What is the diagnosis and treatment for Burning Mouth Syndrome (BMS)?

From the Guidelines

Burning mouth syndrome (BMS) should be diagnosed and treated by addressing underlying causes and managing symptoms, with a focus on reassurance that the condition will not worsen, as suggested by the study published in the British Journal of Anaesthesia 1. The diagnosis of BMS is characterized by burning of the tongue and other parts of the oral mucosa without any visible dental or medical causes, predominantly seen in peri- and post-menopausal women. Some key points to consider in the diagnosis and treatment of BMS include:

• Neurophysiological testing, biopsies, and functional MRI suggest that BMS is a disorder of peripheral nerve fibres with central brain changes 1.
• Secondary causes of BMS, such as oral candidiasis, mucosal lesions, haematological disorders, auto-immune disorders, and pharmacological side-effects, should be ruled out 1.
• Treatment options may include medications, topical treatments, and lifestyle modifications, although the prognosis is poor with only a small number of patients resolving fully 1.
• It is essential to reassure patients that BMS will not get worse, which is often crucial in managing the condition 1. Some potential treatment options for BMS may include:
• Topical treatments such as lidocaine rinses or capsaicin
• Lifestyle modifications, including avoiding spicy foods, acidic beverages, alcohol, and tobacco, and practicing stress reduction techniques
• Addressing underlying causes, such as vitamin deficiencies, diabetes, or thyroid disorders, if present.

From the Research

Diagnosis of Burning Mouth Syndrome (BMS)

• The diagnosis of BMS is challenging due to variations of manifestations 2
• BMS can be classified into two clinical forms: primary and secondary BMS 3
• Primary BMS is essential or idiopathic, in which the organic local/systemic causes cannot be identified and a neuropathological cause is likely 3
• Secondary BMS is caused by local, systemic, and/or psychological factors; thus, its diagnosis depends on identification of the exact causative factor 3

Treatment of Burning Mouth Syndrome (BMS)

• Many medications and treatment methods have been recommended for BMS management, but no one confirmed as the standard method 2
• Pharmacological treatments for BMS include:
  • Capsaicin 2, 4, 3, 5
  • Clonazepam 2, 4, 3, 5
  • Alpha-lipoic acid 2, 4, 3, 5
  • Low-dose aripiprazole 2
  • Duloxetine 2
  • Amitriptyline 2
  • Gabapentin 2
  • Pregabalin 2
  • Ultra-micronized palmitoylethanolamide 2
• Non-pharmacological therapies for BMS include:
  • Cognitive therapy 2, 4
  • Electroconvulsive therapy 2
  • Laser therapy 2, 4
  • Acupuncture and auriculotherapy 2
  • Transcranial Magnetic Stimulation (rTMS) 2
  • Salivary Mechanical Stimulation 2
  • Botulinum Toxin 2
• Vitamin, zinc, or hormone replacement therapy has been found to be effective for reducing the oral burning or pain symptom in some BMS patients with deficiency of the corresponding factor 3
• Psychotherapy and behavioral feedback may also help eliminate the BMS symptoms 3