Burning Mouth Syndrome
Disease Details
Family Health Simplified
- Description
- Burning Mouth Syndrome (BMS) is a chronic condition characterized by a persistent burning sensation in the mouth, often affecting the tongue, lips, gums, and other areas without any apparent cause.
- Type
- Burning Mouth Syndrome (BMS) is not typically classified as a genetic disorder. Its exact cause is often idiopathic, meaning it arises spontaneously without a clear underlying reason. In some cases, BMS may be secondary to other conditions, but there is no established pattern of genetic transmission associated with it.
- Signs And Symptoms
- By definition, BMS has no signs. Sometimes affected persons will attribute the symptoms to sores in the mouth, but these are in fact normal anatomic structures (e.g. lingual papillae, varices). Symptoms of BMS are variable, but the typical clinical picture is given below, considered according to the Socrates pain assessment method (see table). If clinical signs are visible, then another explanation for the burning sensation may be present. Erythema (redness) and edema (swelling) of papillae on the tip of the tongue may be a sign that the tongue is being habitually pressed against the teeth. The number and size of filiform papillae may be reduced. If the tongue is very red and smooth, then there is likely a local or systemic cause (e.g. erythematous candidiasis, anemia).
- Prognosis
- BMS is benign (importantly, it is not a symptom of oral cancer), but as a cause of chronic pain which is poorly controlled, it can detriment quality of life, and may become a fixation which cannot be ignored, thus interfering with work and other daily activities. Two thirds of people with BMS have a spontaneous partial recovery six to seven years after the initial onset, but in others the condition is permanent. Recovery is often preceded by a change in the character of the symptom from constant to intermittent. No clinical factors predicting recovery have been noted.If there is an identifiable cause for the burning sensation, then psychologic dysfunctions such as anxiety and depression often disappear if the symptom is successfully treated.
- Onset
- The onset of Burning Mouth Syndrome (BMS) is often sudden and without an apparent cause. Symptoms can develop spontaneously or progressively over time. However, the exact trigger or onset factors can vary among individuals.
- Prevalence
- Burning Mouth Syndrome (BMS) is estimated to affect about 1-5% of the general population. It is more common in women than men, particularly postmenopausal women. The prevalence can vary based on demographic factors and diagnostic criteria.
- Epidemiology
- BMS is fairly uncommon worldwide, affecting up to five individuals per 100,000 general population. People with BMS are more likely to be middle aged or elderly, and females are three to seven times more likely to have BMS than males. Some report a female to male ratio of as much as 33 to 1. BMS is reported in about 10-40% of women seeking medical treatment for menopausal symptoms, and BMS occurs in about 14% of postmenopausal women. Males and younger individuals of both sexes are sometimes affected.Asian and Native American people have considerably higher risk of BMS.
- Intractability
- Burning Mouth Syndrome (BMS) can be intractable for some individuals. It is characterized by a chronic or recurrent burning sensation in the mouth without an identifiable cause. Treatment can be challenging and often involves a multidisciplinary approach, including medications, cognitive behavioral therapy, and addressing any underlying conditions. While some patients may find relief, others may continue to experience persistent symptoms despite various interventions.
- Disease Severity
- Burning Mouth Syndrome (BMS) is typically characterized by a chronic burning sensation in the mouth, often without an identifiable cause. While the condition is not life-threatening, it can significantly impact quality of life due to persistent pain and discomfort. Severity varies among individuals, ranging from mild irritation to severe pain that can affect eating, sleeping, and other daily activities.
- Healthcare Professionals
- Disease Ontology ID - DOID:4331
- Pathophysiology
-
Burning Mouth Syndrome (BMS) is a complex, poorly understood condition characterized by a burning sensation in the mouth without an obvious cause. The pathophysiology of BMS is thought to involve multiple factors, including:
1. **Neuropathic Mechanisms**: Peripheral and central nervous system alterations are believed to play a significant role. This may involve damage or dysfunction of the sensory nerves responsible for pain and taste.
