Exodontia.Info
Burning Mouth Syndrome (Glossopyrosis, Glossodynia,
Stomatopyrosis, Stomatodynia & Oral Dysæsthesia)
What is Burning Mouth Syndrome (BMS)?

The pain is typically described as burning.  It is a persistent and unremitting soreness without aggravating / relieving
factors.

It often lasts from months to years.

The intensity of the pain varies from slight to very severe.

Pain-killers seem to have little effect.

There is a bizarre pattern of pain radiation not consistent with the anatomy of blood vessels or nerves.  There is
sometimes an associated
bitter or metallic taste or / and a dry mouth.

This is a common condition.  It is not inherited nor is it infectious.
Last Updated 13th March 2020
Useful Websites:

Go 4 Hope - Finding Answers for Burning Mouth Syndrome

National Center for Emergency Medicine Informatics

Emedicine.com

European Association of Oral Medicine

Medscape

DermNet NZ

Orofacialpain.org.uk


Useful Articles:

J Am Dent Assoc 1995.  Burning Issues in the Treatment of Burning Mouth Syndrome - An Evidence-Based Study of
the Literature.

Eastman Dental Institute for Oral Health Care Sciences.  Oral Medicine Clinic.  Burning Mouth Syndrome, Patient
Information Sheet 2003.

Pain Res Manage 2003.  Burning Mouth Syndrome & other Oral Sensory Disorders - A Unifying Hypothesis

Cochrane Database of Systematic Reviews 2004.  Interventions for the treatment of burning mouth syndrome.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005.  Vulnerability and presenting symptoms in Burning Mouth
Syndrome.

American Dental Association 2005.  Burning Mouth Syndrome.

Australian Dent J 2005.  Burning Mouth Syndrome.  An Update on Recent Findings

Cochrane Collaboration 2005.  Interventions for the treatment of burning mouth syndrome

CDA Journal 2007.  The Burning Mouth

QJ Med 2007.  Commentary. Burning Mouth Syndrome (Stomatodynia)

Med Oral Patol Oral Cir Bucal 2007.  Pharmacological Treatment of Burning Mouth Syndrome - A Review & Update

BMJ Clinical Evidence 2008. Burning Mouth Syndrome

Oral Maxillofacial Surg Clin N Am 2008. Burning Mouth Syndrome - Recognition, Understanding and Management.

Med Oral Patol Oral Cir Bucal 2008.  Drug-Induced Burning Mouth Syndrome.  A New Aetiological Diagnosis

Med Oral Patol Oral Cir Bucal 2008.  Burning Mouth Disorder (BMD) & Taste. A Hypothesis

Cochrane Database of Systematic Reviews 2009.  Summary.  Interventions for the treatment of burning mouth
syndrome.

BJOMS 2009.  Serum Zinc Levels & Oral Dysaesthesia — Is There A Link?

Clinical Evidence 2009.  Burning Mouth Syndrome

BJOMS 2010.  Clinical study of tongue pain.  Serum zinc, vitamin B12, folic acid, copper concentrations and systemic
disease.

Med Oral Patol Oral Cir Bucal. 2010.  Burning Mouth Syndrome - Update

J Can Dent Assoc 2011.  Management of Burning Mouth Syndrome

J Can Dent Assoc 2011.  Diagnostic Dilemma: The Enigma of an Oral Burning Sensation

S Afr Fam Pract 2011.  Burning Mouth Syndrome

J Clin Exp Dent 2012.  Burning Mouth Syndrome.  A Diagnostic & Therapeutic Dilemma

BDJ 2012.  Randomized Trials for the Treatment of Burning Mouth Syndrome - An Evidence-Based Review of the
Literature

EYAP 2013 Patient Leaflet.  Burning Mouth Syndrome

IASP Fact Sheet 2013.  Burning Mouth Syndrome

World J Gastroenterol 2013.  Burning Mouth Syndrome

J Med Life 2014.  Burning Mouth Syndrome - A Review on Diagnosis & Treatment

Med Oral Patol Oral Cir Bucal 2015.  Alpha lipoic acid efficacy in burning mouth syndrome.  A controlled clinical trial

Cochrane Database of Systematic Reviews 2016.  Interventions for treating Burning Mouth Syndrome

Dent Update 2016.  Pain Part 8. Burning Mouth Syndrome

Front BioSci 2016.  An Overview of Burning Mouth Syndrome

Ind J Pall Care 2016.  Burning Mouth Syndrome

J Contemp Dent Pract 2016.  Burning Mouth Syndrome - A Review of the Etiopathologic Factors & Management

J Res Dent Sci 2016.  Burning Mouth Syndrome - A Diagnostic Dilemma

Cephalalgia 2017.  Burning Mouth Syndrome

Acta Sci Dent Sci 2018.  Burning Mouth Syndrome - Pathophysiology, Investigations & Management.  A Review

Oral Surgery 2019.  Burning Mouth Syndrome - A Review
Burning Mouth Syndrome - Diagnosis Algorithm
The majority of BMS sufferers have experienced stressful life-events / long-term social problems.  After iron
deficiency
, depression is thought to be the next most frequent causative factor (depression followed by generalised
anxiety & cancerophobia).


In a classification by cause,
Idiopathic BMS is considered Primary BMS or True BMS, whereas Secondary
BMS
has an identifiable cause.

Another classification of
BMS is based on symptoms, stratifying cases into 3 types, as follows:

  • Type 1 BMS:  Patients have no symptoms upon waking, with progression throughout the day.  Night-time
    symptoms are variable.  Nutritional deficiency and diabetes may produce a similar pattern.

  • Type 2 BMS:  Patients have continuous symptoms throughout the day and are frequently asymptomatic at
    night. This type is associated with chronic anxiety.

  • Type 3 BMS:  Patients have intermittent symptoms throughout the day and symptom-free days.  Food allergy
    is suggested as a potential mechanism.

BMS is likely more than one disease process and the cause may be multi-factorial.  The ambiguous definition of
BMS makes evaluation of prognosis and treatment difficult.


Who does it affect?

Middle-aged or older women are mainly affected.

Do I need any special tests?

Yes.  As BMS can be due to anæmia, this has to be checked for first however, in a lot of cases, there is no
indication of
anæmia.

How is it treated?

There is no treatment.  Sometimes treatments for thrush can ease the discomfort.  If the BMS is due to anæmia,
then treatment of the
anæmia will help; likewise, if the BMS is related to diabetes.

Mostly though, it is treated as an
atypical facial pain; that is, with anti-depressants (though not at a dose where
these drugs are acting as
anti-depressants).  It has been found in small studies, that a food supplement (alpha
lipoic acid) has been effective in treating BMS).

Patients often look for constant reassurance and treatment by different practitioners.
What are its Causes?

Why BMS occurs is uncertain.

It seems to arise from a number of possible causes.

There is no visible abnormality or evidence of organic disease.  

BMS is associated with depression, anxiety or a stressful life-situation.

Obsession with symptoms which may rule patient’s life.

Contributing factors may include:

  • Thrush infection (thought to be of minor importance)
  • Bacterial infections (some antibiotics have been reported to improve BMS)
  • Allergies (allergy to denture material)
  • Jaw joint problems (thought to be one of the most commonest causes)
  • Salivary gland dysfunction (severe dry mouth is thought to be a major cause)
  • Deficiencies (in Iron, Folate & vitamin B)
  • Hormonal (Diabetes Mellitus)
  • Psychological & psycho-social factors seem to play an important role in facial & oro-facial pain.
  • Psychogenic factors have been considered as the most common & major causative factors in BMS.