From the Guidelines
Burning mouth syndrome is a chronic condition that requires a comprehensive management approach, prioritizing symptom relief and quality of life, with treatment options including gabapentin, high-potency topical steroids, or viscous lidocaine, as recommended in the most recent guidelines 1.
Diagnosis and Assessment
Burning mouth syndrome (BMS) is characterized by a burning sensation in the mouth without any visible abnormalities, predominantly affecting peri- and post-menopausal women 1. The condition is often associated with dysfunction in taste and pain pathways, potentially involving small fiber neuropathy or central sensitization. A thorough assessment is crucial to rule out underlying causes, such as oral candidiasis, mucosal lesions, haematological disorders, auto-immune disorders, and pharmacological side-effects.
Management and Treatment
The management of BMS involves addressing underlying causes and managing symptoms. According to the most recent guidelines 1, treatment options for oral dysesthesia, including BMS, may include:
- Gabapentin
- High-potency topical steroids (gel or dental paste preferred)
- Viscous lidocaine Additionally, patients should avoid potential triggers like spicy foods, acidic beverages, alcohol, and tobacco. Good oral hygiene, staying hydrated, and using alcohol-free mouthwashes can minimize symptoms. Stress management techniques, including meditation or cognitive behavioral therapy, may be beneficial as psychological factors often exacerbate symptoms.
Quality of Life and Prognosis
While BMS can significantly impact quality of life, symptoms may improve over time with appropriate management, though patience is required as finding effective treatment often involves trial and error. It is essential to reassure patients that the condition will not worsen, and with proper management, they can experience an improvement in symptoms 1.
From the Research
Definition and Characteristics of Burning Mouth Syndrome
- Burning mouth syndrome (BMS) is a chronic idiopathic intractable intraoral dysaesthesia characterized by oral mucosal burning, often accompanied by dysgeusia, paresthesia, dysesthesia, and xerostomia 2, 3
- The etiology of BMS is unknown, but it is thought to be neuropathic in origin, with both oral and systemic factors contributing to its development and persistence 3, 4
Treatment Approaches for Burning Mouth Syndrome
- Various treatments have been recommended for BMS management, including pharmacological and non-pharmacological approaches 5, 3
- Pharmacological treatments include:
- Anticonvulsant and antidepressant agents, such as gabapentin, pregabalin, and amitriptyline 5, 3
- Alpha-lipoic acid (ALA) supplements, which have shown modest evidence of potentially decreasing pain/burning 2, 3, 6
- Capsaicin, which has shown significant improvements in VAS, but is limited by its side effects 2, 5, 6
- Clonazepam, which has shown modest benefit in the first two months 2, 5, 6
- Non-pharmacological therapies include:
- Cognitive behavior therapy, which has shown favorable outcomes in both short- and long-term assessments 2
- Low-level laser therapy, which has shown promise in reducing pain and improving quality of life 2, 4
- Transcranial magnetic stimulation (rTMS) and acupuncture, which have been suggested as potential treatments, but require further research 5, 4
Challenges and Future Directions in Burning Mouth Syndrome Research
- The management of BMS is complicated due to its complex etiology and inconsistent response to various treatments 2, 5
- Further studies are required to assess the analgesic benefits of topical clonazepam and capsaicin, alternative medicines with neurodegenerative prevention capability, and psychology support in treating BMS and reducing systemic adverse drug reactions 2, 5
- A more significant volume of research, including multi-center and multi-arm comparison of therapeutic agents with placebo and longitudinal follow-up studies, is needed to establish a standardized BMS treatment protocol 2, 6