What is Glossodynia?

Glossodynia (Burning Mouth Syndrome)

Glossodynia, also known as burning mouth syndrome (BMS), is characterized by a burning sensation in the oral mucosa without clinically apparent mucosal alterations, most commonly affecting the tongue, lips, palate, and buccal mucosa, primarily in peri- and post-menopausal women. 1

Clinical Presentation

• Burning sensation typically affects the tongue (especially the tip and lateral borders), lips, palate, and buccal mucosa 2, 1
• Pain severity ranges from mild to moderate, with continuous symptoms in most cases 2
• Often accompanied by dry mouth, abnormal taste, depression, and poor quality of life 2, 1
• Oral examination typically reveals normal-appearing mucosa despite symptoms 3
• Most commonly affects peri- and post-menopausal women 1

Diagnostic Approach

• Diagnosis is primarily one of exclusion, requiring elimination of secondary causes 1

• Local factors to rule out:

  • Oral candidiasis (can be misdiagnosed as primary BMS) 4
  • Mucosal lesions or trauma 1
  • Allergic reactions to dental materials 3

• Systemic factors to exclude:

  • Vitamin deficiencies, particularly B12 (can cause atrophic glossitis misdiagnosed as BMS) 5
  • Hematological disorders (anemia, macrocytosis) 5, 3
  • Autoimmune disorders 2
  • Hormonal imbalances (especially in peri/post-menopausal women) 3
  • Medication side effects 2, 6

• Psychological assessment:

  • Depression and anxiety are common in glossodynia patients 7
  • Psychosomatic factors often play a significant role 4, 7

Management

Non-pharmacological Approaches

• Reassurance and education about the benign nature of the condition 1
• Cognitive behavioral therapy (CBT) is a primary intervention for addressing psychological components 2, 1
• Avoidance of potential triggers:
  • Spicy, acidic, or hot foods and beverages 1
  • Alcohol and tobacco 3
  • Stress reduction techniques 6

Pharmacological Management

• First-line medications:

  • Gabapentin has shown efficacy in reducing burning sensation in 50% of patients 1
  • Alpha lipoic acid combined with gabapentin has demonstrated good outcomes 2

• Second-line medications:

  • Tricyclic antidepressants (e.g., amitriptyline) may be effective for symptom management 1
  • Topical treatments including clonazepam, diazepam, and capsaicin have shown some effect 2

Management of Associated Symptoms

• For dry mouth:
  • Improve hydration and limit caffeine intake 1
  • Use saliva substitutes and moisture-preserving mouth rinses 1
  • Consider systemic sialagogues for moderate to severe symptoms 1

Special Considerations

• Treatment failures are common in BMS management 1
• A multidisciplinary approach involving dentistry, neurology, and internal medicine is essential 3
• Avoid unnecessary substitution therapy for suspected but unproven deficiencies 3, 7
• In elderly patients, consider age-related changes, comorbidities, and medication interactions that may contribute to symptoms 6

Pitfalls to Avoid

• Misdiagnosing vitamin B12 deficiency-related atrophic glossitis as primary BMS 5
• Failing to screen for fungal infections, as antifungal treatment has shown high efficacy in some cases of glossodynia 4
• Overlooking psychological factors that may initiate or exacerbate symptoms 7
• Not providing adequate reassurance about the benign nature of the condition, which can increase patient anxiety 1