Lec. 13 ORAL MEDICINE Dr.

Ali Al-Ibrahemy

BURNING MOUTH SYNDROME

Burning Mouth Syndrome (BMS) is a painful, complex condition often
described as a burning, scalding, or tingling feeling in the mouth that may occur
every day for months or longer. Dry mouth or an altered taste in the mouth may
accompany the pain. BMS is most commonly found in adults over the age of 60,
so it is the disease of geriatric.

Etiology of BMS
Burning mouth syndrome usually begins spontaneously, with no known
triggering factor. However, certain factors may increase your risk of developing
burning mouth syndrome, including:
 Recent illness.
 Some chronic medical disorders such as fibromyalgia, Parkinson's disease,
diabetes, autoimmune disorders and neuropathy.
 Acid reflux is a possible cause of burning mouth syndrome (BMS).
 Vitamin B-12 deficiency anemia cause tingling or numbness sensation in
your mouth or on the tip of your tongue.
 An overly stressed body can function abnormally, which can cause a wide
range of abnormal and unusual sensory symptoms, such as this one.
Hyperventilation can also cause this symptom. ... This change can cause
symptoms similar to stress, such as a burning and tingling tongue.
 Can toothpaste cause Burning Mouth Syndrome?
 Habitual smoking, alcohol use, and very hot and spicy foods may
also cause mouth dryness and occasional burning.

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  Dry mouth (caused by such conditions as Sjogren's syndrome, certain
medications, or radiation therapy).
 Lack of iron, vitamin B12, or folic acid.
 Oral thrush (a fungal infection in your mouth).
 Thyroid problems.
 Burning mouth syndrome may signal for anxiety, and depression.
 If menopause does appear to play a role in BMS, its mechanism
remains unclear.

How long BMS lasts?

For those with long-term symptoms (that may last 6-7 years or longer), the
intensity of burning tends to remain fairly stable at a manageable level, although
some patients will return to normal without any residual burning.

Management of BMS
 Review your medical history and medications.
 Examine your mouth.
 Ask you to describe your symptoms, oral habits and oral care routine.

In addition, your doctor will likely perform a general medical exam, looking for
signs of other conditions. You may have some of the following tests:

 Blood tests can check your complete blood count, glucose level, thyroid
function, nutritional factors and immune functioning, all of which may
provide clues about the source of your mouth discomfort.

 Oral cultures or biopsies. Taking and analyzing samples from your mouth
can determine whether you have a fungal, bacterial or viral infection.

 Allergy tests. Your doctor may suggest allergy testing to see if you may be
allergic to certain foods, additives or even substances in dental work.
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 Salivary measurements. With burning mouth syndrome, your mouth may
feel dry. Salivary tests can confirm whether you have a reduced salivary
flow.

 Gastric reflux tests. These tests can determine if you have GERD.

 Imaging. Your doctor may recommend an MRI scan, a CT scan or other

imaging tests to check for other health problems.

 Medication adjustment. If you take a medication that may contribute to

mouth discomfort, your doctor may change the dose, switch to a different
medication, or temporarily stop the medication, if possible, to see if your
discomfort goes away.

 Psychological questionnaires. You may be asked to fill out questionnaires

that can help determine if you have symptoms of depression, anxiety or
other mental health conditions.

Management of BMS

Treatment depends on whether you have primary or secondary burning

mouth syndrome. For secondary burning mouth syndrome, treatment
depends on any underlying conditions that may be causing your mouth
discomfort. For example, treating an oral infection or taking supplements for
a vitamin deficiency may relieve your discomfort. That's why it's important
to try to pinpoint the cause. Once any underlying causes are treated, your
burning mouth syndrome symptoms should get better.

Primary burning mouth syndrome

There's no known cure for primary burning mouth syndrome and

there's no one sure way to treat it. Treatment depends on your particular
symptoms and is aimed at controlling them. You may need to try several
treatment methods before finding one or a combination that helps reduce

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 your mouth discomfort. And it may take time for treatments to help manage
symptoms.

Treatment options may include:

 Saliva replacement products such as Biotène.

 Specific oral rinses or lidocaine such as Citroline F.

 An anticonvulsant medication called clonazepam.

 Certain antidepressants such as Fluoxetine and Amitriptyline.

 Medications that block nerve pain such as pregabalin.

 Cognitive behavioral therapy to develop strategies to address anxiety and

depression and cope with chronic pain.

Lifestyle and home remedies

 Drink plenty of fluids to help ease the feeling of dry mouth.

 Avoid acidic foods and liquids, such as tomatoes, orange juice, carbonated
beverages and coffee.

 Avoid alcohol and products with alcohol, as they may irritate the lining of
your mouth.

 Don't use tobacco products.

 Avoid spicy-hot foods.

 Avoid products with cinnamon or mint.

 Try different mild or flavor-free toothpastes, such as one for sensitive

teeth or one without mint or cinnamon.

 Take steps to reduce stress.