial for their well-being.
- Management may involve avoiding potential triggers, staying well-hydrated, and practicing good oral hygiene.
- Cognitive behavioral therapy may be considered if stress is a contributing factor. It is essential to approach each patient individually, considering their unique circumstances and potential underlying causes, to provide the most effective management for burning tongue syndrome, as the study published in the British Journal of Anaesthesia 1 highlights the importance of a comprehensive approach to this condition.
From the Research
Burning Tongue Syndrome
Burning mouth syndrome (BMS) is characterized by an intense burning sensation of the tongue or other oral areas without a clear etiopathology 2. The syndrome is mainly found in middle-aged or elderly women and is accompanied by xerostomia and dysgeusia 3.
Symptoms and Classification
The symptoms of BMS include:
- Burning sensation of the oral mucosa
- Unremitting oral mucosal pain
- Dysgeusia
- Xerostomia BMS can be classified into two clinical forms: primary and secondary BMS 4. Primary BMS is essential or idiopathic, while secondary BMS is caused by local, systemic, and/or psychological factors.
Treatment Options
The treatment options for BMS include:
- Pharmacological approaches:
- Capsaicin
- Clonazepam
- Low-dose aripiprazole
- Alpha-lipoic acid
- Duloxetine
- Amitriptyline
- Gabapentin
- Pregabalin
- Ultra-micronized palmitoylethanolamide 2
- Non-pharmacological therapies:
- Cognitive therapy
- Electroconvulsive therapy
- Laser therapy
- Acupuncture and auriculotherapy
- Transcranial Magnetic Stimulation (rTMS)
- Salivary Mechanical Stimulation
- Botulinum Toxin 2
- Vitamin, zinc, or hormone replacement therapy for patients with deficiency of the corresponding factor 4
- Psychotherapy and behavioral feedback 4
Effective Treatments
Studies have shown that cognitive behavior therapy, topical capsaicin, and clonazepam, and laser therapy demonstrate favorable outcomes in both short- and long-term assessments 5. Phytomedicines have reported a short-term benefit in pain score reduction, while alpha-lipoic acid has shown positive effects in long-term assessment 5.