2. **Hormonal Changes**: Altered hormonal levels, particularly in postmenopausal women, may influence the onset and severity of symptoms.
3. **Salivary Gland Dysfunction**: Reduced salivary flow or changes in the composition of saliva can contribute to the symptoms.
4. **Psychogenic Factors**: Anxiety, depression, and chronic stress are often associated with BMS, suggesting that psychological factors may exacerbate or even trigger the condition.
5. **Nutritional Deficiencies**: Deficiencies in vitamin B12, folic acid, iron, and zinc have been implicated in some cases.
Despite these insights, the exact pathophysiology remains unclear, making diagnosis and treatment challenging. - Carrier Status
- Burning mouth syndrome (BMS) is not a condition associated with a carrier status. It is a chronic and complex pain disorder characterized by a burning sensation in the mouth. The exact cause of BMS is often unknown, though it can be related to various factors such as nutritional deficiencies, hormonal changes, nerve damage, allergies, or psychological factors. It is not a hereditary or infectious condition, so the concept of a carrier status does not apply.
- Mechanism
-
Burning Mouth Syndrome (BMS) is a chronic condition characterized by a burning sensation in the tongue, lips, or entire mouth without an identifiable medical or dental cause. The exact mechanisms are not fully understood, but it is generally considered a neuropathic pain disorder.
**Mechanism:**
BMS may involve both peripheral and central nervous system components. The sensation of burning may result from:
1. Peripheral nerve damage or dysfunction in the oral mucosa.
2. Altered pain processing in the central nervous system.
3. Dysfunction of the somatosensory system, which affects sensory processing and pain modulation.
**Molecular Mechanisms:**
Several molecular mechanisms have been proposed, including:
1. **Nerve Growth Factor (NGF):** Changes in the levels of NGF, which plays a role in the growth and survival of neurons, may contribute to neuropathic pain.
2. **Neurotransmitter Alterations:** Dysregulation of neurotransmitters such as serotonin, dopamine, and gamma-aminobutyric acid (GABA) can affect pain perception and mood, contributing to BMS symptoms.
3. **Ion Channel Dysregulation:** Abnormalities in sodium channels and other ion channels in nerve cells may lead to increased neuronal excitability and pain sensation.
4. **Inflammatory Mediators:** Elevated levels of inflammatory cytokines, such as TNF-alpha and IL-6, have been observed and may contribute to nerve damage and pain.
5. **Oxidative Stress:** Increased oxidative stress and decreased antioxidant defense mechanisms might damage oral tissues and nerves, leading to pain.
Further research is needed to fully elucidate these mechanisms and to develop more effective treatments for BMS. - Treatment
- If a cause can be identified for a burning sensation in the mouth, then treatment of this underlying factor is recommended. If symptom persist despite treatment a diagnosis of BMS is confirmed. BMS has been traditionally treated by reassurance and with antidepressants, anxiolytics or anticonvulsants. A 2016 Cochrane review of treatment for burning mouth syndrome concluded that strong evidence of an effective treatment was not available, however, a systematic review in 2018 found that the use of antidepressants and alpha-lipoic acids gave promising results.Other treatments which have been used include atypical antipsychotics, histamine receptor antagonists, and dopamine agonists. Supplementation with vitamin complexes and cognitive behavioral therapy may be helpful in the management of burning mouth syndrome.
- Compassionate Use Treatment
-
For Burning Mouth Syndrome, compassionate use treatment and off-label or experimental treatments may include:
1. **Capsaicin**: Topically applied capsaicin can desensitize nerve endings and alleviate pain in some patients.
2. **Alpha-lipoic acid**: An antioxidant that has shown some promise in reducing symptoms in clinical studies.
3. **Clonazepam**: Often used as an off-label treatment, either systemically or topically (dissolving in the mouth), for its anxiolytic and neuropathic pain-relieving properties.
4. **Cognitive Behavioral Therapy (CBT)**: While not a pharmacological treatment, CBT can help manage the psychological components of chronic pain.
