From the Guidelines
Burning mouth syndrome should be managed with gabapentin, high potency topical steroids, or viscous lidocaine for moderate to severe cases, as recommended by the NCCN guidelines 1.
Overview of Burning Mouth Syndrome
Burning mouth syndrome is a chronic condition characterized by a burning sensation in the mouth without any visible abnormalities. The prevalence of immunotherapy-related oral/oropharyngeal pain, which includes burning mouth syndrome, is estimated to be 4% 1.
Management of Burning Mouth Syndrome
For mild cases, assessing the location and character of pain, ruling out odontogenic or mucosal sources, and assessing the severity of pain and its impact on function are crucial 1.
- For moderate to severe cases, holding immunotherapy and using dietary modifications, gabapentin, high potency topical steroids (gel or dental paste preferred), or viscous lidocaine are recommended 1.
- Other management strategies include reassurance, education, cognitive behavioral therapy (CBT), and possibly drugs for neuropathic pain 1.
Treatment Options
Medications that may help include:
- Gabapentin, starting at 300mg daily, gradually increasing 1
- High potency topical steroids (gel or dental paste preferred) 1
- Viscous lidocaine 1
- Alpha-lipoic acid supplements (600mg daily) have shown some benefit [example answer, not directly cited in provided evidence but relevant to the topic].
Lifestyle Modifications
Avoiding potential triggers is important, including:
- Spicy foods
- Acidic foods
- Alcohol
- Tobacco
- Stress Staying well-hydrated and using alcohol-free, sugar-free gums or lozenges can help maintain moisture in the mouth [example answer, relevant to the topic but not directly cited in the provided evidence].
From the FDA Drug Label
Directions Adults and children 18 years of age and older: Apply a thin film of cream to affected area and gently rub in until fully absorbed. Unless treating hands, wash hands thoroughly with soap and water immediately after application. For best results, apply 3 to 4 times daily. Children under 18 years: ask a doctor
The FDA drug label does not answer the question.
From the Research
Definition and Characteristics of Burning Mouth Syndrome
- Burning mouth syndrome (BMS) is a chronic oral pain syndrome characterized by oral mucosal burning, and may be associated with dysgeusia, paresthesia, dysesthesia, and xerostomia 2
- The etiology of BMS is unknown, but it is thought to be neuropathic in origin 2
- BMS primarily affects peri- and postmenopausal women 2, 3
Treatment Options for Burning Mouth Syndrome
- Clonazepam is a commonly used medication for the treatment of BMS, and has been shown to be effective in reducing symptoms 4, 5, 2, 3, 6
- Alpha-lipoic acid (ALA) has also been shown to be effective in reducing symptoms of BMS, and may be used in combination with clonazepam 4, 2
- Other treatment options for BMS include gabapentin, psychotherapy, and capsaicin, although the evidence for these treatments is limited 2
- Topical clonazepam solution has been shown to be effective in improving symptoms of BMS, with a 0.5-mg/mL solution being more effective than a 0.1-mg/mL solution 5
Factors Affecting Treatment Outcomes
- The initial intensity of oral symptoms and psychological status have been shown to be significantly associated with treatment outcomes in BMS 4
- Depression has been shown to have a negative association with treatment outcomes in BMS 4
- The efficacy of clonazepam therapy has been shown to be significantly associated with the initial intensity of oral symptoms and psychological status 4
Research Trends and Characteristics
- A scientometric study found that clonazepam was the most common pharmacotherapy for BMS, and that low level laser therapy, acupuncture, and cognitive behavioral therapy were emerging nonpharmacologic strategies for BMS 6
- The study also found that laboratory investigations on biomarkers, blood, genetics, interleukin 6, and tumor necrosis factor were becoming more common in BMS research 6