Burning mouth syndrome: An update

Abstract

Background: Burning mouth syndrome (BMS) is a chronic and debilitating oral pain of the normal oral mucosa. It mainly affects women in their fifth to seventh decade. Its aetiopathogenesis remains unclear and is probably of multifactorial origin, with increasing evidence that BMS may be a neuropathic disorder. BMS is classified as an idiopathic (nociplastic) orofacial pain with or without somatosensory changes by International Classification of Orofacial Pain (ICOP 2020). The diagnosis of BMS, having excluded ‘oral burning mouth symptoms’, has evolved from basic intraoral exclusion screening to extensive clinical and laboratory investigations, which include the screening of comorbidities and other chronic pains and somatosensory testing. There is no standardised treatment in managing BMS, but a proposed combination of supportive and pharmacological treatment has been recommended. Aim: To review the current concepts of BMS definitions, classifications, aetiopathogenesis, diagnosis techniques, and evidence-based treatments in managing BMS patients. Conclusion: As BMS is a diagnosis by exclusion, thus a stratified approach is required for assessment of patients presenting BMS. A BMS diagnosis protocol is desired using a standardised screening to distinguish BMS from patient’s presenting with ‘oral burning symptoms’, and evaluation of comorbid chronic pain disorders or other medical comorbidities, which will include haematological, fungal, salivary flow, and qualitative sensory testing. Axis II and other additional quantitative sensory testing may further elucidate the causes of this condition. For future BMS prediction and prevention, will be based upon research on the relationship between other chronic pain disorders and familial history, environmental and genetic information.

The use of self‐report questionnaires in an analysis of the multidimensional aspects of pain and a correlation with the psychological profile and quality of life in patients with burning mouth syndrome: A case‐control study

“…The aetiology is unknown and is probably of multifactorial origin, with increasing evidence that BMS may be a neuropathic disorder involving the central and peripheral nervous system. 2 The worldwide prevalence of the disease is around 4% but varies considerably in relation to the different definitions of BMS with consequent different inclusion criteria considered. The prevalence increases in post-menopausal women (18%), with a female-to-male ratio ranging from 3:1 to 20:1.…”

“…In accordance with the International Classification of Oro‐facial Pain, 1st edition (ICOP 2020), 1 BMS is defined as an intra‐oral burning or dysaesthetic sensation, recurring daily for more than 2 h per day for more than 3 months, without evident causative lesions on clinical examination and investigation; including patients report not only bilateral intra‐oral or facial pain but also those with a unilateral symptomatology. The aetiology is unknown and is probably of multifactorial origin, with increasing evidence that BMS may be a neuropathic disorder involving the central and peripheral nervous system 2 . The worldwide prevalence of the disease is around 4% but varies considerably in relation to the different definitions of BMS with consequent different inclusion criteria considered.…”

Phantosmia and psychogenic non-epileptic seizures in a patient with burning mouth syndrome suffering from severe depression

“…Persistent and severe localised perioral burning pain is experienced by patients and accompanied by oral dysesthesia, decreased or impaired taste and xerostomia. There is no actual consensus on its classification or definition, even if there is increasing evidence that BMS could be a neuropathic disorder 2 3. The International Association for Study of Pain has described BMS as a chronic condition characterised by a burning sensation of the oral mucosa for which no cause can be found 4.…”

“…All these psychological factors are relevantly associated with somatisation and somatoform diseases 17 18. Unsurprisingly, somatisation is as well associated with BMS, in particular, functional somatic syndromes have been observed as salient comorbidity 2 19. If BMS has often been attributed to a psychosomatic condition, the evidence contradicts the central sensitisation theory linking this pain condition with other pain syndromes such as fibromyalgia 20.…”

Efficacy of oral nystatin treatment for patients with oral mucosal dysesthesia but without objective oral mucosal manifestations and necessity of Candida culture test before oral nystatin treatment

“…The BMS is typically characterized by the burning and painful sensations on the oral mucosa which is normal in appearance. 1 , 2 BMS is more commonly found in women than in men, 3 , 4 particularly in women during or after menopause. 5 , 6 , 7 The etiology of BMS is multifactorial, and BMS can be classified as primary and secondary BMS, traditionally.…”