5. **Low-Level Laser Therapy (LLLT) or Photobiomodulation Therapy**: Emerging evidence suggests that it might help reduce pain and inflammation in some cases.
These treatments should be considered under the guidance of a healthcare professional experienced in treating Burning Mouth Syndrome. - Lifestyle Recommendations
-
For managing burning mouth syndrome (BMS), consider the following lifestyle recommendations:
1. Maintain Oral Hygiene: Brush your teeth and floss regularly to prevent any secondary infections.
2. Avoid Irritants: Refrain from smoking, alcohol, and consuming spicy or acidic foods that can exacerbate symptoms.
3. Stay Hydrated: Drink plenty of water throughout the day to keep your mouth moist.
4. Use Mild Toothpaste: Opt for non-irritant toothpaste and avoid mouthwashes with alcohol.
5. Manage Stress: Practice stress-reducing techniques such as yoga, meditation, or deep-breathing exercises, as stress can worsen symptoms.
6. Chew Sugar-Free Gum: This can help stimulate saliva production.
Consult with a healthcare professional for personalized advice and treatment options. - Medication
-
There is no universally effective medication for burning mouth syndrome (BMS), but several options may provide relief. These include:
1. Alpha-lipoic acid: An antioxidant that may reduce symptoms.
2. Clonazepam: A type of benzodiazepine often used for its analgesic properties.
3. Gabapentin: An anticonvulsant that can help manage neuropathic pain.
4. Tricyclic antidepressants: Such as amitriptyline, used for their neuropathic pain-relieving effects.
5. SSRIs or SNRIs: Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors can also be beneficial in some cases.
Please consult a healthcare provider for a tailored treatment plan. - Repurposable Drugs
-
Repurposable drugs for Burning Mouth Syndrome (BMS) include:
1. **Clonazepam**: Traditionally used for seizure disorders, it's often utilized for its anxiolytic and neuropathic pain relief properties.
2. **Amitriptyline**: An antidepressant which is sometimes used to manage pain.
3. **Gabapentin**: Commonly used as an anticonvulsant and for neuropathic pain, it may help alleviate the symptoms of BMS.
4. **Capsaicin**: Topically applied, it can reduce neuropathic pain by depleting substance P in sensory neurons.
5. **Alpha-lipoic acid**: An antioxidant that has been suggested to have beneficial effects in reducing the pain associated with BMS.
Note: Consulting with a healthcare professional is necessary before starting any treatment. - Metabolites
- Burning Mouth Syndrome (BMS) is characterized by a burning sensation in the mouth without identifiable dental or medical causes. Research indicates potential involvement of various metabolites, but findings are not definitive. Altered levels of certain neurotransmitters, such as serotonin and dopamine, as well as changes in inflammatory markers, have been observed in some studies. Further research is needed to clarify the specific metabolic pathways involved in BMS.
- Nutraceuticals
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Nutraceuticals for burning mouth syndrome (BMS) may include:
1. **Alpha-Lipoic Acid (ALA):** Known for its antioxidant properties, ALA has been studied for its potential to relieve BMS symptoms.
2. **Vitamin B Complex:** Deficiencies in B vitamins (B1, B2, B6, B12, and folic acid) are sometimes linked to BMS, and supplementation can be beneficial.
3. **Capsaicin:** Found in chili peppers, capsaicin can have a pain-relieving effect in some BMS patients.
4. **Omega-3 Fatty Acids:** These can help reduce inflammation and improve overall oral health.
5. **Probiotics:** May assist in maintaining oral health and reducing symptoms associated with BMS through gut microbiome modulation.
It's important to consult a healthcare provider before starting any new supplementation regimen. - Peptides
- Burning Mouth Syndrome (BMS) is characterized by a chronic burning sensation in the mouth without an obvious medical cause. There is ongoing research into the potential role of peptides in managing BMS, although specific therapeutic peptides have not yet been definitively identified or widely adopted for this condition.